High Court hears special unit for deeply disturbed woman would cost more than €1m
Providing a specialised isolation detention unit for a "deeply disturbed" middle aged woman who is a danger to staff, other patients and herself would cost more than €1m, the High Court heard.
The HSE says it doesn't have that money and says her present accommodation in a mental health facility, while not ideal, is the best that can be provided at the moment.
It says the €1m plus bill would be in addition to present costs of having two nurses permanently chaperone her because she has been involved in hundreds of incidents, including self-harming and assault, since she was first admitted to the facility in 2014 under mental health legislation. One nurse resigned after being seriously assaulted by her and a second is still out on long-term illness as a result, the court heard.
As a result of her involvement in some 196 incidents in 2015, she had to be housed in a common sitting room in the facility where she can be permanently monitored by staff and CCTV at the nurses station, the court heard.
Last September, she was made a ward of court which meant president of the High Court, Mr Justice Peter Kelly, reviews her detention at least twice a year.
Today, the judge ordered her continued detention for another four weeks.
He said he would put it back for this period after he heard that an inspector with the Mental Health Commission expressed concern in relation to recording and registering of her situation in the specially monitored area she has been put into. Seclusion of patients must be done in accordance with approved guidelines and protocols, the court heard.
The judge was told by a solicitor appointed in 2014 to represent the woman following her committal to the mental health facility that recently her behaviour had improved.
He (solicitor) believed she needed a bespoke unit because the situation in which she is presently accommodated was not appropriate even though he said staff were doing their best for her. While her health had improved physically, it had not improved at all from a mental health view, he said.
The solicitor also told the judge she was effectively in seclusion as the room she is in is locked, she does not have access to other patients and could not do so without proper supervision as there would be a risk of assault by her.
The General Solicitor for Wards of Court, who represents her interests under wardship, said the wardship situation had not changed the pressure on the HSE to provide a specialised unit which it was accepted was very expensive.
A solicitor for the HSE said her client did not accept the current arrangement was seclusion in the way it is defined by the guidelines.
What was being provided was the clinically appropriate way at the moment of nursing her, the solicitor said. She cannot be allowed return among other patients, particularly in view of the ferocity of the assaults on two staff, she said.
The HSE was acutely aware of the inappropriateness of her current situation but it was "the best place at the moment taking into account capital constraints", the solicitor said.
Mr Justice Kelly said there was a concern the current situation compromised her dignity. She was locked in a room with little or no therapeutic space, he said.
All the evidence before him was she was deeply disturbed as a result of a psychiatric condition for a long time. He had last September authorised appropriate restraint, monitoring and seclusion in accordance with the guidelines.
While the general wardship solicitor and her solicitor appointed under mental health legislation view her current placement as inappropriate it was the best the health service can provide with the budget at its disposal, he said. Efforts to find a place for her in the UK were not successful.
He directed that a report be provided by the court's own independent mental health service inspector and put the case back for four weeks with the detention order remaining in place until then.
