Judge wants 'gold standard' for mental-health care for children

STATE agencies have been urged to aim for the “gold standard” in establishing a mental health care system in Trinidad and Tobago designated solely for children.

The advice came from a judge in a recent decision. She ordered the Minister of Health to make available a portion of a general hospital to be used as a psychiatric hospital or ward for the treatment of children diagnosed with mental impairment and in need of an inpatient facility.

The Children’s Authority has asked Justice Nirala Bansee-Sookhai to mandate the minister to appoint any part of a general hospital as a psychiatric ward for such children.

The authority submitted that the minister was responsible for establishing an appropriate facility or ward specially designated for inpatient care for children. It also contended that the absence of a separate and specialised ward for children in need of long-term health care emphasised the need for such a space to be designated.

Under sections 4 and 5 of the Mental Health Act, the minister has a duty to establish an appropriate, special facility for the inpatient care of children, in keeping with the rights of the child and international best practice. Such a facility should be separate from any psychiatric ward caring for people over 18.

In response, the State argued that the court did not have the power to direct the minister to appoint any part of a general hospital as a psychiatric ward, and such an appointment was at the discretion of the minister, but not mandatory. It also contended the St Ann’s facility already treated mentally ill adults who had the mental capacity of a child.

In her judgment, Bansee-Sookhai said a child had a “right of access to basic healthcare facilities and is entitled to the protection of the law.”

She said the lack of separate and specialised accommodation for children in need of inpatient psychiatric care was "an irrational, unreasonable, unfair or arbitrary deprivation…and a contravention of rights under section 4(b) of the Constitution.”

Bansee-Sookhai also said the State and its agencies were responsible for ensuring the best interests of the child wre preserved and positive actions taken to protect the rights of the child.

She said the provisions of international treaties and the way children with long-term mental illness who depend on the State for their care have been treated led to the logical conclusion that the State has failed to provide these children with adequate treatment and care to protect their fundamental rights.

Acting in the best interests of the child, she said, should be done fully and not in a way convenient to those responsible for protecting children.

"Children with mental illness deserve to be treated with dignity, respect, care, and consideration.”

In determining if Ward 13 at St Ann’s could be used for children's long-term care and treatment, she pointed out that it did not usually admit children for long-term care, and that specific ward housed adults.

She said the court “cannot and will not” interpret “child” to mean an adult with the cognitive function of someone under 18.

“If the Executive arm seeks to introduce a new definition to the term ‘child,’ perhaps the legislature may wish to explore this."

She said the court had not power to ascribe a definition from outside the realm of the legislation, especially as the definition under the Children Act was unambiguous.

“It could never have been the intention of Parliament that the definition of ‘child’ is to include an adult whose cognitive functions are those of a person younger than 18,” she said.

Bansee-Sookai said it was “abundantly clear” that children should be separated from adults and accommodated in an environment conducive to their age, condition, nature of care, and treatment and development.

As she quoted from a 2019 decision in which another judge spoke to the failure of the State to allocate resources for such children and from a joint select committee report on mental health, Bansee-Sookhai said the State was fully aware of the need for appropriate facilities to address issues of mental impairment facing children.

“Despite this, it appears that the priority to be given to these children has been severely misplaced,” she said.

"…The needs of our nation’s children for care and treatment in addressing mental illness can no longer remain unresolved." This must be treated with the utmost urgency even though the health care system was grappling with the covid19 pandemic.

She pointed out that mental impairment usually arose during childhood and manifested if left untreated.

Having proper facilities to treat these issues, she said, "will lead to early detection, treatment, care and proper reintegration of children into families and communities." This would result in a healthier and more stable society.

“Let us as a country do what is right for our children. Let us be proactive rather than reactive in the care of children.

“Mental impairment affecting children in Trinidad and Tobago is a serious issue that has for far too long been unaddressed and inadequately treated." There ws no better time than the present, she added, to remove barriers keeping these children from the highest standard of mental health care in their best interest.

She said the case had demonstrated the inadequacies of all state agencies in properly addressing the needs of children with mental health issues, and recommended careful thought and consideration be given in identifying a suitable location in accordance with the court’s order.

The court concluded that owing to the number of children with severe mental impairment, an inpatient facility is required to ensure all such children are properly treated and cared for.