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	England and Wales Family Court Decisions (other Judges)
You are here: BAILII >> Databases >> England and Wales Family Court Decisions (other Judges) >> C (A Child), Re [2017] EWFC B16 (07 March 2017) URL: http://www.bailii.org/ew/cases/EWFC/OJ/2017/B16.html Cite as: [2017] EWFC B16

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IN THE FAMILY COURT
SITTING AT NEWCASTLE-UPON-TYNE


IN THE MATTER OF THE CHILDREN ACT 1989
AND IN THE MATTER OF: C (A CHILD)

		The Law Courts The Quayside Newcastle-upon-Tyne NE1 3LA
		7th March 2017

HER HONOUR JUDGE MOIR:

1. The local authority, Newcastle City Council, applies to the court for a secure accommodation order in respect of Ai, although Ai likes to be known as A and so that is what I will call her. A was born on 1^st November 1999, so she is aged 17. There is a considerable history in relation to this matter, some of which I will refer to shortly. This application has been before two judges prior to coming before me. On the last occasion, His Honour Judge Wood adjourned the case specifically to enable further information to be provided in relation to the plan of the local authority, actions which the local authority had taken previously, enquiries which had been made and could be made, and to enable there to be time for evidence to be heard.
2. I have heard evidence from Stephanie Patterson, the social worker who has been involved with A since August of last year and from Paul Bramley, the services manager. I have heard from A herself, and also from Kelly Garner, the guardian appointed in this matter. In addition, I have read the social worker's statement, the initial statement dated 21^st February 2017 and the addendum provided following up on His Honour Judge Wood's directions. That is dated 6^th March 2017. I have read the care plan in respect of A. I have had the assistance of a position statement filed on behalf of A dated 1^st March 2017. I have also read and considered carefully a handwritten letter provided by A and addressed to the judge who was hearing this application.
3. A is, as everybody recognises, an intelligent and obviously articulate young lady who has had particular difficulties within her childhood and adolescence. Those difficulties have no doubt shaped the person whom A is now and she recognises and told me that she has mental health problems. She told me that she does want to get better and the way she sees the optimum way of achieving that is to try and help herself and to access therapy at her own pace.
4. The local authority maintains their stance that, at this juncture, only secure accommodation will contain A and keep her safe and provide the opportunity for therapy, which everyone recognises A desperately needs and, indeed, deserves in light of her experiences. A, whilst recognising that she needs help by way of therapy is opposed to going into secure accommodation feeling that it would make her so frustrated because her mental health had slipped. That she would be mixing with other young persons in respect of whom she feels would contribute to her problems. She is fearful of being in an environment which is noisy and she emphasised that she would feel that she was being punished because her mental health had slipped. Thus, she wishes to remain in Residence A where she has resided since 16^th February and where she has resided previously.
5. The guardian told me in evidence that she thinks that this is a very finely balanced case. Her concerns are around the information which has been provided and she told me she remains concerned about the lack of practical information about how A's mental health needs will be met in the placement proposed. She told me what is lacking as to how practically they would deliver the mental health support which A needs. The guardian was emphatic in describing the decision to be made as crucial. I recognise that it is a crucial decision because A herself wants to be provided with appropriate help and the time limits which are imposed by reason of A turning 18 in November make the decision which has to be taken at this stage the crucial decision to which the guardian refers.
6. The application is made under section 25 of the Children Act 1989. Specifically, the local authority plead that if accommodation is not provided which restricts liberty, and if A is kept in any other description of accommodation, she is likely to injure herself or other persons. The court has to be satisfied that the criteria for keeping a child in secure accommodation are satisfied and I remind myself that welfare is not my paramount concern but, of course, remains relevant and that this is not one of those decisions where there is a requirement to consider specifically the welfare checklist.
7. The guardian has remained at one with A and there has been no separation of their interests. The guardian, on the basis of the history of the matter, has specifically stated that the chronology of events is not in dispute although there has been a slight factual dispute in relation to what has been said by A about self-harming. The majority of the factual background, which is set out within the papers provided to me, is not disputed. The court therefore has to consider the position with regard to what I will call 'the outcome'; namely, where A should be residing.
8. Briefly, the history of this matter is set out within the statement of Stephanie Patterson. A has a longstanding history of mental health difficulties. She has continued to self-harm. Whether that is three occasions in the past fortnight or more really makes not a great deal of difference. A herself accepts that she has cut herself twice visibly and in respect of which she has told the staff at Residence A and once intimately which she has not disclosed to the staff. A has made attempts to end her own life on numerous occasions and made plans to end her life. The view which is generally expressed in relation to this is that A does not want, in fact, to die, but that she feels overwhelmed at times with her problems and the attempts to end her life are a symptom of her mental health difficulties. The very great concern, however, is that there may be an occasion when A achieves an end that she does not intend by accident.
9. A, as I have mentioned, is intelligent and articulate and if I recall correctly, has been described as a pleasure to work with, good sense of humour, aims to please, and is an intelligent girl. These qualities however, and they are undoubted qualities, taken with her very difficult experiences mean that she is able to be untruthful and manipulative with professionals. A herself accepts that, at times, she behaves in that way.
10. A was placed in an adoptive placement. It was not wholly successful and in 2013, A was taken into foster care because of aggressive and challenging behaviours. I emphasise that the history and the consequences of that history, putting it in blunt and simple terms, is not A's fault, far from it. She has, quite rightly, at various times relied on others. They have let her down and, more particularly, when she was placed in fact in Residence A residential unit in the early part of 2014 she was a victim of rape, was given drugs, and assaulted. She has been part of Operation Sanctuary, but I am told that those men accused were found not guilty and, understandably, all of this has had a significant impact on A and has shaped and instigated the difficulties which she has.
11. A has lived in various accommodations since early 2014: a foster placement which was, it seems, successful, and Residence B, Sunderland, where she did not settle and by her behaviour made it necessary for a move. She then went to a smaller placement in Gretna, but disengaged from staff and again demanded to be moved. At this stage, A continued to self-harm and was aggressive and, indeed, caused injury to staff members there. A was moved to Residence C on 9^th November 2016. This was what was called a bespoke placement, namely, it had been chosen and tailored to meet A's specific needs and had specialist mental health support. However, A, within days of being within that placement, seriously assaulted a member of staff and set fire to her room such that police had to be called.
12. On 19^th November, for serious self-harm, A had to be taken to hospital for stitches and was admitted to hospital after taking an overdose of tablets that she had managed to store and pretend to take. In recounting these matters, I do not wish to upset A but, of course, it is necessary for this court to consider these matters alongside all the other factors in this case.
13. On 18^th December, A ingested cleaning fluid and bashed her head against the wall repeatedly causing head injuries. It was clear that the placement at Residence C was not managing to ameliorate A's difficult behaviour and the risks to herself and to others. A's behaviour escalated and the professionals decided that A required hospital admission and treatment. Unfortunately, the practicalities of that proved quite challenging and the result was that A was detained under section 2 of the Mental Health Act. She was placed on a ward highly sedated and deemed to be unwell, suffering psychosis, post-traumatic stress, and low mood. Emerging personality disorder was suspected but remains undiagnosed because of A's age.
14. She was placed in an intensive care bed but that was then reduced and on 24^th January, A transferred to Organisation A. The medical view was that A had made progress and, on 9^th February 2017, the sectioning under the Mental Health Act was ended. She remained at the hospital as an informal patient and on 13^th February, the medical professionals found it appropriate to discharge A from hospital.
15. She returned to Residence C but, sadly, on 12^th February during home leave at Residence C, that is the day before the decision to discharge, she made an attempt to tie a ligature upon the wardrobe door and A was found standing on a chair attempting to do that. The concerns of the local authority and the social worker continued despite the discharge. The discharge summary concluded that A displayed symptoms of someone with post-traumatic stress disorder, emerging personality disorder, attachment disorder and developmental trauma. That she is a prolific self-harmer which had resulted in multiple scars and, in the space of two months, she had had hospital attendances for paracetamol overdose, for digesting cleaning fluid and that despite hospital admittance and attendance, A's engagement had been at a superficial level only.
16. The problems continued and on 15^th February there was a further incident involving ingestion of sanitiser and an attempt to hang herself from the door in her bedroom blocking the door. The staff at Residence A took the view that the police needed to be called and A was placed on an emergency basis at Organisation B. She was discharged by the crisis team but Residence C were unable or unwilling for A to return to their care taking the view that they were not able to keep her safe and contain her behaviours.
17. Enquiries were made as to an appropriate placement, but there was no obvious placement as many of those placements approached refused to take A given the risks and, at that stage, no secure bed could be located. It is right that the local authority had decided at this stage that an application for a secure order was appropriate. In the meantime, A was placed at Residence A on an emergency basis. That, of course, is the accommodation where she remains. The local authority takes the view that it is inappropriate as it is not a unit which is geared up to provide the best setting for A and, more particularly, it is where she was residing when in the past the traumatic event which I have described took place.
18. The local authority requested a further mental health assessment and the intensive community treatment service were requested to monitor the situation. My understanding of what I have been told is that the ICTS can do no more than monitor A. They are not a service which can provide any therapy and, further, I have been told that if a service to provide therapy was engaged, then ICTS would withdraw. It is perhaps unsurprising that the mental health service which could provide therapy will not offer their services whilst A remains in a placement which is not deemed to be a relatively stable placement. By that, I mean somewhere where it has been decided that she should remain for a length of time. Thus, the present situation is that there has been involvement of two doctors, Dr Nairn and Dr Bgaja who were called as part of the crisis team to assess A. They provided the information to which I have been referred at I61, namely that the acute risks are not evident with regard to serious self-harm attempts and the doctors are:

"...of the opinion that continued engagement with community treatment is required at this time."

19. They felt uncomfortable making A go to hospital when she is so willing to engage in the support and she is not refusing this. Thus, at that stage, the medical assessors took the view that immediate hospital detention was not appropriate and that community treatment would be the way forward on the basis that A was willing to engage with community treatment.
20. The present circumstances, as I have indicated, are that ICTS monitor the situation and A has had the benefit of speaking to Dr Paul Singalis I think, on two occasions and last night, who has been asked to review A's medication. She has told me that she has felt that he has been able to spend time with her and given her appropriate advice that she feels has been very useful. She wishes to stay at Residence A.
21. The court has to look at realistic proposals and propositions. The court has to make orders, or an order, which is proportionate in line with the legislation. The realistic alternatives that are placed before the court are either secure accommodation at Residence D, with the facilities and programme that are now set out within the second statement of Stephanie Patterson at paragraphs 12, 13 and 14. The plan would be for A to be within a six bed unit. The staff at Residence D deal with crisis situations and there is an in-house psychologist and cognitive behavioural therapist. The programme would include an assessment and then a restorative approach. The local authority, with their knowledge of A, feels that it would best meet her needs.
22. I have seen an email from Nicky Hill who is a consultant clinical psychologist who had involvement with A. However, as Nicky Hill points out, she has not had direct contact with A since mid-January when she was at Residence C and any opinion provided by Nicky Hill is based on her knowledge at that time. Her opinion is that A does present with repeating patterns of initial compliance which quickly deteriorates as placements start to put boundaries and expectations in and A's behaviour is challenged in any way. Thus, the staff then become unable to manage the high levels of risk-taking behaviour and the attention which A's emotional state requires and the impact that she has on staff teams and others within residence at the accommodation.
23. Nicky Hill's view is that A requires a therapeutic environment with ongoing flexible access to therapy and a therapeutic parenting approach. With the caveat that I have repeated, Nicky Hill supports the local authority plan for the therapeutic secure setting which the local authority proposes. Nicky Hill emphasises the need for the greatest possible opportunity for A to build relationships as that is the key for her beginning to recover from her chronic and horrific childhood traumas. Nicky Hill says without the opportunity to experience safety and security through a secure-base relationship, she will be unable to develop the internal coping skills necessary to promote some resiliency or to learn to use adults to support her when she needs them to do so after which she will have a greater chance of being able to effectively start more trauma-based work.
24. The alternative placement is Residence A. I am satisfied that the local authority has made extensive enquiries as to other possible placements. I am told that there was a list of 28 other units, local providers, some of which have other provision, but that the units who have been approached are either full or will not consider A as the risk is deemed to be too high, or she would not match with other residents. The guardian suggested two possible placements, neither of which took the view that they could provide what A needs.
25. Thus, the practical position is that there is no further option. Even during the course of yesterday, further enquiries were made. I am told that Residence E, which is a more local secure unit, indicated that they would be unable to accommodate A and, in reality, based upon the enquiries that have been made, which I accept have been extensive, there is no alternative placement available which would meet A's particular needs and which would be willing to take her. Thus, it is necessary to examine what is available at Residence A.
26. I appreciate that the guardian still has reservations about the information provided and whether there are gaps in the knowledge in respect of the plan, but I am satisfied that I am in a position to make a decision in relation to the application that is made to me. I have no doubt whatsoever that if I adjourned this matter, further information could be provided, but I am satisfied that the information before me is sufficient to enable me to make a proper decision.
27. I know what is on offer from Residence D, not the intricate detail, but I do know what the proposals are in relation to assisting A as far as mental health difficulties are concerned and as far as dealing with the level of risk that A demonstrates to herself and others. I know what is practically available at Residence A. The benefits of Residence A are obviously that A herself wants to remain there. She has been there for a fortnight and there has not been such an escalation of behaviour that steps have had to be taken to either have police assistance or mental health crisis assistance. A, in her evidence before me, has told me that she feels able to progress there. That within the five months that she could remain there, she said that she believes that she could work to bring the risks down and that she would work and access therapy at her own pace, but that she would engage and take advantage of ICTS, Dr Singalis, and the support of the staff. So clearly, the positivity of A in relation to that placement is important.
28. On the negative side, however, is the fact that ICTS can only be a monitoring service. Therefore, there is no work being done by them to deal with the underlying problems that any mental health services provider would become engaged in in any meaningful way. From the information provided to me, what would be being looked at would be something in the nature of, at best, weekly visits.
29. The court recognises that A has worked hard over the past fortnight, but Stephanie Patterson's view and professional opinion, and she knows A, is that while there is focus on the ongoing court proceedings and attendance at court, and the number of professionals involved at this time, A has been provided with a situation, I suppose putting it colloquially, where she can be on her best behaviour. There is an audience there to observe her best behaviour and therefore the professional opinion is that, in those circumstances, A is able to regulate, maintain, and contain her behaviours to show her in the best light so that she need not go into secure. Indeed, that is a perfectly understandable and normal response.
30. The concern that has been expressed is that once the focus is removed and the spotlight is turned away, that A's difficulties will surface. I again emphasise that I am not criticising A. That is not what this is about. I am not blaming A. She is in a situation which she, more than anybody else, wishes to change. The difference of opinion is how that can be achieved.
31. I am satisfied, and I know A will not like this, that the only way that can be achieved is by placement in secure. The reason I have come to that decision is that I have reviewed very carefully the history of this matter. I have looked at what I have been told as far as what is occurring recently and I have looked at the pattern and the cycle. What I want is what is best for A and to give her every opportunity to be able to make something of herself in her life because she has huge potential, I have no doubt about that whatsoever. I have heard her give evidence. I have heard what other people have to say about her, and she is a young lady who has an awful lot there to give. It needs the help of people whom she can trust and who actually come through for her to enable her, when she is 18, to be able to benefit from whatever is on offer for her, to be able to move forward and, as I say, make the most of her potential because I have no doubt that she has potential. To remain at Residence A, I am certain is likely to result in a further application at a later stage and more time is going to be lost.
32. Time is precious, it needs to be taken and I finish by saying I hope that A does engage and take the opportunity. People want to help her. She deserves the help and I just hope that she takes it. So I will make the order for three months, but what I would like is for this matter to be reviewed in six weeks' time so that I can be given an update and an account of what is happening.
[Judgment ends]