A County Council v A Mother
| Jurisdiction | England & Wales |
| Judge | Mr Justice Holman |
| Judgment Date | 01 December 2021 |
| Neutral Citation | [2021] EWHC 3303 (Fam) |
| Docket Number | No. FD21P00920 |
| Year | 2021 |
| Court | Family Division |
[2021] EWHC 3303 (Fam)
IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION
Royal Courts of Justice
Strand
London, WC2A 2LL
Mr Justice Holman
(In public)
No. FD21P00920
Mr A. Lorie (instructed by Legal Services, a county council) appeared on behalf of the applicants.
THE FIRST RESPONDENT MOTHER did not attend and was not represented.
THE SECOND RESPONDENT FATHER did not attend and was not represented.
Ms K. Cann (instructed by Reeds LLP) appeared on behalf of the child's guardian.
Ms A. Ahmed (instructed by Clyde & Co) appeared on behalf of the fourth respondent.
(As approved by the judge)
This case concerns a deeply troubled girl aged almost 14 and a half. She is, and has been, in the care of a local authority pursuant to a care order made as long ago as January 2014. There is absolutely no doubt on the evidence in this case that the criteria under section 25 of the Children Act 1989 for making a secure accommodation order are satisfied. However the local authority have been unable, and remain unable, to identify suitable regulated premises where she can be accommodated pursuant to such an order. Accordingly, such an order cannot currently be made and the local authority have not applied for one. So, instead, they apply for a so-called DOLS order in a way that has, frankly, become far too frequent in recent years.
As I have already made clear, I decline today to renew such an order on the facts and in the circumstances of this case. By this ex tempore judgment, I will give my reasons for declining to do so. I wish, however, to make very clear indeed at the outset that I perfectly understand the acute difficulty that the local authority face in the present case and I am, frankly, very sympathetic to them. The fact of the matter is that there is a grave, and now scandalous, shortage of suitable establishments in this country where very troubled children such as this child can be kept safe whilst respecting their dignity and, so far as possible, their liberties. However, it needs clearly to be understood by this local authority, and by all local authorities, that the court itself does not have any resources at all available to it, nor a cheque book. I cannot myself find or create any solution in this case; but I am, frankly, not prepared simply to rubber stamp what the local authority and the other parties all know to be an unlawful situation at the moment in the present case.
The essential factual background is that this child was born in 2007. She was removed from her mother's care in March 2013 and, as I have said, a full care order was made in January 2014. In February 2015 the child was placed with a foster family in the same county in which she had been living with her mother, and the county of the present applicant local authority. For about six years there appears to have been a period of some stability. Very sadly, in March 2021 that foster placement broke down, and the foster family felt that they could no longer keep her. Initially, their own adult daughter offered to try to care for the child. She lived some distance away in another county, but it was to her that the child moved. That arrangement seems to have survived for about three months, but in June 2021 that foster carer also said that she simply felt unable further to cope.
In July 2021 the child was moved to a residential home within the applicants' county. Here, she displayed considerable self-harming behaviour. This included banging her head against a wall, running away, stating that she wished to die, and damaging property. In September 2021 she self-harmed again and was admitted to hospital. During that admission, the residential home in which she had been living gave notice that they would not have her back. She remained in hospital for some time until a second residential home was identified for her in south London, a quite considerable distance from the area of the local authority in which she had previously lived.
During her period in hospital the child had been assessed as being on the autistic spectrum and this particular residential home is experienced in caring for such children. She moved there during September 2021. Initially she appeared to be reasonably settled, but in early November 2021 there was a marked deterioration in her behaviour. That may or may not have been triggered by her mother making contact with her for the first time in several years. At all events, she resorted again to head banging, cutting her limbs, much verbal and physical aggression, damage to the property, and attempts to abscond. In the period between 5 and 8 November 2021 she was admitted three times to hospital under forms of police restraint. I have been told that on one occasion while she was in hospital, no less than seven police officers were required to restrain her. The second residential home has now refused to have her back.
On 9 November 2021 the child was assessed by a consultant child and adolescent psychiatrist attached to the CAMHS team for the area in which the second residential home is located. There is a report dated 11 November 2021 from that consultant child and adolescent psychiatrist, Dr HM. She says in that report that she was asked to assess the child as a duty psychiatrist on 9 November 2021 in the A&E unit of the hospital to which she had been taken. She says that the child had absconded while on a trip to a supermarket and that this was her third presentation to the A&E unit in three days. The formal diagnosis of Dr HM is:
“Emotional dysregulation secondary to developmental traumas and attachment/abandonment issues on a background of autistic spectrum disorder, moderate learning difficulties, and probable attention deficit hyperactivity disorder.”
Dr HM describes how in recent times the child had absconded, had self-harmed by head-banging, had assaulted staff, and had run into traffic saying she wants to die.
On 8 November 2021 she had run off in a supermarket, possibly into traffic. The police were called and she had been taken to A&E. Dr HM reports that while in hospital she has been prescribed a number of essentially sedating drugs, including risperidone, promethazine, and lorazepam. Dr HM records that on examination the child was fidgety, and her conversation was limited and very rigid and concrete. There was no evidence of any new major mental disorder. She did not appear to be depressed. She talked about wanting to die, but did not indicate any actual plans to kill herself, although she is an impulsive person. She was not psychotic. She was oriented in time, place, and person, but showed no insight. Dr HM records that she:
“…is not Gillick competent to consent to treatment plans, including medication.”
The overall impression of Dr HM is recorded as being that the child:
“…is a 14-year-old presenting with distress following review in new placement and contact with parents. She has attachment/abandonment issues upon a background of neurodevelopmental conditions of ASD and LD — she also shows signs of ADHD — and her presentation should be seen in this context rather than the onset of a new acute mental disorder. Her current location in A&E is not particularly therapeutic and there is no indication she requires admission to a general adolescent unit. With her current profile, this would increase her risk and be another placement…”
Dr HM identified the risks to herself as:
“…high through absconding and impulsive self-harm when distressed — requires to be managed with high staff ratio in short term and medication/secure transport.”
Her risk to others is “high” and her level of vulnerability is “high”.
In her report, Dr HM gave as a plan that the child should return to the residential home in which she had been living in south London with three to one observation 24 hours a day. As I have mentioned, however, not long after that the residential home made plain that it would not have her back. So, essentially, she has remained in the hospital in east London ever since.
She has, on occasions, absconded from the hospital and been taken back by police, and on at least one occasion handcuffs were required to be used. While in the hospital she has frequently locked herself in the bathroom, lain on the floor, and banged her head. She has broken her bedroom window and attempted to harm herself with a piece of broken glass. She has frequently been sedated with some of the oral medication to which I have referred, and also olanzapine.
So the current situation is that this troubled young person is not physically ill. She does not require any form of physical hospital treatment in the specialist paediatric unit in which she is currently being detained. I am told that during the course of last week there was an exercise of powers under section 5(2) of the Mental Health Act 1983 under which it was lawful to detain her for up to 72 hours, which were due to expire last Saturday, 27 November 2021. Up until that time, neither the local authority, nor the relevant NHS trust, nor anybody else have sought recently to engage this or any court.
At about 9.00 p.m. last Friday evening, 26 November 2021, I was...
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