Saturday 24 March 2018

Two young women ordered to be force-fed by High Court have made progress but concerns remain

A 15-year-old boy has pleaded not guilty to assaulting a school principal
A 15-year-old boy has pleaded not guilty to assaulting a school principal

TWO young women with severe anorexia nervosa - who were the subject of force feeding orders by the High Court - have made progress but issues of concern remain, a judge was told.

The father of one of the women, hospitalised involuntarily since last April due to her weight dropping as dangerously low as 24kg,  secured an order from Mr Justice Nichola Kearns directing the HSE to have a detailed written aftercare treatment plan for implementation whenever she is discharged from hospital.

His daughter, who has suffered with eating disorders since aged 12, was previously discharged with no such plan and had "fallen through the cracks" before, the father said.

A psychiatrist who assessed the woman at the request of lawyers representing her interests agreed with a HSE psychiatrist she lacked the necessary mental capacity to appreciate the severity of her condition, John Lucey SC, who was appointed by the court to represent the girl's interest, told the court. 

A 15-page letter from the 26-year-old woman expressing her views about her treatment and other matters was handed in by Mr Lucey. On being told the woman would like to express her views herself but was physically unable to attend court, the judge said he would hear from her via video-link if that was regarded as appropriate.

The feeding orders made in the case of the second woman, dating from January last, were discharged yesterday in circumstances including her weight has now reached 39/40kg and she will be subject of a detailed after care plan involving daily visits to hospital.  Orders permitting her detention under the Mental Treatment Act will also be lifted, the court heard.

That woman, aged 22,  remains "terrified" of putting on weight but recognises she needs nutrition if she is not to die, her treating psychiatrist told the judge.

She self-harmed on occasions to get back to hospital as she received a lot of attention there and it was being sought to address such institutionalisation by having her discharged home and permitting her return daily for therapy, the doctor added.

Both cases were before Mr Justice Kearns for review.

Both women are students who were detained involuntarily in hospital under the provisions of the Mental Treatment Acts after doctors certified they did not have the necessary mental capacity to appreciate the severity of their condition and their lives and/or health were at risk if they did not take the necessary levels of nutrition.  

Yesterday, the judge was told, after he had made the orders sought by the HSE to permit force feeding of the women if necessary, by means including via a naso-gastric tube inserted after sedation, both agreed to take the nutritional supplements.

In the most recent case, of the 26-year-old woman, Timothy O'Leary SC, for the HSE, said her condition is significantly better and she has gained some weight. Her doctors believed her agreement to take nutritional supplements was due to the court orders and it was "still early days".

In the second case, Peter Finlay SC, for the HSE, said the woman, whose weight was 26kg at one point, had progressed from a position of near organ failure to reaching a weight of 39/40kg. This was a "success story with a small s" and she needed a planned aftercare programme on her discharge home from hospital.

Her psychiatrist said she was satisfied the woman now has mental capacity to appreciate her illness having made significant physical and cognitive improvements after taking necessary nutrition.

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