A judge has described as a “horrible dilemma” having to choose between keeping a woman who is no longer mentally ill in a psychiatric hospital or returning her to her “squalid” home with no supports.
The woman has an incurable personality disorder.
It is "an indication of the state of the health services" that the woman's psychiatrist, whose office is some distance from her home, has no access to a social worker for her, High Court president Mr Justice Peter Kelly said.
“That is the world in which we live, I’m afraid,” he added.
The woman is a ward of court and, in the circumstances and for her wellbeing and safety, he must order her continued detention in the mental hospital, the judge said.
That course of action involved a lesser risk than the only other option which was to release her to “squalor”, he said. Her fire-damaged home, described as “filthy”, is full of rubbish and not fit for habitation. Such is the condition of the house, if he made an order releasing her, she would have nowhere to sleep that night, the judge said.
Her continued detention must be “for the shortest period of time” and the HSE should take steps to make the woman’s house habitable and put in place a range of supports, he said. Her psychiatrist, whom she has been seeing for some time, must be an integral part of that, he added.
While the woman had had considerable funds, she had “squandered” most of that and her finances are close to “rock bottom”, the court heard.
The woman has an incurable personality disorder which, while not treatable, is being managed, it was stated.
Although she has suffered episodes of severe mental illness, which lead to her current detention, her mental health has improved and doctors say she does not now meet the criteria for detention under the Mental Health Act. They also expressed concerns about what would happen to her if she was discharged.
Groundless allegations
The judge was told the woman had previously been placed in high support units but those placements had not worked out for reasons including her tendency to make serious, groundless allegations against others.
The judge described as “nebulous” an offer of either remaining in the acute unit or returning home with some structures. “I don’t see any plan,” he said.
His dilemma was that he could see no legal basis for detention in a mental hospital but it was also clear her situation could deteriorate as it had in the past on several occasions.
He was told one unit which was a possible option was full while another was unsuitable due to the age profile of its residents. Other options which could be explored are supported housing and a community treatment order with supports, the court heard.
The judge also heard the HSE’s general strategy is to provide accommodation in high-support hostels and to leave the provision of short- to medium-term accommodation to the housing sector, including voluntary organisations.
The woman’s psychiatrist said she considered it was important, for the woman’s own psychiatric wellbeing and so her children can visit her, that she have a place of her own.
