X (A Child) (No 3)

When a child presents extreme and continuing risks of suicide and self-harm, the authorities must pursue an effective, realistic and safe placement plan directed to the child’s clinical and therapeutic needs. Secure containment alone is inadequate where it cannot provide the necessary treatment. A placement must be the least restrictive setting capable of managing the identified risks. Resource scarcity cannot dictate the medical care plan or justify an unsafe or unsuitable community placement. The State’s duties under articles 2, 3 and 8 of the European Convention must be kept in view.

The proceedings concerned X, a 17-year-old child subject to a care order and detained under a Youth Court Detention and Training Order in a secure unit. At the previous hearing, the High Court had made a care order and approved a plan of action intended to identify a suitable placement before her release: Re X (A Child) (No 2) [2017] EWHC 1585 (Fam).

X had repeatedly attempted serious self-harm and suicide. The evidence indicated that the existing placement was unable to meet her clinical needs and that she required a secure therapeutic setting. A Tier 4 adolescent low secure unit was preferred, but no suitable bed was available. The central issue was what interim placement, if any, should be selected pending further enquiries.

Disposition. No placement suitable to meet X’s needs was available. The court adjourned the case for urgent enquiries and a further interim placement decision.

1. Clinical placement. The evidence established that the existing secure unit was containing X but was not meeting her needs. She required mental-health assessment and therapy in an appropriate clinical setting, preferably a Tier 4 adolescent low secure unit for approximately 18–24 months. A psychiatric intensive care unit would not meet her complex needs, and the evidence did not establish the threshold for medium secure provision.
2. Resources and care planning. The child’s care and medical plan had to be driven by her identified needs and risks, not by the absence of suitable NHS or other placements. A community placement, even with 24-hour wrap-around medical support, was not feasible and would not meet X’s needs.
3. Convention duties. The conditions in which X was being kept, including constant observation, repeated restraint, removal of ordinary personal items and anti-ligature clothing, raised serious questions under article 3 of the European Convention. Article 8 was also engaged. Given X’s repeated attempts to take her own life, the State’s positive obligations under article 2 were plainly engaged. The court referred to Rabone and another v Pennine Care NHS Trust (Inquest and others intervening) [2012] UKSC 2, [2012] 2 AC 72. No final finding of breach was made.
4. Further directions. The case was adjourned to enable enquiries about interim placements in medium secure, adolescent psychiatric intensive care or adult psychiatric intensive care settings. The further hearing was to determine which was the least worst available option, although none would appropriately meet X’s needs. Copies of the judgment were directed to be sent to the relevant public authorities.

First-instance judgment. The judgment records an earlier High Court hearing at which a care order and a plan of action were made in Re X (A Child) (No 2) [2017] EWHC 1585 (Fam). The present hearing was adjourned for further enquiries and an interim placement decision.