‘Blood on our hand’. State trumps autonomy. Care feeds secure private mental.

 

Sir James Munby proclaimed in a highly publicised judgment ‘we would have blood on our hands’, if the NHS/LA could not provide a low secure inpatient bed for a 16, rather than an 18 year old.

https://www.judiciary.gov.uk/wp-content/uploads/2017/08/in-the-matter-of-x-a-child-no-4.pdf

A number of suitable beds were found the next day.

http://www.itv.com/news/granada/2017-08-04/beds-identified-for-suicidal-girl-after-judges-blood-on-our-hands-warning/

However no concern was voiced for the Local Authority’s treatment of 16 year old X, after her removal from her mother and siblings at 14 , nor that it was her desire to be reunited with them, the only people she knew and loved, that made her want to commit suicide.

Only last year, Local Authorities attempted to statutorily exempt themselves from liability for those, such as X they are paid to protect not abuse.

Xs Guardian had stated of X’s years in care:

“The facts of this case are calamitous. Indeed, a review of the initial evidence of the local authority from April 2015 makes for sobering reading at what must today be the final hearing.

At the time these proceedings were issued, the local authority were concerned for a child with poor school attendance, ‘low-level criminality’, periods of absconding and a mother who lacked the insight and parenting capacity to assist.

Now, in June 2017, the court finds itself tasked with determining issues of welfare for a child seemingly committed to killing herself, with a raft of serious criminal convictions to her name and a toxic relationship with her mother’.

So who, one wonders proved the better parent?

The local authority’s final care plan set out three ‘contingency’ plans, each involving a return to the community with support from an organization whose employees operated under a ‘no restraint policy’ and would be reliant on the local police.

The first two plans provided a return by X to her home town, either living with her mother, or in a “bespoke placement”.

The third plan was a similar “bespoke placement” but outside X’s home town.

But by the penultimate hearing when a further care order was made, although set to expire in weeks on X’s 16th,, a final plan was still not in place.

And worse still at the final High Court hearing just 11 days before the expiry of X’s Youth Custody Order and freedom for X, all plans were scrapped.

Why ?

Because of  a single visit of X’s guardian, the opinions of X’s care staff and the belated notification of 85 Reportable Incidents since X’s arrival in Youth Custody, all  apparently  ‘as a result of self-harming risks and behaviours’. The vast majority resulting in restraint.

At this hearing Sir James Munby relied heavily an email by the guardian to the Local Authority the day after her visit saying;

’ It requires to be read in full, and considered very carefully indeed, by everyone concerned with X.

While at ZX ( Youth Custody Centre), the guardian in the judge’s words, witnessed a ‘profoundly disturbing and distressing scene when X self-harmed by repeatedly banging her head and face against the wall. The guardian commented in her email that:

“This … came out of nowhere. My visit to her had been pleasant … She was full of smiles and laughs. Within 15 minutes however she was beyond herself.”

We are not told why, or what had been discussed in this 15 minutes, that might have made X ‘beyond herself’ but the Guardian later reports,

“… there has been no assessment of risk or contact planning ( with X’s mother). This needs to happen as a matter of urgency. At this time, the guardian does not support unsupervised contact and would not support an increase from the current fortnightly arrangement; telephone contact needs to be fully monitored.”

The guardian adds,

“I have never seen or heard anything like it in my 32 years of practice.”

The email then went on to summarise what the guardian had been told by the staff at ZX:

“The entire staff group’s opinion that:
‘X’s goal is not to go to [her home town] it is to kill herself’ (emphasis added)

Any care plan that allows X to visit home yet not live there is likely to underline this feeling of rejection and is therefore dangerous to X and to other people.

… The unit has 2:1 staffing levels, they have risk assessed every inch of X’s surroundings. She has still managed to eat all the silicone around the windows, still attempts to tear up doorplates to ingest either pieces of wood or screws, all the plastic sockets had to be replaced with metal, she cannot have carpet in her room (which is nothing more than a cell),

she has to be checked every 50 seconds in the shower and only this morning was found naked banging her head off the sink, the mirror had to be removed in case she smashed it and cut herself.

Staff feel their professional opinion has to be conveyed to the court as they believe X has begun to open up to them, make some level of attachments to staff, yet resents them for stopping her carrying out her deeply held wish to die.

They wish it to be known that their collective view is that X is not acting out because she is in a secure unit and this behaviour will stop as soon as she is given her freedom, they can only foresee X making continued attempts to kill herself due to whatever is buried deep within her and which intensifies whenever she experiences the negative atmosphere of her mother’s home where her emotional needs are not met (they state contact is poor quality and is not emotionally nurturing to X) and where in fact she feels she is less important and loved by [her mother] than her siblings’.

So it is the contact with her mother that makes her want to commit suicide yet both X and the expert psychiatrists say it is the opposite.

And on the strength of this unopposed, untested, inadmissible, non expert opinion evidence of anonymous ‘staff’ on X’s relationship with her mother, reason for suicide and her home life that sealed X’s fate, she could not be sent free, and all care plans were scrapped.

What of X’s mental assessments ?

They had only made tentative diagnoses of Emotional Instability Disorder and ADHD, both understandable in X’s dire, 2.1, 24/7 supervised encaged existence, with an overriding diagnosis of Reactive Adjustment Disorder;

linked to her frustration, agitation and profound disappointment that her only wish is to return home to her mother … cannot be fulfilled and she is hopeless as to her future.’

But no depression and X’s suicidal tendencies,

‘are behavioural rather than issues of mental health’, so ‘a low secure facility which has the therapeutic facilities to manage her presentation, rather than a medium secure facility’ was recommended.

As experts, at most found ‘mild learning disabilities’, they assessed X as having capacity under the MCA, so COP and a DOL could not be used to remove her freedom.

Nor could X be sectioned under the MHA, as X’s issues were behavioural not mental.

X’s Care Order expired at 16, and in 11 days her youth custody order so X could not be detained unless an order was made under the High Court’s inherent jurisdiction.

And, practically, X could not be detained in Youth Custody, or even receive the suggested care packages, as these could not involve restraint, or medication, whilst a mental facility could.

So what of X’s undisputed ‘toxic relationship’ with her mother, who care workers’ hearsay of X’s confidential conversations, and their observations and opinion on them conclude,

’ contact is poor quality and is not emotionally nurturing to X)and where in fact she feels she is less important and loved by [her mother] than her siblings’.

And a guardian who wanted to ‘risk assess future contact to further restrict the 2 fortnightly visits and for telephone contact needs to be fully monitored.”

X had fortnightly visits from her mum, on the unit the risks were assessed as too great to be held in the usual visiting areas.

The visits were closely supervised by two staff at all times, and extra staff are positioned on the unit should any incident arise during the visit.

X had made all allowed five visits, despite no doubt a lengthy ( 30 mile) public journey from Kendal, confidentiality excludes us knowing the name of the custody centre, but from hearings it appears in Liverpool.

And great significance, appears attached by the guardian to the fact that

‘ each of [ these visits] resulted in [her] demonstrating behaviours which have resulted in the need for her to be physically restrained later the same evening’.

Anyone, forced apart from their Mum, after not being allowed a word of private conversation, or expression, knowing they would not be back for two weeks, would indeed be upset and furious, this shows X’s need and attachment to her Mum and fury at the conditions of her containment.

A mother who sought out her own legal representation, which gave evidence that X was on “a path of self-destruction”.

And, that she was “deeply worried” that X would continue to self-harm, if she remains in secure accommodation, but equally is worried that X could attempt to kill herself if living in the community.

The mother as did her daughter believed her contact with X should be increased in frequency and take place under more relaxing conditions.

Not like the guardian and workers who wanted contact risk assessed and curtailed. Why?

X’s first preference, as expressed to her solicitor, when she visited her at ZX on 11 June 2017 , is to return to her home town to live with her mother; if that cannot be achieved, she would want to live nearby her mother so as to be able to see her every day.

This is showed, in her solicitor’s view, that X’s “determined focus”, as repeatedly expressed during her visit, is to return to her home town as soon as possible,

and she records X as simply shutting down at any mention of her actions and as being “not interested, or perhaps not able” to discuss possibilities when it comes to future care planning, we assume because these did not involve being reunited with her family.

All contrary to the guardian’s repeated worker hearsay.

Why cannot X return to her own town and see the only people she knows and lived with until she was 14 ? What else has she got and who else really cares about her ?

If this were the care plan surely this would allievate her suicidal tendancies.

It is assumed X was not in court, when her liberty was removed for a suggested 18 months with enforced medication.

The Judgment, nor I assume any lawyers made reference to X’s right to liberty under Article 5, nor to a family life under s8 HRA .

The High Courts Inherent jurisdiction trumped both, and who could or would appeal ?

If our present draconian legislation can’t be used to encage, it appears our courts will use their own inherent unlimited and unchecked powers to encage.

This trend can only but continue, as the for profit private institutions increase and liberty decreases and our vulnerable are used as commodities.

http://www.zenithchambers.co.uk/current-awareness/family/%E2%80%8BLack%20of%20secure%20accommodation%20%E2%80%93%20%E2%80%9Cblood%20on%20our%20hands%E2%80%9D%3F

The shortage not existence of mental inpatient beds continues at November 2017 in media although on checking Cygnet bed availability on net beds appear permanently  available. https://fullfact.org/health/were-no-psychiatric-beds-available-anywhere-england-weekend/?utm_content=bufferff8d8&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

 

 

 

 

 

 

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11 Comments

  1. Reblogged this on | truthaholics and commented:
    “Contrary to the guardian’s repeated worker hearsay.

    It is assumed X was not in court, when her liberty was removed for a suggested minimum of 18 months with enforced medication.

    The Judgment, nor I assume any lawyers made reference to X’s right to liberty under Article 5 nor to a family life under s8 HRA .

    The High Courts Inherent jurisdiction trumped both and who would or can appeal ?”

    Reply

  2. Finola Once again, my mind boggles.

    And once again it is your blog.that brings this to our attention.

    When will be able to get the LA in the criminal courts – for this is without criminal behaviour. And when will the Court of Protection be on the side of the victim??????

    Reply

    1. Thanks Shirley for alerting me. I assume this is what you refer to and his tweets.

      http://www.independent.co.uk/news/uk/politics/stephen-hawking-jeremy-hunt-scientific-nhs-reform-weekend-tories-a7901586.html

      It shows how powerful. politically, Blair’s third way conservative/labour coalition still is, that the Health and Social Care Act was passed and effect has not even been commented on even during the election, and NHS England and the Foundation Trusts rule regardless, with nearly a quarter of NHS budget spent on private mental with no checked outcomes and just 7% on GPs rapidly herded into super company practices, The very GPs who in CCGs were supposed to lead the commissioning of NHS services…………………..
      .

      Reply

    1. Hope, as I said in comment to you on last post, this is not a pernicious push to use MCA, instead of MHA which appears to be happening already and how training is taught, instigated by the executive in the guise of MCA knowledge and awareness.

      As the MCA, is far more draconian, and for life with only DOLs and no rights just continued restrictions.

      The capacity test per se, as I blogged is unworkable, as is its use for every decision which the Act requires.

      And, as experts and lawyers openly state ,’ the mental health system is awash with people who do not engage with their capacity assessments’,ie mainly the autistic or those under the effect of medication.

      As in my blog post, those assessed ‘incapable’ are similar to Professor Hawking without his voice box.

      Experts say the autistic mind automatically will fail the functional part of the test, purely by being autistic because they live in the present and can’t foresee any consequences of their actions.

      And autism and practically anything-effect of drink/drugs is an impairment of the mind.

      The test in any event, relates to competency, rather than capacity,defined in the act, as ‘the ability to make a decision’ not to perform it.

      The MCA gives even less rights to the assesse – effectively none- than the MHA .

      In any event, how is it relevant to allowing Conor to lie in a bath in a locked room for hours.

      Conor would know this could be dangerous for him as an epileptic, as they ought to have known, its common sense, obvious care not to allow this to happen, or advise against at the very least, AND leave door open and check on him, you do not need to invoke all the complications of the MCA .

      Best Wishes Finola

      Reply

  3. excellent analysis! many thanks! I would like to consult you ona not unrelated matter. If you are happy to do so, perhaps you could grant me permision to pm you on fb? Many thanks and best wishes in any case!

    Reply

  4. The latest on MB The expert has declared MB has capacity in all areas.

    The LA is challenging this and has got a second opinion.

    The judge will declare on capacity one way or the other on 16 October.

    The S49 was used to get a statement on MB’s care, the S21A has disappeared. Madness upon madness. I have told the judge, on MB,s behalf that what she is doing is illegal. She states I must talk to MB’s solicitor.

    Re Sara Ryan and Connor. First rule – if you have epilepsy with tonic clonic seizures, you NEVER HAVE A BATH. The person convulses, goes forwards or backwards, breathes in, drowns. It is also impossible to get a person who is convulsing out of the bath.

    Reply

    1. You must, as I said, get a capacity hearing in COP at least 2 days, as all experts and M need to give evidence in chief and be x examined..

      As I said you need the best qualified expert on M’s capacity – a psychiatrist specialised in epilepsy as well as GP.

      No doubt the LA know if they have one, it will trump M’s GPs evidence.

      As one who knows more than anyone about epileptics bathing, thank you for this information, which should have been known and allowed for by those caring for Connor for their at least 5,000 per week.

      Best Wishes Finola

      Reply

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