A deprivation of liberty case involving a vulnerable 14-year old with autism and a learning disability has been called "shocking" by a judge who described the child's situation as “brutal and abusive”.
Mr Justice Macdonald said the child ST had been comprehensively failed by Manchester City Council and the NHS Trust after being admitted to a general paediatric ward as a place of safety.
Following her admission the local authority employed a private company to provide two security guards and two carers in order to supervise ST on a 4:1 basis. The company was engaged on a five day rolling contract, which meant there was a high turnover of staff supervising ST, resulting in her waking up to unfamiliar adults and being scared by that change, further adversely impacting on her behaviour and wellbeing.
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She was also subject to multiple physical restraint holds including on one occasion by five people, inappropriate restraint of her head, being tranquilised/subject to chemical restraint on numerous occasions and being required to walk around the ward in a restraint. On one occasion ST managed to break into a treatment room in which a dying infant was receiving palliative care and had to be restrained in that room by three security guards.
Evidence was given that on one occasion, nurses witnessed the security guards on top of ST's legs and holding down her arms while she was laying upset in her bed. There was also a male support worker holding her head from above pressing her head into the mattress with fingers coming over her forehead. ST was screaming very loudly and sounded very scared. Nursing staff advised that restraint of the head was not appropriate.
The judge commented on multiple adults restraining ST, their identity changing from day to day under the rolling commercial contract as well as ST's fear and distress and it being played out in view of members of the public.
The judge said that placement to a paediatric ward was unsuited to the task of meeting ST's needs and the court described the current situation as "brutal and abusive" for ST.
Background to the case
On 15 February 2022, ST was presented to the hospital by her father who refused to return her to the family home. ST's parents had found it increasingly difficult to manage her challenging behaviours and had resorted to locking her in the dining room. ST's escalating dysregulation had also resulted in her siblings locking themselves in their rooms, impacted the mother's mental health and caused a termination of ST's school placement (where there was 6:1 staff support under an Education and Health Care Plan).
Manchester City Council had been aware of these issues but it was unclear what support, if any, they had provided.
ST's treating Child and Adolescent Psychiatrist had previously advised against admission to hospital (without a medical need) due to the risks of harm to ST and others in the hospital environment.
There was also no physical or psychiatric need for medical treatment for ST, on a paediatric ward of otherwise. The court noted that the local authority was unable to offer any explanation as to why it had failed to make an application for an interim care order at this point of obvious crisis.
The judge said that it would not be appropriate to delay publication of this judgment or to anonymise the identity of Manchester City Council in circumstances where, again, the omissions that have caused the court immediate concern cannot be the subject of serious dispute.
He added: "Subject to the redaction of the identity of the child and the family and the location of her current placement, (which requires, at least for the time being, the anonymisation of the applicant NHS Trust), it would be entirely wrong in my judgment to keep those matters from the public domain.
"As has been made clear in previous judgments, this court is regularly faced with applications under the inherent jurisdiction for declarations authorising the deprivation of liberty of children and young people in circumstances where there is an acute shortage of suitable residential therapeutic placements to meet their needs.
"A number of those cases have involved children who have been placed, entirely inappropriately, in hospitals for want of any other placement provision. Within this context, the court is used to dealing with situations that are sub-optimal for the child and with having to consider the extent to which deprivation of liberty in such sub-optimal situations can be said to be in the subject child's best interests, at least for a short period whilst more suitable provision is identified.
"Used as this court is to dealing with the plight of vulnerable children and young people caught up in the foregoing circumstances, it is difficult to describe the case that comes before the court this morning as anything other than shocking."
Following the hearing, the local authority has identified a bespoke, short-term placement for ST and has now applied itself for a declaration authorising ST's deprivation of liberty in that placement. The Local Authority continues to search for a residential educational placement for ST.
Last month, a man with learning disabilities also received a six-figure settlement after being unlawfully detained in a care home for more than seven years.
The man, who has autism, was removed from his family home aged 24 and placed in accommodation by Lancashire County Council. Between February 2010 and April 2017 he lived in a care home which was a 45 minute drive away from his family in the Fylde. The accommodation was locked with an alarm on the door and the man was under one-to-one supervision for up to 14 hours a day. He was prevented from or heavily restricted in accessing the internet, social media sites and email.
CHH, who lived at home with his parents and siblings, was moved to a temporary care home in January 2010 following an issue at home. His initial placement was deemed completely unsuitable and so a month later he was transferred to the care home that he lived in until April 2017.
Lancashire County Council has now agreed a £200,000 settlement for the man, who is known as CHH. It has also agreed to pay £155,000 towards the cost of a deputy to manage CHH’s funds on his behalf as he lacks mental capacity to manage his property and affairs.
Fiona McGhie, Senior Associate Solicitor at Irwin Mitchell, said: “This is a shocking case where the unlawful restrictions placed on CHH have had a profound impact on his life.
“During his placement he was in effect imprisoned, living in locked accommodation miles away from his family. To make things worse, CHH and his family repeatedly stated that he was unhappy and he wanted to live nearer to his family. Given his strong objections to his placement, the local authority should have referred his case to the Court of Protection to determine where it was in his best interests to live. It didn’t do that and so CHH was denied the opportunity of being able to challenge the deprivation of his liberty in a court.
“As a result he lived for many years in a placement where he was extremely unhappy, despite health professionals also raising concerns that he was inappropriately placed.
“While nothing can make up for the years CHH lost we’re pleased that we’ve at least been able to secure this settlement for CHH and hope he can now try and look to the future the best he can. For the moment, he is now living happily with his family at home.
“This case acts as a stark reminder to all local authorities of the need to ensure that the Deprivation of Liberty Safeguards are followed, and that those objecting to their placements are supported to challenge them in the Court of Protection.”