Jersey Unreported Judgments

Care order

[2023]JRC067

Royal Court

(Samedi)

27 April 2023

Before     :

Sir William Bailhache, Commissioner, and Jurats Averty and Le Heuzé

 

IN THE MATTER OF EE (CARE ORDER)

AND IN THE MATTER OF THE CHILDREN (JERSEY) LAW 2002

Advocate J. E. A. Kerley for the Minister.

Advocate E. L. Hollywood for the First Respondent.

Advocate E. L. Wakeling for the Child.

Advocate B. J. Corbett for the Third Respondent.

judgment

the COMMISSIONER:

Background

1.        This judgment concerns the adjourned hearing on 16 March in relation to the Minister's application for a Final Care Order.  At that adjourned hearing; the Court had the benefit of further oral evidence from Dr Kaushal, and an addendum report together with some oral evidence from Dr Murray.  We also had the benefit of the minutes of the meeting held on 22 February in accordance with the Court's order of 16 February, that meeting being attended by a number of professionals and representatives of Agencies; and we had the advantage of the transcripts of that meeting. 

2.        Dr Kaushal told us that the Mother needs support from an autism specialist nurse who can monitor her taking of the ADHD medication.  He was willing to prescribe that medication through the public health scheme.  He did not consider that Autism Jersey, which are willing to support the Mother to the extent of one hour a day, have the clinical abilities to monitor her use of the medication because they are not nurses.  Equally, the Jersey Adult Autism Service was not in a position to carry out this work.  Social Services would, in effect, have to commission the work and it would have to be paid for privately.  Dr Kaushal was aware that there were two such specialist nurses in Jersey - he had contacted one, who was willing to help, but the other was on holiday at the time he tried to make contact.  He thought there was no reason why both would not be able to assist in what was a three month programme.

3.        The medication has to be taken every day.  The autism specialist nurse would be able to give both the Mother and Autism Jersey training as to how monitoring the taking of the medication should take place.  Autism Jersey would in effect ensure that the Mother was taking her medication daily; when asked about the use of a 'dosette' box for convenient monitoring of that medication, which apparently the Mother was unwilling to use, Dr Kaushal indicated that it was possible to work with the Mother on that to persuade her to do so.

4.        Monitoring of the taking of thyroid and anti-depressant medication would be a matter for the Mother's general practitioner.

5.        Dr Kaushal said that he would be seeing the Mother weekly for six weeks, and then fortnightly.  Once a month he would test her more formally to monitor her progress.  He did not consider that the Mother's IQ was so low that she could not benefit from training as to how to manage her autism, and the medication for ADHD would assist so that potentially that IQ could be reviewed during the period of treatment. 

6.        When asked about what success would look like, Dr Kaushal said that the Mother should show reduced procrastination, distractibility and irascibility, and increased focus.  He could not say how successful the treatment would be, but in his view, it had a better than even chance of success insofar as the Mother's ADHD was concerned.  The giving of that medication could happen in very early course.

7.        Dr Murray's addendum report addressed the question of the Child's timescales in relation to the proposed package of support for the Mother - the context was Dr Kaushal's opinion that 'if the Mother had the right support and the right treatment (including thyroid and ADHD medication) he had no doubt there would be no issues in her parenting ability and that any improvement would be visible over six to nine months'.

8.        Dr Murray's addendum report highlighted that the Child was at a stage in her life where good quality parenting was very important and every week and month counted.  The impact of inadequate parenting or poor quality parent / child relationships is greater at a young age than when a child is older.  For the Child to have the best chance of thriving in the long-term, his view was that it was very important for her to have good quality parenting input immediately and for this to continue consistently.  Having regard to the diagnosis of ASD, which was a lifelong neurodevelopmental condition, the diagnosis of ADHD, which could be substantially and rapidly treated with medication and psycho-education, and the diagnosis of depression which again could be treated successfully with medication or psychological therapy, Dr Murray considered that there were real risks of relapse which would adversely impact the chances of the Mother providing the parenting which the Child required.  He then concluded:

"Because of all these points above, my view on balance is that it would be better for the Court to take a decision about [the Child's] placement now rather than wait for nine months, since

a.     the likelihood of significant and sufficient improvement in parenting skills in nine months is in my view a long way less than certain.

b.    even if [the Mother's] depression, ADHD and thyroid problems are adequately treated she will still be experiencing impairments produced by ASD, learning difficulties, and her poor social network.

c.     [the Child] as a young child has a need for stability and good quality parenting immediately.

My view, on balance, is that to wait for a further nine months would be to jeopardise [the Child's] long term future for uncertain gain."

9.        The addendum report in summary suggested that the potential for improvement in the Mother's parenting skills rested on too many imponderables in her treatment and in the available support and thus it would be better to take a decision now. 

10.      When asked in examination in chief as to whether there was a material difference in a delay of six months or nine months, Dr Murray said that there was no fixed term to be applied, but the general principle was that the longer the delay the greater the risk of harm.  In his view, six to nine months was a long time, and the amount of change that could be anticipated over the period might not be enough to get the Mother to the stage of 'good enough' parenting. 

11.      On cross-examination by Advocate Hollywood, it became apparent that Dr Murray was not aware of Dr Ruddy's view that the Mother was not suffering any longer from depression, and Dr Murray readily accepted that that reduced his concerns, albeit he said that when there were a number of episodes of depression there was statistically a greater risk of a relapse.  The fact that she was not suffering any depression at the moment did not mean that she would not suffer this in the future. 

12.      However, he agreed that he used the expression 'on balance' because this was a decision taken on fine margins.  He also agreed that there was a very much reduced risk to the Child if the circumstances were that the rehabilitation of the Mother failed but the current foster carers were to be the Child's adopters.  He had not been aware that that was a possibility.  In his view that tipped the balance of the current decision making and a wait of three to six months might well be more appropriate, because the Child would have consistency of care with the foster parents/putative adopters regardless of the Mother's progress.

13.      Given the Minister's Care Plan is for a Final Care Order and a freeing for adoption and given the importance, before making a Freeing Order, of the Court ensuring that such an order is something of a last resort, all other options having been investigated and explored, Advocate Kerley accepted that it would be appropriate for the Court to order a further adjournment so that the work anticipated by Dr Kaushal, including the prescribing of the relevant medication for ADHD, could take place, with a further review at the end of the three month period to see what progress had been made.  This would be a purposive and considered delay which could work in the interests of the Child and it would not seem to be likely to cause the Child harm particularly if the Mother was unable to make the changes necessary and the current foster carers ultimately were to become the Child's adopters.  Such a delay was naturally supported by Advocate Hollywood for the Mother, and was also supported by Advocate Corbett for the Father and by Advocate Wakeling for the Child.

14.      In the circumstances, the Court ordered that the Interim Care Order should continue and the application for a Final Care Order should be further adjourned.  The Court noted that it was not thought by Advocate Kerley that there would be difficulties in relation to the provision of finance for the specialist autism nurse and Autism Jersey to provide support, but there were apparently some administrative arrangements within the Children and Family services which might need to be satisfied.  Given that the only reason for an adjournment of these proceedings was to enable the Mother to receive this support in order to ascertain, for the best interests of the Child, where her long-term placement would be, any uncertainty or delay in this respect was in our judgment unacceptable.  The Court understood that Advocate Kerley was, on instructions, unable to confirm that the necessary finance would be made available, although he thought it would, and accordingly the Court considered the best solution was to order the Minister to provide funding for Autism Jersey and for the specialist autism nurse, with liberty to the Minister to apply.

15.      The parties were ordered to attend on the Bailiff's Judicial Secretary to fix a two day hearing on or after 12 July, with all parties to file their position statements two weeks before whatever date was fixed.  In addition, the Minister was to file an addendum report by Dr Kaushal at least three weeks before the adjourned hearing in order that there could be an assessment of the progress which the Mother had made over the next three months and as to the possibility of further improvements being made thereafter.

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