Saturday 10 December 2016

Legal action over vulnerable woman ends 'without satisfactory outcome'

Mary Carolan

Published 27/10/2015 | 17:48

A LEGAL action over the treatment of a vulnerable young Irish woman, who was returned here last summer from involuntary detention in a UK psychiatric unit, has concluded without a satisfactory outcome, the High Court heard.

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She had been detained more than 20 months in the UK and reports showed she has refused to engage in recommended therapies, the courts also heard.

Mr Justice Seamus Noonan said, although the reports showed she is not making progress, his hands were "tied" given his previous High Court finding she has the necessary mental capacity to make decisions about her treatment.

The HSE and all the parties had acted in the woman's best interests but, in light of the court's findings and the fact the woman and the HSE both wanted the case to be over, he must strike out the entire proceedings, the judge said.

He refused an application on behalf of the woman's court-appointed guardian, which was supported by her father, to adjourn the case for one final review.

Liability for the costs of the case, estimated at more than €1m, will be decided at a later date.

The 18-year-old woman, who has a borderline personality disorder making her prone to unpredictable episodes of self-harm including trying to take her own life, has spent almost all of the last four years in psychiatric units in Ireland and England.

The €400,000 annual costs of her care in St Andrews' hospital in Northampton, England, would have built a purpose built unit for her here, Mr Justice Noonan previously observed.

Last March, another High Court judge directed an arrangement should be put in place for her return to Ireland by June 12.

The HSE later brought further proceedings arguing her circumstances had changed since that March order.

Some doctors belived she could not be kept safe in the Irish services and should remain in the UK unit where high levels of security could be put in place, the HSE argued.

The further proceedings, involving six senior counsel, at least three juniors and six solicitors, came before Mr Justice Noonan on more than 20 occasions, ultimately leading to the HSE accepting the woman had capacity to make decisions about her treatment.  As a result, the HSE was no longer seeking to have her detained further in England.

The case raised complex legal issues related to the Irish High Court's jurisdiction to order the involuntary detention in a psychiatric unit in England of an Irish adult with a personality disorder.  This is in the context of Irish mental health legislation specifically prohibiting the involuntary detention of adults with personality disorders.

The Oireachtas' view personality disorder should not be subject to involuntary detention is shared by other jurisdictions, including Scotland and Wales, Mr Justice Noonan previously said.

The evidence was that the Irish approach to treatment of persons with personality disorder is considerably different to the approach in England, he also noted.

The Irish services engaged in more positive risk taking and believed long term detention distorts normal human behaviour and makes it difficult to achieve transition to normal living.

The sides later agreed last July she should be returned to Ireland on terms including appropriate facilities would be put in place for her within months.

It was also noted, while there remained agreement she had the necessary capacity, the decision whether or not she engages with the services was for her to make.

She had said she would do so and, after exchanges with her, the judge said she impressed him as "very bright and articulate"  with her whole life ahead of her "and every reason to live it".

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