District Court grants Care Order under Child Care Act 1991 s.18 due to mother's mental health risks to child.

[2012] IEDC 2

AN CHUIRT DUICHE THE DISTRICT COURT

HEALTH SERVICE EXECUTIVE

APPLICANT

-AND-

SC

RESPONDENT

CHILD CARE ACT, 1991— SECTION 18

IN THE MATTER OF CHILD 1

27 January 2012

1. This is an application for a Care Order under section 18 of the Child Care Act, 1991 in respect of Child 1, born June 2003.

2. Child 1’s mother is the respondent. She is represented by Counsel instructed by the Law Centre in the proceedings.

3. The father of Child 1 is not a legal guardian and has never participated in the proceedings or in Child 1’s life to date.

4. Child 1 was appointed a Guardian Ad Litem (“GAL”) to represent his separate interest in the proceedings. The GAL is legally

represented.

5. Child 1 has had four distinct periods of care or supervision by the HSE:

(a) 15 April 2010–10 June 2010: Interim Care Order was granted on 15 April 2010. The Interim Care Order was

extended on three occasions thereafter and Child 1 was returned to the care of his mother on 10 June 2010;

(b) 10 June 2010–4 January 2011: Supervision Order was granted for a period of 6 months to the HSE on 10 June

2010 to ‘safety net’ the return of Child 1 to the care of his mother. A further Supervision Order was granted on 12

October 10. The mother appealed the latter Order to the Circuit Court which affirmed the Order of the District

Court. The HSE did not seek a further Supervision Order on the expiration of this Order;

(c) 09 May 2011 –14 July 2011: An Garda Síochána exercised powers under section 12 of the 1991 Act on 9 May

2011 and, arising from this, the HSE sought an Emergency Care Order which was refused by the Court. The Court

granted a Supervision Order and appointed the GAL on the making of the Supervision Order; and

(d) 27 July 11 to date: ICO was granted on this date and extended on 22 occasions to the first day of this two day

haring. The mother appealed the original Interim Care Order and has lodged 12 appeals against the interim orders.

6. The HSE brought this application on the basis that Child 1’s health, development, and welfare is likely to be avoidably impaired or

neglected if he is returned at this time to the care of his mother because her mental health issues have negatively impacted on her

son’s health, development, and welfare and furthermore impede her from recognising the effect of her behaviours on her son despite

the supports available to her from the mental health services. Furthermore, they contend that the mother lacks the capacity to

provide Child 1 with a psychologically healthy experience of parenting, to provide an appropriate home environment, and to support

his educational and social development due to her own significant personal difficulties associated with her diagnosis as suffering from

a paranoid personality disorder. It is their case that the mother’s deeply held belief systems have not shifted appreciably despite 21

sessions of psychotherapy. It is acknowledged that the mother loves and cares deeply for her son, who in turn loves her and is

concerned about, and loyal to her.

7. The mother, through her legal team, concedes that her behaviour and responses towards professionals in the health, education,

and HSE services in and around April–June 2010 were negatively impacted by the absence of medication, isolation from family, and the

cumulative impact of what she felt were the unsafe and threatening circumstances associated with her accommodation in the inner

city at that time. She is clear, however, that it was her intention and priority to ensure her son’s physical safety, to ensure his

emotional health, and to secure appropriate safe housing. She contends that she has made efforts to address her mental health

issues and her housing issues. She has undergone six months of psychotherapy to address the diagnosis of paranoid personality

disorder. She has declined medication as it is not a required element for the treatment of that diagnosis. She has now secured a nice

home environment and she wants her son returned to her care at this time. It is her case that she should be supported to achieve

family reunification under a Supervision Order.

8. The Court heard evidence from the following witnesses over a two day period:

o The Psychiatrist;

o Social Worker 1;

o The Psychologist;

o Social Worker 2;

o The mother; and

o Guardian Ad Litem.

9. The Following Reports were admitted:

o Reports of the GP;

o Reports of the Psychiatrist;

o The Home School Liaison Officer;

o The Hospital doctors, dated 13 April 2012; and

o Report of the Medical Social Worker, dated 9 April 2010.

10. The HSE solicitor has set out a Case Summary and Counsel on behalf of the mother has also set out a comprehensive Case

Summary from the perspective of the respondent and setting out facts admitted/agreed and disputed in this case.

11. The Psychiatrist, gave evidence in support of his three reports to Court dated 2 June 2010, 4 January 2012, and 5 July 2012. His

diagnosis is that the mother suffers from a paranoid personality disorder. A person with such personality develops maladaptive, deeply

ingrained patterns of behaviour, which run against societal norms and make the person ‘stand apart’. This isolation may be

compounded if the person is paranoid and highly sensitive to criticism, misinterprets events, bears grudges, or believes in

conspiracies. His diagnosis of this disorder has been formed over time, as he first treated the mother in 2007. He detected no

symptoms of psychosis but could not rule out the possibility of a prodromal psychotic disorder. The mother has attended 21

psychotherapy sessions and has now disengaged from psychotherapy. She was offered medication to address the possibility of a

prodromal psychotic disorder but declined same in the absence of a diagnosis. The Psychiatrist noted that psychotherapy works

slowly and requires a long-term commitment of anything up to 24 months.

12. Social Worker 1 gave evidence in support of his reports to Court of the 5 May 2010, 3 June 2010, and 5 October 2010. I do not

propose rehearse his evidence in support of a Care Order.

13. The Psychologist, gave evidence in support of her report to Court of 6 July 2012. Psychometric testing undertaken by her reflect

that the mother has a normal IQ but her social comprehension is poor due to preoccupation with her own interests, her social

adjustment is low, and she is socially isolated. Her professional opinion is that the mother lacks the capacity to provide Child 1 with

psychologically healthy experience of parenting and her ability to support his educational and social development is seriously impaired

due to her own significant personal difficulties. Returning Child 1 to her care would expose him to a serious risk of a very deficient

experience of family life and socialisation. This would pose significant short and long term implications for his emotional, psychological,

and social development and his mental health.

Her evidence was that her interactions with Child 1 satisfy her that he is aware of his mother’s mental health issues. He has indicated

that he wants to return to her care when she is “perfectly better”. If the mother achieves good mental health, the best outcome

would be family reunification. However, her evidence is that, in her professional opinion, the mother’s difficulties have not resolved at

this time.

14. Social Worker 2 gave evidence in support of her reports to Court. There is no purpose in recounting the evidence given by her,

save to say that it is her professional view that having undertaken a framework assessment of the likelihood of harm, she concluded

that Child 1’s health, development, and welfare is likely to be avoidably impaired and neglected and that Child 1 requires care and

protection that he is unlikely to receive unless a Care Order is granted. In reaching this professional conclusion, she also relied upon

the psychological and parental capacity assessment undertaken by the Psychologist, and the medical diagnosis of the Psychiatrist,

that the mother suffers from a paranoid personality disorder. Social Worker 2 acknowledged that the mother has no intention of

harming her son in any way; she also acknowledges the efforts made by the mother to overcome her anxiety, and deal with her

mental health difficulties and — to the extent possible — she has engaged with the mental health services, psychotherapy, and social

work department in the last eight months. However, she nonetheless came to the conclusion that based on past experience, this

tentative co-operation and engagement is insufficient to address the level of concern for Child 1’s welfare. Support service provision

(augmented by a Supervision Order) would not in her professional opinion address the risks posed and would not ensure that Child 1

receives a safe standard of care were he returned to his mother at this time. The family has been within the ambit of concern of the

HSE since 2009 and Child 1 has had 3 admissions to care since this time due to concerns regarding the mother’s mental health and

the impact of same on him. While his educational achievements, personality, and demeanour speak to his own resilience, it also

speaks to periods of good parenting and security in his mother’s love and attention. The report of the Home School Liaison Officer was

acknowledged to speak to the fact that Child 1 also experienced periods of regular school attendance, but Social Worker 2 noted that

despite supports made available to the mother from the Home School Liaison Officer and others, the mother was still suspicious and

detached from supports. In consequence, there have been periods when Child 1 was isolated and at times kept out of school walking

the streets with his mother or in the library or at exhibitions. His home life was dysfunctional and he has spoken of feeling

embarrassed at times. She therefore concluded that Child 1’s needs would not be fully met if he returned to his mother’s care at this

time. That said, she also acknowledged that the mother is a central figure in her son’s life. She noted the upset caused by the

mother’s decision to disengage from access with Child 1. She acknowledged that Child 1’s expressed wishes to her is that he wants

his mother to get better and would like to return to her care then, but not until then.

15. The mother gave evidence that she found the court process and engagement with the HSE Social Work Department to be very

stressful. This was evident in the course of this two day hearing. She could not accept the evidence tendered by the Psychologist,

Social Worker 1, the Psychiatrist, and Social Worker 2. She was adamant that while she found it difficult to engage with the HSE, and

she particularly distrusted Social Worker 2, she had engaged with the medical social worker. She also engaged with the Psychiatrist in

psychotherapy for 21 sessions. She conceded that she disengaged from psychotherapy but is willing to re-engage. She took some

medication prescribed by the Psychiatrist to deal with anxiety but she declined anti-psychotic medication as it was not consistent

with her diagnosis. She has now transferred to another medical team and will be under the care of another doctor because he is now

in a new catchment area because of her new accommodation. She was prepared to do a cookery course, and has been allocated a

place in a community employment course for two mornings per week. She enjoyed the educational opportunity and was happy to not

be so isolated. Her goal was to return to the happy position she enjoyed five years ago. Her isolation began at the end of her earlier

CE scheme. She was ending that period and was prepared to co-operate with the HSE now in the context of a Supervision Order so

that she is no longer isolated, and she would ensure his continuance in the current school and after-school activities. Her evidence

was that given her new accommodation, she should be reunited with her son now within the circle of protection provided by a

Supervision Order. On the question of access, she declined to commit to availing of access in an access centre. She conceded that

while it was a nice place and Child 1 liked it, this arrangement was not for them, and she wanted him to be returned to her care. She

opposed the idea of access on principle. She has only availed of same in order to ensure her son’s return to her care. It was her firm

belief that access came at a cost to herself and her son and she did not want to put him through that. It was also her belief that

Court Reports indicated that certain things were conveyed to her son and this was tantamount in her view to putting him on a

“suicide list”. She was particularly upset that she did not have the opportunity of explaining things to him herself. Her desire was for

the Court to “open the gates” and allow him to come home to her.

16. The GAL, gave evidence that Child 1’s wishes and feelings are that he does not want to go home to his mother yet, but when she

is “really, really better” he wishes to go home. Child 1 is nine years old and is making excellent progress at school. His mother is at the

top of the list of important people in his life. It was her professional opinion that the nub of the issue in this case is the mother’s

mental health. This was linked to her mistrust of and unwillingness to meaningfully engage with supports offered to her.

Decision

17. Having heard the evidence tendered by the witnesses in support of the reports, having considered the reports and document

agreed and contained in the HSE Booklet furnished to Court, and having read the GAL Reports filed, I am satisfied that:

(a) The mother’s disengagement in psychotherapy and her unwillingness to attend access with her son is suggestive

that there has been very marginal movement in the rigid (all or nothing) thinking pattern diagnosed by the

Psychiatrist as a feature of the mother’s paranoid personality disorder.

(b) The Psychiatrist’s diagnosis is tempered by his evidence that with commitment and therapy, long-term change is

possible for the mother. A diagnosis of paranoid personality disorder does not preclude parenting, but it can affect

it; I am satisfied on the evidence that this occurred in this case. I am also satisfied on the evidence that the

mother’s mental health difficulties lead to her isolation and lack of enduring supports. However, I am satisfied that

her poor housing conditions (in what to her seemed to be an inhospitable neighbourhood) and her experience of

harm in an intimate personal relationship quite understandably contributed to her fearful view of the world.

(c) The mother’s relationship with the HSE and the GAL has been marred by her suspicion and belief that they are

not truly helping her or her son but are obstacles in the way of her parenting her son. Her experience of her son’s

removal from her care has been devastating for her. She has been reinforced in her suspicions by her reading of

Social Work and GAL Reports which in her view only log perceived failures and not the whole picture of her

relationship with her son.

(d) The Psychologist’s parenting capacity assessment firmly links the mother’s mental health difficulties to the

circumstances leading to her son’s admission to care and with regret she has concluded that Child 1’s welfare would

be detrimentally affected if he were returned to her care under a supervision order even with support services at

this time, in light of his experiences of unintentional harm while in her care. In her view, insufficient progress has

been made by the mother in overcoming her mental health difficulties at this time. She also concluded, however,

that his mother is a central figure in her son’s life and his connection to her is also important for his sense of

personal identity and emotional security.

(e) The GAL has reported to the Court Child 1’s wishes, which were very hard to hear for any mother. Put simply,

she cannot accept that he has expressed those wishes. On the issue of his welfare, she supports the application of

the HSE for a Care Order, until Child 1 is 18 years old but with a review in 24 months to reassess the position at

that time in the event that the mother has gained further traction through psychotherapy and has been abele to

demonstrate her ability to prioritise Child 1’s need to see her regularly.

(f) I am satisfied that the mother on her own evidence has endeavoured to overcome her mental health difficulties,

her poor housing, and her isolation. I am also satisfied that her perception of the circumstances leading to Child 1

coming into care remains largely unchanged. She perceives herself to be unjustly separated from her child and she

remains suspicious of HSE Social Work Department and the GAL. She cannot accept the professional advice that her

son needs to see her and in its place she reinforces her own firm view that access is detrimental to his welfare and

her welfare. She will not see him if he is not returned to her care.

18. I am satisfied that the threshold criteria are met under section 18(1) and that the health, development, and welfare of Child 1 has

suffered avoidable impairment in the period April–June 2010 and in the month of June 2011 until he was taken into HSE care. Having

considered the evidence, I am satisfied that the HSE has made reasonable efforts to prevent or eliminate the need for Child 1 coming

into the care of the HSE under section 18 by virtue of the Mental Health Team support, HSE advocacy for housing, and access

facilities designed to assist and encourage family reunification.

19. I am satisfied on the evidence tendered by the Psychologist that the mother does not have sufficient parental capacity or ability

at this time to provide appropriate care for Child 1 accordingly a Care Order should be made. Section 24 mandates the Court to have

regard to the rights and duties of parents under the Constitution and otherwise, to regard the welfare of the child as the first and

paramount consideration, and, in so far as is practicable, to give due consideration, having regard to his age and understanding, to

the wishes of the Child. In order to discharge this obligation, I must make the Care Order in respect to of Child 1 until Child 1 has

attained the age of 18 years. I am satisfied on the evidence that a shorter order would not meet the need for his security and

stability. However, I am also satisfied on the evidence that should the mother gain traction over her mental health issues that the

HSE must review the potential for family reunification at that time and that this will accord with the rights and duties of the mother

and the wishes of her son, Child 1. Accordingly, I have made provision for a full review of the Care Order in 2 years.

Section 37 Access

20. Access shall be at the discretion of the HSE and within the parameters of section 37. Access must meet the needs of the child

and his mother. I hope that the mother will engage in supported access in the access centre in the short-term with a view to

normalising access between mother and son in their own home.

Section 47 Directions

21. The court makes the following directions pursuant to section 47:

a. That the Court review the case on 6 February 2013 as the Long Term Foster placement is to be resolved and the

updated Care Plan with allocated Fostering Link Worker identified is to be filed in Court as approved by the GAL. The

GAL is to remain engaged until this happens and thereafter the GAL is to be discharged with the usual order as to

reasonable costs, such costs to be taxed in default of agreement.

b. That the Court review the case on 10 December 2014 to assess the progress which the mother has made in

gaining sufficient traction on her mental health issues at that time and the needs of Child 1 at that time to assess

the potential for family reunification. The Guardian to be re-appointed four weeks before the date of re-entry.

c. That the Case is Re-Entered before the Court and the Guardian re-appointed four weeks before the date of re-

entry in the event that

(i) The case becomes unallocated to a Social Worker/ Fostering Link worker for a period of four weeks;

(ii) A planned or unplanned change of the current foster placement; and

(iii) After Care Review on Child 1’s 17th birthday on [date given] to assess After Care Services if he

remains in the Care of the HSE at that time under this Order; GAL to be reappointed six weeks in

advance of the date of Re-entry for the purposes of any such After Care Review and provided with

access to all HSE files in that regard.

d. That the HSE provide all appropriate therapeutic interventions and services to the mother tailored to meet her

specific needs in order to ensure the preservation of the mother/son relationship.

e. That the HSE take all steps necessary to ensure that Chid 1 receives all identified therapeutic interventions and

services set out in the finalised Care Plans to be filed in Court and as reviewed by the HSE from time to time.

f. That the section 47 Application of the GAL be adjourned further to 4 December 2012 (For Mention Only) at 10.am

for the purposes notification as to the identity of the Fostering Link Worker and to receive a set of access

proposals from the mother’s legal team. The HSE Social Workers, GAL, and the mother are excused from personal

attendance as the adjournment is for the legal advisors to advise the Court and if necessary list a formal hearing

date (if a section 37 Application is received).