The State has been ordered by a High Court judge to provide all funding and resources necessary to ensure a secure unit for a profoundly disturbed teenage girl is available within three months.
Meantime she will remain locked up in an adult psychiatric hospital with 29 mentally ill adults because there is no appropriate facility for her.
Mr Justice Kelly refused an application by the Minister for Health and Children to compel the hospital to keep the girl - the Minister should be "not only embarrassed but ashamed" to seek to keep a "vulnerable and damaged human being" in "completely substandard" conditions.
He refused to "turn doctors and nurses into jailers" or compel them to inject the girl forcibly with chemical sedatives just to control her behaviour when they had ethical difficulties with such practice and had also voiced concern about medical risks.
The 16-year-old girl is not psychiatrically ill but is severely traumatised following neglect, rejection and sexual abuse as a young child. There is no isolation unit in the hospital.
Refusing to order the girl's detention at the hospital, he made a "permissive" order allowing the health board to detain the girl at any facility of which a named child psychiatrist approved. He directed that a secure unit being prepared for her be operable by August 23rd and said he would review progress on July 3rd.
The judge said the case was the most difficult children's case to come before him and represented the State's failure to provide adequate services to address the needs of such children. The State's "neglect, omission and lack of care has reached an all-time climax in the case of this child" and he saw "no enthusiasm" for improving the position, the State having resisted court orders to build such units.
He noted two other judges were presiding over tribunals into how children in care and haemophiliacs were dealt with in the past and, whatever good they might do, they could not restore life to the dead, health to the sick or youth to those whose youth was blighted. But the human tragedy enfolding daily in the courts was happening when something could be done to help children.
The girl was in foster care from infancy after being rejected by her 15-year-old mother. She was sexually abused when she was seven and alleges she was raped at 11. She exhibited serious behavioural problems at eight, was diagnosed with severe conduct disorder in 1994 and in 1996 a child psychiatrist recommended a secure unit with supports and therapy.
Mr Justice Kelly accepted the psychiatrist's view that if it had been provided four years ago she would have made progress.
He said the girl felt unwanted and rejected from her earliest years. She abused alcohol, sniffed lighter fuel and took drugs, had engaged in prostitution and had a miscarriage. She was violent, had frequent episodes of self-mutilation and had attempted to hang herself. She had set fire to herself and this had led to her detention at the hospital from May 6th. The case then came before Mr Justice Kelly and he heard evidence from psychiatrists and other witnesses last week.
In his reserved decision yesterday, the judge refused an application by the girl's lawyers for an order compelling the Minister to provide an appropriate unit within 48 hours. He said there was no suitable facility.
Refusing the board's own application to send the girl to the Central Mental Hospital, the judge said he accepted evidence from a psychiatrist there that it would be medically, ethically and morally wrong to send the girl there. The hospital was full. The judge also refused to make no order in the case (which would probably have led to the girl being freed onto the streets). The judge again drew attention to the "ludicrous situation" where, under the 1991 Child Care Act, health boards have statutory responsibility for the welfare and protection of children but no statutory powers, funds or facilities to meet those responsibilities and must apply to the courts when they wished to detain children. They depended on the Department to provide the premises and facilities needed.
Minister of State, Ms Mary Hanafin, last night said she hoped to have a new secure unit ready before August. The girl would stay in the hospital until then but not with the adults.
