A Young Girl in Distress

AIMS: The purpose of sharing this case is to bring attention to the complexities in implementing legal framework for children and adolescents as well as the serious shortages of in-patient adolescent psychiatric beds, which can adversely affect the mental health of young people. METHODS: A young girl with a diagnosis of Depressive Disorder and Disordered Eating was treated by community mental health team for two years. She took an overdose and was admitted to a private NHS funded in-patient adolescent psychiatric unit, where she was placed on Section 2 of Mental Health Act. After two months she was transferred to an out of area psychiatric bed. While on home leave she took another overdose and needed admission in High Dependency Unit. When medically fit she was moved back to psychiatric unit. After two months she was moved to a local in-patient unit. Due to dietary restriction she was commenced on nasogastric feed. At that point the local psychiatric unit could not provide the support she needed and she was transferred to another in-patient adolescent unit in the region. After being an in-patient for 18 months when her condition improved a discharge planning meeting took place. She was still on nasogastric feed and sometimes had to be restrained. The local and regional in-patient and crisis consultants suggested that she should be discharged under Community Treatment Order. The community consultant took legal advice. The legal advice was that the provision of nasogastric feeding in the community without young person's consent would be likely to be unlawful and a violation of her Article 3 rights under the European Convention of Human Rights. Such restraint would be likely to amount to an unlawful deprivation of liberty and a breach of her Article 5 rights under the European Convention of Human Rights. RESULTS: It is deeply concerning that she had to be moved between four in-patient units during one episode of in-patient admission due to lack of appropriate bed availability. Due to her age and complexities in the case, legal advice had to be taken because the consultants involved failed to agree on the appropriate application of legal framework. CONCLUSION: This case clearly highlights the need to address the issue of adolescent in-patient psychiatric bed shortages as well as the importance of educational programmes aimed at improving the knowledge and skills of professionals on the application of legal framework in children and adolescents.