Young man with intellectual disability to be discharged from hospital into community

An intellectually disabled young man detained in hospital since November due to concerns about the serious effects of his persistent failure to take necessary medication is to be discharged into the community with supports, writes Ann O’Loughlin.

The detention was ordered following an emergency application by the hospital to have the man made a ward of court when he went there in November in what the President of the High Court, Mr Justice Peter Kelly, described as a "wretched" condition, seriously underweight, incontinent and at risk of sepsis".

He has had multiple earlier admissions, including emergency ones, due mainly to not taking medication for a serious physical condition or taking care of his personal health.

Having been deemed not to have the capacity to make decisions affecting his health, the orders were continued a number of times and the case came for further review on Tuesday.

The man’s father and a disability services manager with the HSE both appealed to the judge not to continue his detention in a small room in the hospital where, due to his challenging behaviour, he is watched by security staff. 

Both also said the man should not be detained in a psychiatric facility when several reports stated he is not psychiatrically ill. Three private residential secure facilities considered as possible options had all refused to take the man, the judge also heard. 

The father said various events over several years, including his mother’s death, appeared to have put his son on a "downward spiral" but he believed his son could benefit from a range of disability supports in the community.

While the hospital detention has lead to considerable improvement in his physical condition, his confinement in a small room was contributing to his challenging behaviour, including assaulting a nurse, for which he apologised. His son is "being talked at, not talked to" and needs a purpose in life, his father added.

The HSE manager said she knows the man for years and believes he could do very well living in the community with supports, including an independent advocate. Being kept in a small room was very restrictive on him and while his behaviour cannot be excused, it underlined he "wants to be somewhere else". 

She appreciated the challenges facing the services but the issue was his best interests now and into the future. Like everyone else, he was entitled to an opportunity to live in the community and make choices, good and bad, and containment was not in his best interests. "The higher you build the wall, the more some people climb over it."   A medical social worker said she considered detention in a psychiatric facility the best option for ensuring the man takes his medication and to safeguard his health. Otherwise, she feared further admissions.

In his ruling, Mr Justice Kelly said he could not justifiably order the man’s further detention either in a hospital or a psychiatric facility because he is medically fit for discharge, not psychiatrically ill and the impact of his behaviour on staff and patients.

The whole point of detention was to ensure the man looks after himself but that was not a realistic or justifiable basis for it, he said. He also took into consideration the views of the man’s father and evidence of the HSE manager, who said the young man's voice has not been heard.

The judge said he would discharge the man into the community and hoped the disability services would provide necessary supports. While that carried a risk the man would return to his old habits, there was only so much the hospital and court could do, he said. He had no doubt the man’s father would do his best to ensure the man behaved sensibly but there are limits to what even a parent can do, he added.

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