A high court judge has expressed her “deep frustration” at NHS delays and bureaucracy that mean a suicidal 12-year-old girl has been held on her own, in a locked, windowless room with no access to the outdoors for three weeks.
In a hearing on Thursday, Mrs Justice Lieven told North Staffordshire combined healthcare NHS trust “you are testing my patience”, after she heard that a proposal to move Becky (not her real name), could not progress until a planning meeting that would not be held until next week, and that a move was not anticipated until 2 March.
Three sets of doctors at the hospital trust have disagreed as to Becky’s diagnosis; at her most recent assessment doctors said she was not eligible to be sectioned, which would trigger the protections provided by the Mental Health Act, because her mental disorder was not of the “nature and degree” as to warrant her detention.
In the absence of medical consent to section her, and because of previous incidents of self-harm, judges have decided Becky must be deprived of her liberty by court order for her own protection.
Becky has been held in a hospital seclusion room since 27 January, her only human contact via a hatch in the door. All parties to the case agree that her deterioration while in hospital is due at least in part to her prolonged isolation in a room that has fewer home comforts than a prison cell.
The idea of moving Becky to a paediatric mental health unit, requiring renovations to make it suitable for her care, had “only recently been floated”, counsel for the trust told the court, “and unfortunately public bodies are required to go through a bureaucratic and procurement process”.
In a robust exchange, the judge demanded: “Where’s the urgency in this … I cannot believe that the life and health of a 12-year-old girl is hanging on an issue of NHS procurement, when you cannot tell me what it is you’re trying to procure.
“If the delay is procurement, I’m not having it,” Lieven continued. “I will use the inherent jurisdiction to make an order. We have a 12-year-old child in a completely inappropriate NHS unit for about three weeks, and it’s suddenly dawned on your client that ‘actually we’ll put her in a Tier 4 unit and we might have to do some [building] work.’”
Sometimes, the judge said, “public bodies have to move faster”.
The trust told the court that cost issues were not a consideration.
When asked to return her iPad to hospital staff last week, Becky broke it and attempted to self-harm. After being subjected to what the local authority described as “full restraint” in the course of which she assaulted staff, Becky again attempted to self-harm. She was found huddled under a blanket by hospital staff and required oxygen to save her life.
Warning that Becky’s “risk of deliberate or accidental death is very high”, her guardian, who is appointed by the court, pointed out that the state had a positive obligation to protect her life. She also highlighted the state’s positive obligation to protect Becky’s human right not to be subjected to torture or inhuman or degrading treatment.
In a statement that emphasised the court must keep at the forefront of its mind the legality of Becky’s situation, the guardian stated her view that the conditions the child was living in “takes to the extreme what is permissible within the boundaries of article 5 [of the European convention on human rights] within which ‘deprivation of liberty’ authorisation operates”.
Becky’s mother is permitted to speak to the media about her daughter’s case thanks to a transparency order made by the judge.
“It’s four weeks tomorrow since I last hugged her,” she said. “I can only stroke her hair and wipe her tears through the hatch. Even now she’s in hospital seclusion she’s been able to attempt her life. I still fear a knock at the door.”
In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.
