District Court grants Care Order under Child Care Act 1991 s.18(1) due to mother's mental illness and substance abuse.

[2013] IEDC 7

AN CHUIRT DUICHE THE DISTRICT COURT

HEALTH SERVICE EXECUTIVE

APPLICANT

-AND-

SM

RESPONDENT

CHILD CARE ACT, 1991— SECTION 18(1)

IN THE MATTER OF CHILD

15 March 2013

1. This is an application for a Care Order under section 18(1) of the Child Care Act, 1991 (herein after referred to as ‘the 1991 Act’) in

respect of Child 1 who was born in the month of June 2012.

2. Child 1’s mother is legally represented in the proceedings by her solicitor and is supported by her mental health social worker.

3. The separate interests of Child 1 are represented in the proceedings by the Guardian Ad Litem (“GAL”) appointed by the Court on

23 July 2012 who is also represented in the proceedings by his solicitor. The GAL indicated to the Court his support for a Care Order in

respect of the child and recommended such Order for the full duration until the child reaches the age of 18 years. The GAL approves

of the Care Plan in respect of the child provided to the Court by the HSE.

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

or neglected if Child 1 is returned at this time to the care of her mother due to the risk of the unintentional harm and neglect which

Child 1 would be likely to suffer due to the mother’s mental ill health difficulties, cognitive impairment, and poly substance abuse

issues — all of which have resulted in her lack of functional capacity to care for her newborn child.

5. I am satisfied that it has not been possible to notify Child 1’s father and his identity is unknown.

6. I am satisfied that the [District given] has jurisdiction to hear this application.

History

7. Child 1’s mother was a long term inpatient in a psychiatric hospital for a considerable time before Child 1’s birth. She had a

diagnosis of bipolar affective disorder, a history of poly-substance misuse, and abuse of stimulants and cannabis. The Mental Health

Services endeavoured to put in place supported accommodation for the mother to avoid institutionalisation but found that such

accommodation was unsuitable in meeting her needs for safety.

8. Prior to the birth of her child, she formed the view that she wished to have the child adopted, but then changed her mind

indicating that she would like to have her child placed in long term foster care as she did not have accommodation.

9. On 21 April 2012 the mother left the maternity hospital during the day and returned under the influence of alcohol. Her behaviour

was notably disorganised and disinhibited. On 8 May 2012, the mother was found smoking cannabis in the ward.

10. The HSE held a pre-birth conference on 16 May 2012 to facilitate full consideration of the mother’s plans for the care of her child

following birth in the light of the mother’s diagnosis and level of functioning. The HSE received advice from the mother’s psychiatrist

to the effect that the mother evidenced poor frontal lobe executive cognitive functioning. This was manifested by combinations of

apathetic, impulsive, and preservative behaviours giving cause for concern around her ability to care for a child without significant on-

going support.

11. By an order of the High Court, dated 12 June 2012, it was determined that the mother did not have sufficient capacity to consent

to medically appropriate treatment. Certain ancillary and associated assistance was appropriate for her proper treatment and the

proper treatment of her baby when born and therefore the High Court authorised the giving of appropriate care and treatment and

assistance as necessary to vindicate the mother’s life, bodily integrity, and privacy of the mother pursuant to Article 40.3.1, Article

40.3.2, and Article 40.3.3 of the Constitution and to provide all necessary ante-natal and post-natal care for both mother and baby.

12. Child 1 was born at 36 weeks and 3 days gestation. His birth weight was 2680 grams. He had a “jittery episode” on the day of his

birth and was cared for in Special Care Baby Unit for medical observation however he did not experience any other drug withdrawal

symptoms and is reaching normal milestones.

13. Following the birth of her child, the mother exhibited a good bond with her child. She sang and cuddled her child and was

interested in her child’s care with midwifery support. She advised the social workers that she wished to parent her child and live in a

supported and protected environment of a friend or family member.

14. On 18 June 2012, the Social Worker met with the mother, a family member, the mother’s Mental Health Social Worker, the

Principal Medical Social worker, the mother’s Psychiatry Nurse, and a midwife to discuss HSE concerns about the absence of a safe

home environment for the mother and child. No concrete plans were proposed by the mother as to her plans following discharge from

the maternity hospital.

15. On 19 June 2012, the friend identified by the mother contacted the HSE and informed them that she would put herself forward as

a long term carer for the child however she declined to care for the mother as well as she felt that she could not cope with the

complex needs of the mother and the newborn child together. She put herself forward for HSE assessment as a foster parent however

such an assessment would take a number of weeks to complete. The mother’s family could not provide a fostering arrangement for

mother and child or child alone either.

16. Due to her history of mental ill health, poly substance misuse, alcohol abuse, and cognitive deficits the HSE concluded that the

mother was particularly vulnerable and accepted the medical advice that the mother’s decision making capacity was considerably

impaired by virtue of her memory problems and a poor understanding of the consequences of her actions and decisions. For these

reasons it was concluded that the mother did not have the capacity to make decisions that may be in her baby’s best interest.

Consequently, the HSE sought an Interim Care Order

17. Child 1 was admitted to the care of the HSE on the granting of an Interim Care Order on 23 July 2012 which has been extended

by the Court on 4 occasions since that date until the date of hearing.

18. Due to her mental health difficulties, the mother was not in a position to attend the child’s Child in Care Review held on 26 July

2012. Her mental health difficulties exacerbated in the period from July to September following a close family bereavement and the

reception of her child into care. She could only attend one access period with the child between July and September and she found

that access to be difficult. The Social Work team endeavoured to remediate the difficulties following a meeting on 26 September 2012

as it was clear that the mother did not wish to lose her close bond with her child. Unfortunately, the situation did not improve and

there was no further access until December 2012. Her difficulties exacerbated even further at that point resulting in one episode of

attempted self-harm.

19. On the day of hearing, it was indicated to the Court that the mother did not propose to contest the application of the HSE for a

Care Order for the child until age 18. It was also indicated to the Court that the facts as set out in the findings of fact document

submitted to the Court by the Applicant was admitted. All Medical Reports contained in the Booklet of Reports submitted to the Court

were admitted without need for formal proof, including the Reports of the Consultant Psychiatrist and Senior Clinical Psychologist.

20. I have read and considered all the Medical Reports adduced in evidence and I have heard the evidence of the Allocated Social

Worker and the GAL.

21. The Social Worker in evidence outlined the history of the case and the love and affection which the mother bears for the child as

set out in the sundry Reports to Court by the Social Worker. Her professional opinion was firm that the mother lacked functional

capacity to consistently care for a baby who is entirely dependent for care on a primary caregiver. It was her evidence that to return

the child to the mother under a supervision order even with significant supports would expose the child to avoidable and unintentional

neglect and harm. The Social Worker was supportive of the mother having access to the child. Supported access has been provided

for the mother during January and February and regular supported access will continue to be facilitated for the mother on the basis

that the mother presents well, is taking prescribed medication, and is not under the influence of alcohol or non prescribed drugs on

the day of access. The arrangements proposed were one and a half hours every fortnight unless otherwise agreed or determined not

to be in the child’s best interest (due to mother’s presentation at access). It was her evidence that the mother is very supportive of

the child’s foster carers and is happy that the child seems so well in their care. The foster carers are equally supportive of the mother

and ensure that pictures and audiotapes made by the mother are available to the child. The also created photo album of the child’s

stages of development during the year for the mother at Christmas.

22. The GAL in evidence noted that it was important for the Child to preserve the bond with the mother. The child was too young to

express views however he has observed the child with the foster carers and the child is thriving in their care. They are attuned to the

needs of the child. It was clear that the mother loves the child but due to the constellation of difficulties which she operates under, it

was the GAL’s view that these could cascade into an episode of unintentional harm to the child were the child in her care. The GAL

was of the view that access should be supervised and supported and should continue to take place, with the necessary safeguards in

place for the child’s safety and welfare. The GAL noted that the mother has now discharged herself from institutional care and is

endeavouring to live in the community and the GAL agreed with the mother’s solicitor that the mother appears to be more lucid and

functioning better and accessing services recently. The GAL was concerned that the HSE Placement Committee would approve the

current foster carers as the long-term carers for the child.

Section 18 Threshold

23. Having heard the evidence set out above, having considered the findings of fact submitted by the HSE and admitted by the

mother’s solicitor to be proven, and having taken into account the GAL Reports, I am satisfied that in respect of Child 1 the threshold

criteria under section 18(1)(c) of the 1991 Act are met and that the child’s health, development, and welfare is likely to be avoidably

impaired or neglected if a Care Order is not granted. I am satisfied that the duration of the Care Order shall be until the child reaches

the age of majority at eighteen years [date given].

24. My reasons for making this order for this duration are that the child requires consistency of care during childhood and the

evidence adduced is that the mother has an enduring functional incapacity by reason of mental ill health and cognitive impairment

that would make it unsafe for her to be the primary carer for a child.

25. I am satisfied this decision is proportionate because the evidence adduced is that a Supervision Order and the provision of

supportive services for the mother would not be sufficient to enable her to safely parent the child.

26. I approve the Care Plan and note the GAL’s approval also.

Section 37 Access

27. Having heard the evidence set out above, I direct that access between the mother and child be at the discretion of the HSE

pursuant to section 37 of the 1991 Act and noting that the arrangement outlined in Court is supervised and supported access for the

mother with the child for a duration of one and a half hours once every two weeks, unless otherwise agreed or determined by the HSE

not to be in the best interests of the child.

Section 47 Directions

28. Under section 47 of the 1991 Act, I make the following directions:

A. That access for the mother be supervised and supported and the HSE ensures that the mother has the services

of an advocate or mental health support worker to assist her in meaningfully engaging during access for the benefit

of the child. The HSE is to provide all appropriate supports tailored to meet the mother’s needs;

B. That the case is to be re-entered before the Court by the HSE on 5 June 2013 in the event that the process for

matching the child’s long term placement with his current carers has not been finalised. The GAL to remain in place

until the final matching process has been completed and the amended Care Plan has been approved by the GAL and

filed in Court. Liberty to apply to Court on or before 5 June 2013 to confirm the completion of the matching process

and the filing of the amended GAL approved Care Plan for the child. Thereafter, the GAL is to be discharged with

costs to be paid by the HSE and taxed in default of agreement;

C. That the case is to be re-entered before the Court by the HSE and on notice to the GAL in the event that the

case becomes unallocated to a designated Social Worker/Fostering Link Worker for a period of six weeks;

D. That the case is to be re-entered before the Court by the HSE and on notice to the GAL in the event any

planned or unplanned change of current foster placement;

E. If the GAL in this case is no longer available, then the HSE is to bring an application to the Court to have a GAL

appointed pursuant to section 23;

F. After Care Review for the child on the child’s 17th birthday [date given] to assess After Care Service needs;

G. Liberty to apply.