CHILD AND FAMILY SERVICES REVIEW BOARD
M.B.
v.
Youthdale Treatment Centres
REASONS FOR DECISION
Indexed as: M.B. v. Youthdale Treatment Centres (CFSA s.124)
INTRODUCTION
1M.B., the “Child”, asks the Child and Family Services Review Board (the “Board”) to review his August 13, 2014 emergency admission to the Treatment Program at the Youthdale Treatment Centre (“Youthdale”). His position is that criteria (a), (b), (d) and (e) of the statutory criteria for emergency admission contained in subsection 124(2) of the Child and Family Services Act, R.S.O. 1990, c.C.11, as amended (the “Act”) were not met.
2The Board is satisfied that the Child met all the criteria for emergency admission at the time of admission. His request for release from Youthdale is therefore denied. Since the Child conceded criteria (c) in subsection 124(2) of the Act, the Board will only give reasons for its findings concerning criteria (a), (b), (d) and (e).
BACKGROUND
3The Child is 15 years old and was living with his biological father and 2 sisters aged 17 and 10. His parents are separated.
4[ ] (the “Society”) became involved when the father asked for support in early 2013. The Child came into the care of the Society under a Temporary Care Agreement from late October to December 2013. He was in foster care until he came home in December for the holidays and the father agreed to take him back. In June of 2014, the Child went into care again due to conflict at home and was placed for 30 days for assessment at a mental health facility. Subsequent to that, he was placed in foster homes until he was involuntarily admitted to hospital and then to Youthdale on August 13, 2014.
ANALYSIS
5Section 124(13) of the Act provides that;
The Board shall make an order releasing the child from the secure treatment program unless the Board is satisfied that the child meets the criteria for emergency admission set out in clause 124(2) (a) to (e).
Section 124(2) sets out the criteria which must be met at the time of admission.
124(2) The administrator may admit a child to the secure treatment program on an application under subsection (1) for a period not to exceed thirty days where the administrator believes on reasonable grounds that,
a. the child has a mental disorder;
b. the child has, as a result of the mental disorder, caused, attempted to cause or by words or conduct made a substantial threat to cause serious bodily harm to himself, herself or another person;
c. the secure treatment program would be effective to prevent the child from causing or attempting to cause serious bodily harm to himself, herself or another person;
d. treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates; and,
e. no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.
Section 112 of the Act defines mental disorder:
s.112 “mental disorder” means a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments.
Criterion (a) the child has a mental disorder.
6The Admitting Psychiatrist testified to the state of the Child on admission and the Admission Summary which she completed. She concluded that the Child was experiencing emotional and behavioural dis-regulation and was at risk of harm to himself. She noted that his emotional dis-regulation has impacted his thought processes such that the Child’s judgement is grossly impaired resulting in behaviours such as substance abuse, suicidal statements, anxiety, auditory and visual hallucinations. The Admitting Psychiatrist considered the Child’s mood instability, his anger issues, high risk behaviours, and his conflict with his family. She noted that his perceptual abnormalities while under stress manifested in hallucinations. She was of the opinion that the Child’s substance abuse could be a coping mechanism and that he turns to substance abuse and self-harm as a result of his emotional dis-regulation. When agitated, the Child cannot think rationally, loses control over his behaviour, makes suicidal threats and acts impulsively placing him at risk. The Admitting Psychiatrist is of the opinion that the Child’s has a substantial disorder of emotional and thought processes which grossly impairs his capacity to make reasoned judgements.
7The Admitting Psychiatrist is of the opinion that the child displays many features of borderline personality comorbid with depression. She noted that the Child was actively seeking prescription medications from physicians. She was concerned that the Child was taking high dosages of benzodiazepines which bring quick relief to anxiety but are very dependence forming. Upon admission the Child was taking nitrazepam, olanzapine, Dexedrine and diazepam.
8The father testified to the Child’s behaviour leading to his admission to Youthdale. In his grade 9 year at school, the Child had much anxiety about school and did not attend regularly. He would stay home, play video games, sleeping during the day, smoked and hanged out with friends who also did not attend school. His hygiene deteriorated to the point that he was not caring for himself. In January of 2014, the Child refused to attend school altogether.
9The father stated that the Child became more and more withdrawn and became worse within the last 3 or 4 months. The Child has a poor relationship with his mother, with reactions against each other consisting of the Child swearing and yelling at her. The Child had a physical altercation with the older sister in June of 2014 in which the Child had his sister on the ground and was kicking her in the head. The sister was shaken up, had minor bruising and was taken to the hospital. At that time, the Child stated that if he saw the sister again, he would kill her. The Child has threatened the father with a baseball bat on the May 24, 2014 weekend and has shoved the father with the intention of goading him into a physical altercation. Last summer or fall, he threatened the father with a knife. In June of 2014, the father found a long serrated knife in the Child’s laundry and a large mallet under his pillow. The Child has also taken a pellet gun from a locked cupboard in his room.
10The Child frequently used marijuana combined with high dosages of prescribed medication. The father found a collection of pills in the Child’s room which he could not identify. The Child does extensive research into medications and suggests dosages to the doctor, saying that the previous medication was working but is not working any more.
11The Child testified that he has taken magic mushrooms, lsd, ecstasy, but has not tried crystal meth. Cocaine is the strongest drug that the Child has taken though he only uses it occasionally because it is very expensive. He stated that he currently smokes marijuana once a week with friends. The last time he used cocaine was right before he assaulted his sister in June.
12The father testified that within the last few months, the Child has threatened to burn himself and the house down. The Child would say that he had no future, he was messed up, there was no next year and that there was no point continuing. The Child confided to the father about a year ago that he was hearing voices telling him to do bad things, to kill. In November or December of 2013, the Child saw a faceless 7 foot man following him. In January 2014, the Child felt like he was being followed by someone for the past 2 hours. In May of 2014, the Child saw someone sitting in the car in the garage and thought that the person wanted to kill him. The father went down to check and saw no one there.
13The latest hospitalization was on August 10, 2014 when the Child went to a sleep over at a friend’s house. He reported passing out after 2 beers and later found track marks on his arm. The same night, his friend was hospitalized for drug overdose and the Child suspected that someone had injected him with drugs when he was passed out. He was taken to the hospital for drug testing and tested positive for multiple substances including benzodiazepines, THC, amphetamines, MDA, morphine, oxycodone and methamphetamines. He was involuntarily admitted to hospital. Around the same time the Child told staff at the care home that he had burned and cut himself and that he had gone to the roof of the garage where he had previous threatened to jump from. The father noted that in the past few weeks there was a noticeable increase in the Child’s anxiety and mentioning of suicide.
14The Board concluded that the Child had a mental disorder at the time of admission and that his mental disorder substantially impaired his judgement. The Board accepted the evidence of the Admitting Psychiatrist that at the time of admission the Child had a mental disorder within the meaning of the Act. The Admitting Psychiatrist is of the opinion that the Child’s emotional processes are so dis-regulated that the Child cannot think or behave rationally. This is reflected in his behaviours, his suicidal threats to harm himself, his involuntary admissions to hospital, his assaultive behaviour towards his sister, and his hallucinations.
15The Board is satisfied that criterion (a) has been met.
Criterion (b) the Child has, as a result of the mental disorder, caused, attempted to cause or by words or conduct made a substantial threat to cause serious bodily harm to himself or others.
16The Admitting Psychiatrist rated the Child as high risk to commit suicide. She believed that the Child at the time of admission was on multiple medications, was in crisis, and even if he may not have the intent, his lack of judgement and instability puts him at high risk to kill himself. He has threatened to seriously cause bodily harm by jumping off the parking garage, the roof of his own home, as well as other threats.
17The father testified that the Child has talked of climbing up on the roof of a building, in particular, the parking garage at the hospital, and jumping off. Recently, he told the father that he was there and decided that the parking garage was not tall enough to kill him. In May of this year, the Child while in withdrawal from his medications, took the screen off the window at his home, climbed on the roof, came back in the house and climbed back up on the roof again. The father requested assistance to get him off the roof.
18The father stated that the Child has made various suicide attempts and has been hospitalized in the adolescent psychiatric unit. One time, the child took 13 extra strength ibuprofen. Another time, he took a variety of prescription and non-prescription drugs including cold medicines. He was hospitalized again in January 2014 when he told his sister he tried to suffocate himself by putting a bag over his head. In March, he threatened to harm himself with a kitchen knife. In May of 2014, he was hospitalized when he was withdrawing from his medications. He was involuntarily admitted usually not for more than 72 hours. On multiple occasions in May and June 2014, the Child would ask to be taken to the hospital but then wanted to leave before being seen by a doctor or immediately after triage.
19The Child admitted to the incidents when he tried to harm himself such as the overdose of ibuprofen, the attempt to suffocate himself and the knife threat when he threatened to slit his own throat. However, he denied that he intended to harm himself when his father discovered him in the garage with his shirt off and a can of gasoline close by. In that circumstance, he said that he was just smoking in the garage and it got hot.
20The Child stated that he did not climb to the top of the hospital parking garage but in the past he has said that is how he would kill himself. More recently, he went to the same parking garage and noted that it was not high enough. Several days before he was injected with drugs he was feeling down and took the bus to the hospital. He texted his father saying that the parking garage was not high enough. He sat outside the hospital, met a friend, calmed down and did not go in.
21The Child testified that he tried to harm himself because he felt neglected by his dad and he had a physical addiction to Benzodiazepines. He explained that he wants to end his life, and then the feeling goes away usually in 30 minutes. He stated that it is an impulsive thing that lasts until he calms down. Usually, by the time he goes to the hospital and goes to triage, he was over the feeling.
22The Society Worker testified that while at the children’s mental health centre in June of 2014, the Child threatened to kill himself by injecting bleach into his veins, throwing a radio through the window and then jumping out. He threatened not to take his medication and said that he knew where to get a gun in the community. The mental health centre also reported that the Child had hallucinations. Just prior to his admission, the care home reported that the Child said he would kill himself, showed staff cuts, had an exacto knife, and told staff he had gone to the hospital garage and decided that the garage was not high enough. The care home did not feel that it could keep him safe.
23The Board concluded that the Child made a substantial threat to cause serious bodily harm to himself and that this was a result of his mental disorder. The Board considered the Admitting Psychiatrist’s professional opinion that the Child was at serious risk of harming himself because of his mental disorder. The Board considered the evidence of the father that the Child within the last few months had decompensated and was talking and planning suicide with intensity. The Board also considered the evidence of the Child who stated that he had planned to commit suicide by jumping off the parking garage in the past and that in August several days prior to being involuntarily admitted to hospital and then to Youthdale, he was feeling down and rode the bus to the hospital. He then texted his father saying that the parking garage was not high enough. The Child has testified that when he feels agitated, he wants to end his life and that it was an impulse that goes away when he calms down. The Board concluded that the Child had a plan to commit suicide, contemplated it prior to his admission and because of his impulsivity and lack of control when agitated, could have caused serious bodily harm to himself.
24The Board is satisfied that criterion (b) has been met.
Criterion (d) treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates
25The Crisis Worker testified to the treatments that Youthdale can offer the Child. A child psychiatrist is immediately available to the Child and can meet with him every day or every other day for cognitive therapy. Peer therapy is available every day and offers the Child the opportunity to sit with peers and a psychiatrist to share experiences. Art therapy is available several times a week. Youthdale provides the medical services of a general practitioner who comes in everyday and a nurse is on the unit at all times to ensure that medications are taken on time.
26Youthdale is a contained structured environment which stabilizes and calms children who are in crisis. The Admitting Psychiatrist noted that Youthdale offers a very structured program with a high staff to patient ratio. It offers a secure environment with no access to street drugs so that the Child’s medications can be rationalized.
27The Board concludes that treatment appropriate for the Child’s mental disorder is available at Youthdale and that criterion (d) has been met.
Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances
28The Admitting Psychiatrist is of the opinion that the Child needs a secure environment to keep him safe. The Child has accessed services in the community but that has not been sufficient and the Child still placed himself at risk. He has been involuntarily admitted for acute care at the hospital and subsequently released. He is under the care of his family physician but does not like to attend sessions with his psychiatrist whom he does not like.
29The Child is on high dosages of medications which are highly addictive. The Admitting Psychiatrist stated that taking him off all the medications at once would cause withdrawal symptoms and seizures. Youthdale offers a safe, secure environment to taper the Child off his medications with a nurse to monitor him around the clock. This process can take weeks which is longer than a stay in an acute hospital. As well, the Child cannot get access to street drugs which would cause him harm and hinder his treatment.
30The Board concludes that a secure environment is needed to keep the Child safe while he is being tapered off his medications and while he is being assessed.
31The Board is satisfied that criterion (e) has been met.
CONCLUSION
32Pursuant to section 124(13) of the Act, the Board, having satisfied itself that each of the criteria in subsections 124(2) (a) through (e) have been met, denied the application for release of the Child on August 19, 2014.
CONFIDENTIALITY ORDER
33Pursuant to Rules 30.1 and 30.2 of the Board’s Rules of Procedure, parties and their representatives must not use, share, discuss or disclose any Board documents or decisions or any other documents or information provided or used in this application with anyone including through the media or on-line. The Board prohibits the use of any of this information for any purpose outside of the Board’s proceedings.
NATHALIE FORTIER
_____________________
Nathalie Fortier
Presiding Member
ALINA LAZOR
_____________________
Alina Lazor
Panel Member
MARY WONG
_____________________
Mary Wong
Panel Member
Dated in Toronto, Ontario on this 27th day of August, 2014.