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Suicidal girl to be moved to special unit after judge approves care plan Suicidal girl to be moved to special unit after judge approves care plan
(about 1 hour later)
A high court judge who warned that society would have “blood on its hands” unless a 17-year-old girl considered at high risk of killing herself was given urgent support has approved an NHS care plan for her. A suicidal 17-year-old girl is to be moved to a secure unit on Thursday after a senior judge warned that plans to release her because of a shortage of secure beds for mental health patients would leave “blood on our hands”.
Sir James Munby, the president of the family division of the high court, warned last week that the girl, known only as X, could kill herself within 48 hours of being released from detention on 14 August if mental health services could not find a place for her to receive intensive treatment. But in his latest ruling in the case of the youngster known only as X, Sir James Munby was scathing that the decision to find her a bed only followed his outspoken warnings that a failure to do so could result in her taking her own life.
On Monday he approved a plan put forward by NHS England, which has offered her “a bespoke package of care” for up to four weeks following a transfer to a new facility on Thursday. The president of the family court said that without his intervention last week, NHS England would have not acted as effectively or speedily.
In his judgment, Munby said: “I cannot escape the powerful feeling that, but for my judgment, the steps subsequently taken would have been neither as effective nor as speedily effective as appears to have been the case. “This, however, is not a matter for congratulation,” Munby added. “On the contrary, it is, of itself, yet further cause for concern. The provision of the care that someone like X needs should not be dependent upon judicial involvement, nor should someone like X be privileged just because her case comes before a very senior judge.”
“This, however, is not a matter for congratulation; on the contrary, it is, of itself, yet further cause for concern. The provision of the care that someone like X needs should not be dependent upon judicial involvement, nor should someone like X be privileged just because her case comes before a very senior judge. The case of X has proved an embarrassment to the NHS and shines a light on the lack of resources to cope with the most extreme mental health cases where lives can be immediately at risk.
“I emphasise this because a mass of informed, if anecdotal, opinion indicates that X’s is not an isolated case and that there are far too many young women in similar predicaments. How are they to be protected?” Munby himself wondered who else might be at risk as the country’s mental health system strains to deal with rising demand from young patients at a time when the supply of beds as not been able to keep up.
He remarked how his outspoken comments had “prompted substantial coverage” in the media. “It was, for example, the main front page story in both the Guardian and the i. This seems to have had some effect.” In his ruling, he added: “I emphasise this because a mass of informed, if anecdotal, opinion indicates that X’s is not an isolated case and that there are far too many young women in similar predicaments. How are they to be protected?”
Munby made the stark claim that the girl’s situation demonstrated the country’s “disgraceful and utterly shaming” lack of proper mental health provision. X had been detained in a secure unit following a youth court order and was expected to be released in the middle of August. But following several “determined attempts” on her own life, staff at the unit, known as ZX, concluded the care plan to send her back to a community setting was “a suicide mission to a catastrophic level”. They thought she would kill herself within two days of release.
In a judgment last week he explained that X had made a large number of “determined attempts” on her life. She was due to be released from a secure unit, named as ZX, and doctors believed she needed to be placed in further care for her own protection. He revealed there were no places available for her in an “appropriate clinical setting”. However, none of England’s 124 places in low secure units were currently available and there was a six-month waiting list even though X was due to be released within days.
“If, when in 11 days’ time she is released from ZX, we, the system, society, the state, are unable to provide X with the supportive and safe placement she so desperately needs, and if, in consequence, she is enabled to make another attempt on her life, then I can only say, with bleak emphasis: we will have blood on our hands,” Munby wrote. In his first judgment last week Munby, president of the family division, issued a stark warning about the needs of X and said the inability to find care for her embarrassed the nation.
On Friday, the NHS said it had found a hospital to look after her. Dr Mike Prentice, NHS England’s medical director for its north of England region, said: “Following extensive assessments, the NHS has identified a bed for this young woman in a safe and appropriate care setting which will best meet her needs.” He wrote: “If, when in 11 days’ time she is released from ZX, we, the system, society, the state, are unable to provide X with the supportive and safe placement she so desperately needs, and if, in consequence, she is enabled to make another attempt on her life, then I can only say, with bleak emphasis: we will have blood on our hands.”
The senior judge ordered the judgement to be sent to Amber Rudd, the home secretary, Jeremy Hunt, the health secretary, Justine Greening, the education secretary and the secretary of state for justice, David Lidington, and it sparked a flurry of activity in the following hours and days among health officials who announced on Friday that they had found X a place.
Last week’s ruling also “prompted substantial coverage” in the media, Munby said in yesterday’s judgment. “It was, for example, the main front page story in both the Guardian and the i. This seems to have had some effect.”
On Monday morning, NHS England finally submitted a detailed plan to keep her in a low secure unit, by creating new beds from those in a psychiatric intensive care unit, instead of trying to care for her in the community. Munby has now approved the plan which also includes new funding for her care – which requires a three-to-one staff ratio.
Munby revealed how the secure facility where X is currently housed could no longer keep her and he said he accepted their case. The facility had told the judge it had already spent £125,200 on looking after the troubled girl in additional staffing and complained that the Youth Justice Board had failed to provide additional resources.
It said that since X arrived she has diverted staff to the extent that 13 of the 24 people who normally live there have complained the quality of care is in breach of their statutory rights. Three staff are also off sick with stress and anxiety from “unusual experiences these staff have observed with X”.
The NHS plan is now to move X this Thursday into a psychiatric intensive care unit temporarily awaiting the conversion of beds to the status of a low secure unit. The same staff will be looking after her in both environments. An agreement has also been made for NHS England to fund an extra package of care in order for her needs to be met, including treatment that will be recommended following a comprehensive assessment.
“This will also include dedicated staff to support her throughout her admission, therapy and treatment including psychological and pharmaceutical input,” according to Munby’s ruling.
When the plan to convert a psychiatric intensive care unit into a low secure unit was announced on Friday the move was welcomed by Prof Wendy Burn, president of the Royal College of Psychiatrists. But she said: “Securing the right support for others like X should not be, and cannot be, dependent on one of the highest judges in the land showcasing his outrage and frustration. We urgently need to devise a national strategy so that people with personality disorders are supported from their adolescence into adulthood.”
Munby agreed with this analysis on Monday saying in his judgement: “Quite so.”
NHS England declined to comment. But on Friday, when it said it had found a hospital to look after her. Dr Mike Prentice, NHS England’s medical director for its north of England region, said: “Following extensive assessments, the NHS has identified a bed for this young woman in a safe and appropriate care setting which will best meet her needs.”
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found hereIn the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here