R X (A Child) (No. 4)  (2017)

Keywords: Mental Health, NHS resources

In this case, Sir James Munby, President of the Family Division, expressed his concern about the lack of appropriate mental health beds for children and young people in England and Wales.

The case concerned a 17-year-old girl in desperate and urgent need of a suitable placement to prevent a serious risk of suicide.

In the preceding hearing, Sir James Munby had expressed publicly his outrage and frustration at the failure to provide a suitable placement for the girl.

NHS England’s resulting offer of a suitable bed was not a matter for congratulation, but a further cause for concern. Securing the right clinical support for those who needed it could not be dependent on the lottery of an individual’s case coming before a senior judge and attracting widespread publicity. 

X, who was the subject of a care order, was imminently due to be released from a secure unit (ZX), having served a Detention and Training Order there. ZX could not lawfully detain her further and was, in any case, struggling to meet her needs. Whilst at ZX she had made multiple, determined attempts to commit suicide and there was strong clinical evidence that, if released into the community, she would more than likely commit suicide within days.

In the previous judgement, Sir James Munby had described a care plan to place X back in any community setting as “a suicide mission to a catastrophic level”. He had ordered copies of that judgement sent to NHS England and Secretaries of State with relevant responsibilities and his views had attracted extensive media coverage.

By the time of this hearing, NHS England was able to offer a bed for X by converting a psychiatric intensive care unit into an 8-bed low security unit. Whilst this provided a solution to the immediate situation for X, Sir James Munby stressed that the provision of care for young people like X should not depend on judicial involvement or public pressure. He concluded:

“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; 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. 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?” [Para. 18]

 

Full transcript available at: https://www.judiciary.gov.uk/wp-content/uploads/2017/08/in-the-matter-of-x-a-child-no-4.pdf