X (A Child) (No 4)

Where a child’s existing custodial or secure placement cannot safely and lawfully continue, the responsible agencies must secure an appropriate alternative before release. The alternative must reflect the child’s assessed clinical needs and provide a safe, realistic care plan. The court may require detailed evidence and directions to ensure that an agreed placement is implemented promptly. Judicial intervention should not be the ordinary means by which suitable clinical care is obtained. Public services should plan nationally for children whose needs cannot be met by unsuitable or age-inappropriate placements.

X was detained in a secure unit under a Detention and Training Order and was due to be released on 14 August 2017. Earlier judgments recorded repeated suicide attempts, the unsuitability of the unit, and the absence of an immediately available Tier 4 adolescent low secure placement. The court adjourned the matter to permit further inquiries.

By 7 August 2017, NHS England had identified a proposed transfer to a CAMHS psychiatric intensive care unit under Mental Health Act 1983, section 47, with a bespoke package of care pending conversion of part of the unit into a low secure unit. The issue was whether that plan was sufficiently appropriate and developed to safeguard X’s welfare after release from the existing placement.

1. Outcome. The court accepted that X’s interests would best be served by transfer from the existing secure unit to the proposed CAMHS placement on 10 August 2017, subject to completion of the legal and practical arrangements.
2. The existing unit could not lawfully or practically retain X after expiry of her Detention and Training Order. The evidence showed that it was not meeting her needs, that a low secure adolescent unit was clinically indicated, and that continued placement there would also prejudice other residents and staff.
3. The available interim options were all less satisfactory than a low secure placement. NHS England’s evidence supported a bespoke package at the proposed CAMHS unit, providing care equivalent in substance to low secure care while the unit was reconfigured and its registration changed.
4. The proposed transfer was to occur under Mental Health Act 1983, section 47, while X remained subject to her sentence. If that route failed, detention under section 2 was identified as an alternative. The court recognised that the transfer required medical recommendations and other statutory inputs.
5. To ensure that the plan was capable of implementation, the court ordered NHS England to file and serve all available documentation concerning X’s care and treatment plan, including arrangements for physical transfer, or to explain any incompleteness. The hearing could be restored if necessary.
6. The judge expressed wider concern that access to suitable care should not depend on intervention by a senior judge or on the publicity surrounding an individual case.

The judgment records earlier first-instance hearings and judgments in the same proceedings: [2017] EWHC 1585 (Fam) and [2017] EWHC 2036 (Fam). No appeal is stated.