HSE’s legal costs ‘would fund unit in Ireland for girl’

A High Court judge has said the costs of HSE legal proceedings aimed at keeping an 18-year-old with a severe personality disorder in a specialised unit in England against her wishes would fund a “purpose-built” unit for her in Ireland.

The costs to date of various proceedings in Ireland and England concerning the woman are estimated to exceed well over €1m. It also costs £400,000 a year to keep her in St Andrew’s unit in Northampton, where other Irish children and adults are regularly detained.

The woman has been detained for 19 months in St Andrew’s. Before that, from the age of 14, she was treated in various units in Ireland for about two years.

When Mr Justice Seamus Noonan observed that the costs of the case would fund a purpose-built unit for the woman here, Gerry Durcan, counsel for the woman, said the legal costs of similar cases involving vulnerable young people over the last 20 years would pay for an entire “purpose-built system”.

Eleven barristers — six senior and five junior counsel — and at least five solicitors are involved in the latest case brought by the HSE before Mr Justice Noonan.

The case raises important issues, including whether the involuntary detention in St Andrew’s, when the Irish Mental Health Acts prohibit detention of adults with personality disorders, breaches the woman’s rights under the Constitution and European Convention on Human Rights. Most of the doctors agree that, as of now, she has capacity to make decisions about her treatment.

The HSE wants the woman to stay in St Andrew’s but she wants to return to Ireland, as provided for by the High Court in an order last March. It directed that a care plan and other arrangements be put in place in time for the woman to return earlier this month. She has told the judge via video link from Northampton that she will voluntarily co-operate with treatment here.

The HSE claims circumstances have changed since the March order and that it has appealed that order to the Court of Appeal. Pending that appeal, it asked Mr Justice Noonan to vary the March order to keep the woman in St Andrew’s in the hope she will co-operate with a form of therapy considered the “gold standard” for her condition. Doctors involved with her treatment have said they consider her a high suicide risk.

Lawyers for the woman, her estranged parents, and her court-appointed guardian, all of whom are separately represented, accept she is a suicide risk but disagree that her circumstances have changed materially since March. It has also been argued that the HSE took no effective steps to put measures in place allowing for her treatment here.

In evidence to the court, a psychiatrist who dealt with the woman in Ireland said there is a tension between her liberty, her right to live in the land of her birth, and her need for treatment. He considered it was in the woman’s best interests to have her condition managed in St Andrew’s.