Z.D. v. Youthdale Treatment Centres, 2014 CFSRB 50

CHILD AND FAMILY SERVICES REVIEW BOARD

Z.D.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: September 10, 2014

Citation: 2014 CFSRB 50

Indexed as: Z.D. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1Z.D., the “Child”, asks the Child and Family Services Review Board (the “Board”) to review his August 26, 2014 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”). His position is that criteria (a), (b) 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) and (d) in subsection 124(2) of the Act, the Board will only give reasons for its findings concerning criteria (a), (b), and (e).

BACKGROUND

3The Child is a 14 year old boy who was living with his mother and father until July 23, 2014 when he was placed in foster care under a Temporary Care Agreement with the [ ] (the “Society”). The Child’s mother recently underwent a serious medical procedure and is a person with a number of physical disabilities.

4The Society contacted Youthdale on August 15, 2014 with a request for a bed on the Transitional Psychiatric Unit for a comprehensive assessment of the Child’s health needs since he was displaying concerning behaviour. However, following some suicidal threats, he was taken to the emergency department of the hospital on August 22, 2013 and involuntarily admitted on August 23, 2014. He remained in hospital until he was transferred to Youthdale on August 26, 2013.

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 is of the opinion that the Child fulfills the criteria under the Act because his emotional and thought processes are so impaired that his capacity to make reasoned judgments is not in his control. On admission, the Child was very disinhibited and not thinking rationally. She noted that his answers to questions did not make sense and there was no logic to what he was saying. The Admitting Psychiatrist described his thinking as “disturbed”. From a psychological perspective, she believed that the Child was showing symptoms of mania. The Admitting Psychiatrist noted that the Child has many organic medical issues which could impact his capacity to function. She described his emotions as labile and fluctuating between happy to irritable to angry within minutes. His thinking is very disorganized and not connected. The Child finds it difficult to control his impulses and does not think of consequences.

7The Crisis Worker described the Child’s behaviour on admission. The Child was brought via ambulance and upon release from the gurney, ran down the alley and had to be escorted back by ambulance attendants and the nurse attendant. During the intake process, the Child asked to go to the washroom, lunged for the door and then urinated on the floor. He then exposed himself to staff. The Child was on the floor saying things such as “why don’t you just kill me”. Afterwards he was remorseful about his behaviour. He was there 45 minutes before he could settle down.

8The Society Worker testified that the Child was in the care of the Society under a Temporary Care Agreement. He was found sleeping in the subway on July 23, 2014 and said that he had been out of his home for 3 weeks. On July 28, 2014, the Child went missing when he went to the library. Instead of waiting for the foster mother to pick him up, he rode the bus around town and ended up in the outskirts of town. He then called a cab to his godmother’s home.

9The Society Worker stated that the Child’s condition has deteriorated during the time he was in care. The Child needed to be encouraged to complete his hygiene. The Child would tell grandiose stories about his life and the things he did to his parents. He claims that he has stolen over $10,000.00 from his parents. The Child recently accompanied his mother to hospital, took her cell phone and left her there. The Child told the Society Worker that he had a rifle and had a girl in his sights, and then turned it to a pigeon. At times, he told her he hit the pigeon and at times he did not. The Society Worker confirmed with the parents that the Child stole $3,000.00. The father said the incident with the rifle never happened. The Society Worker never knew whether the Child’s stories were true.

10She stated that the Child’s behaviour was unpredictable and getting worse. The Society was working to find a placement capable of handling him. He required a one on one worker while he was at the foster home.

11The foster mother testified to the Child’s behaviour. The Child was anxious and could not focus. He was feeling depressed and his sleeping pattern changed. The foster mother monitored the Child’s food intake since he was diabetic but the Child would sneak food. She watched the Child take his medication but would find his medications all over the house. His sugar levels were awry. Near the end of his stay at the foster home, the Child spoke of suicide. When he was on an outing with the Child and Youth Worker, the Child spoke of jumping out the window. The Child and Youth Worker became concerned and reported it to the foster mother who spoke to the Child later in the evening. She noted that the Child was clearly depressed. He was crying and talked of historical issues with his parents. His body language was very lethargic and he was very angry with the way his parents had treated him. The Society advised her to take him to the hospital. The Child became very agitated and did not want to go to the “crazy house”. Paramedics and police came to escort the Child to the hospital. The Child was subsequently admitted involuntarily. Two other youths in the home said that the Child had spoken of jumping out the window.

12The Board concludes that the Child had a mental disorder within the meaning of the Act. The Board accepts the evidence of the Admitting Psychiatrist that the Child had a substantial mental disorder that grossly impairs his ability to make reasoned judgments. The Admitting Psychiatrist is of the opinion that the Child’s emotional and thought processes are so impaired such that he is not able to control his behaviours or make reasoned judgments. This is reflected in the suicidal threats of the Child, the rapid decompensation in his behaviour as described by the foster mother and Society Worker and his behaviour on admission to Youthdale.

13The 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.

14The Admitting Psychiatrist is of the opinion that the Child is at very high risk of harm to himself at this time. On admission the Child made a statement to her that he was feeling suicidal. During her 4 years at Youthdale, the Admitting Psychiatrist had never heard of a child urinating in the interview room or a child who was so disinhibited as to expose himself to staff. The Child is not able to control himself and his erratic behaviour is very concerning. She took the global situation very seriously and would be very worried for his safety if he was released.

15The godmother testified that the Child stayed with her from July 31 to August 4, 2014. During this time, the Child had mood fluctuations, sometimes high and sometimes low. He mentioned suicide to her 2 or 3 times. He told the godmother that he had planned to commit suicide by jumping onto the subway tracks but his girlfriend stopped him. He told her that sometimes he hears voices coming from his head. The Child said that he takes molies, a combination of street drugs, to feel better. He used gangster slang terms. His behaviour was so unpredictable that the godmother never knew what he was doing when he was alone. The Child displayed highly sexualized behaviour by walking around the house in the nude and kissing her 4 year old daughter really hard and putting his arms around her like a date. He was so unpredictable that family members were afraid of him and kept their bedroom doors locked.

16The Board concludes that the Child made a serious threat to cause serious bodily harm to himself and that this was a result of his mental disorder. To arrive at this conclusion, the Board considered the professional opinion of the Admitting Psychiatrist that the Child was at very high risk of harming himself at the time of admission. The Board also considered the evidence of the Society Worker and the foster mother that the Child’s condition and behaviour had decompensated within the last month leading to an involuntary admission to hospital prior to his admission to Youthdale. The Board considered that the Child had plans to commit suicide by jumping out a window or by jumping onto subway tracks. The fact that he was found sleeping on the subway adds veracity to his intent. The Board concludes that because of the Child’s lack of control, his impulsivity and his unpredictability, he could have caused serious bodily harm to himself.

17The Board is satisfied that criterion (b) was met.

Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances

18The Admitting Psychiatrist believes that there is no less restrictive method of providing treatment for the Child. The Child poses a flight risk since he has run away from home and was found sleeping in the subway. He has tried to run away from the ambulance. The Child is not compliant with taking his medications while in the community. The Child is extremely disinhibited and not thinking rationally and needs a secure environment to keep him safe.

19The Admitting Psychiatrist believes that the Child needs a period of stabilization at Youthdale. The parents do not have the capacity to keep him safe and have entered into a Temporary Care Agreement with the Society. Even if the Child was admitted to a general hospital, the Admitting Psychiatrist believes that the Child would still need a secure setting.

20The foster mother also indicated that she would not be capable of handling the Child. She was not prepared to monitor him every moment of the day.

21The Board concludes that the Child needs a secure environment to keep him safe while he is undergoing treatment.

22The Board is satisfied that criterion (c) has been met.

CONCLUSION

23Pursuant 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 September 3, 2014.

CONFIDENTIALITY ORDER

24Pursuant 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.