It would cost more than €1 million to provide a bespoke isolation detention unit in a mental health facility for a “deeply disturbed” woman who is deemed a danger to staff, other patients and herself, the High Court has been told.
The HSE says it does not have the money to do so and that the woman’s current accommodation, while not ideal, is the best that can be provided at the moment.
It says the €1 million plus bill would be in addition to current costs of having two nurses permanently chaperone the woman because she has been involved in hundreds of incidents, including cases of self-harm and assault, since she was first admitted to the facility in 2014 under mental health legislation.
One nurse resigned after being seriously assaulted and a second is still out on long-term illness leave, the court heard.
As a result of the woman’s involvement in some 196 incidents in 2015, she had to be housed in a common sitting room in the facility where she can be permanently monitored by staff and CCTV at the nurses station, the court heard.
The woman, who is middle aged, was made a ward of court last September which means the president of the High Court, Mr Justice Peter Kelly, reviews her detention at least twice a year.
On Monday, the judge ordered her continued detention for another four weeks. He said he was doing so after being told an inspector with the Mental Health Commission expressed concern in relation to the recording and registering of her situation in the specially monitored area.
Seclusion of patients must be done in accordance with approved guidelines and protocols, the court heard.
The judge was told by a solicitor, appointed in 2014 to represent the woman following her committal to the facility, that her behaviour had improved recently.
Not appropriate
The solicitor believed she needed a bespoke unit because the existing situation was not appropriate, although staff were doing their best for her. While her physical health had improved, her mental health had not, he said.
The solicitor said the woman is effectively in seclusion as her room is locked, she does not have access to other patients and could not do so without proper supervision as there would be a risk of assault by her.
The General Solicitor for Wards of Court, who represents her interests under wardship, said the wardship situation had not changed the pressure on the HSE to provide a specialised unit, which it was accepted was very expensive.
A solicitor for the HSE said it did not accept the current arrangement was seclusion in the way it is defined by the guidelines.
What was being provided at the moment was a clinically appropriate way of treating the woman, the solicitor said. The woman cannot be allowed to return to living among other patients, particularly in view of the ferocity of the assaults on two staff members, she said.
The HSE was acutely aware that her current situation was inappropriate but it was “the best place at the moment taking into account capital constraints”, the solicitor said.
Dignity
Mr Justice Kelly said there was a concern the current situation compromised her dignity. She was locked in a room with little or no therapeutic space, he said.
All the evidence before him was that she was deeply disturbed as a result of a psychiatric condition for a long time. He had last September authorised appropriate restraint, monitoring and seclusion in accordance with the guidelines.
While the general solicitor and the woman’s solicitor appointed under mental health legislation view her current placement as inappropriate it was the best the health service can provide with the budget at its disposal, he said. Efforts to find a place for her in the UK were not successful.
He directed a report be provided by a court medical visitor and put the case back for four weeks with the detention order remaining in place until then.