Time to address “silent crisis” of finding safe placements for children with profound needs long overdue, says judge

The High Court has ruled that a vulnerable teenage girl should be moved from hospital to her local authority’s proposed placement in an unregistered placement “as a matter of urgency”, under a high degree of restriction to keep her safe.

In X, Re (Child: Deprivation of Liberty: Lack of Placement) [2023] EWHC 3416 (Fam), HHJ Moradifar, sitting as a High Court judge, warned that the girl, referred to as X, was “not alone in her experiences of a system that is not equipped to meet her needs”, adding that she was “one of many children who are the subject of similar applications before this court”.

He said: “There is a common thread that binds these children. They do not easily fit the criteria of established services. These children and the adults supporting them face a gargantuan and at times an insurmountable challenge to finding a safe placement that can cater for their needs. A suitable and stable placement is key to meeting their therapeutic, educational, emotional and educational needs. Without a suitable placement, they are usually lost in the ever increasing gaps between services that are provided through different public bodies.

“Invariably, these children are in their teens with professionals being presented with the last opportunity to assess, identify and address their profound needs so that they have a reasonable prospect of entering adulthood with a glimmer of hope and optimism. Sadly, the significant challenges in providing these children with appropriate placements and services, will contribute to making their future prospects ever more uncertain and raising the likelihood that they will require continuing professional support as adults.”

At the time of the hearing, X was living in a hospital room, under the constant supervision of three professionals.

In October 2023, X had arrived at the Accident and Emergency Department of the hospital in handcuffs and she was admitted under s. 2 of the Mental Health Act 1983 for a period of assessment.

The period of assessment ended the next month, during which time X's behaviour was a “profound cause for concern necessitating her seclusion, restraint and sedation”, said the judge.

Due to a lack of suitable placements, X continued to reside in a separate room at the hospital. The hospital trust applied for authorisation by the court to permit it to deprive X of her liberty.

HHJ Moradifar said: “The local authority has conducted an exhaustive search of over two hundred registered placements and it has been unable to identify a single placement that is willing to accept or suited to accommodate X. Consequently, the local authority now plans to place X in an unregistered placement pending an application to Ofsted for the placement to become registered.”

The local authority sought the court's authorisation to deprive X of her liberty, once at the new placement, by locking the doors and windows, not allowing her to leave the placement alone, or to be in the community unaccompanied, to be supervised by three adults and to use physical restraint when her safety demands it.

The judge noted there could be “no doubt” that the restrictions already placed on X constituted a clear deprivation of her liberty.

He said: “Her circumstances clearly meet the 'acid test' as she is confined to her room and under constant supervision by three adult professionals.

“X does not and cannot give consent to these arrangements as she does not have the capacity to do so and the confinement is clearly imputed to the State in the form of the Trust and the local authority who seek the court's authorisation. Therefore, I must conclude that the current arrangements and the proposed arrangements for X's transfer and residence in her new placement meet the acid test and that she is and will be deprived of her liberty.”

The judge agreed that X could not continue to live in the hospital. He said: “The local authority has now identified a placement that can be tailored to meet X's needs. The placement is not registered with Ofsted, but urgent appropriate applications are being made to address this in accordance with the President of the Family Division's Guidance of 2019 and its 2020 addendum.”

He noted that given the limited available options, the condition of "imperative considerations of necessity" was “entirely satisfied”.

HHJ Moradifar said that for the duration of X’s stay in the hospital, there was “no option but to approve the continuation of the existing restrictive regime that has already been approved by the court to ensure her safety”.

He continued: “Once at the new placement, X will require a high degree of restriction and support to keep her safe and the permissive measures that are sought by the local authority are entirely proportionate which currently present the least restrictive measures that would keep X safe.”

HHJ Moradifar said he was “most grateful” to the Trust for its efforts to keep X safe despite the significant challenges that this had presented to the trust. “I am also grateful to the local authority that through a significant concerted effort of the social work team and other professionals, has identified a placement that is far more suitable for X. I note the significant number of hours and resources that have been employed to achieve this in a very short time which stands as testament to the commitment of the professionals involved who have worked tirelessly above and beyond that which may be normally expected of them.”

The judge said the impact of concerns about the system was not limited to the children themselves but permeated through their immediate family that can include their siblings and other close family members.

“Furthermore, there is a significant impact on the front line professionals who are often not trained to deal with these children's specific needs and presentation. In the instant case, the nurses involved have been fearful for their safety. They have become anxious, emotional and suffered with stress. Such has been the impact on them that through its in-house psychologist team, the Trust has provided them with break out and debriefing sessions,” he said, adding that X's behaviour had also impacted other patients.

HHJ Moradifar said: “None of this is X's fault. She and many children like her require access to suitable placements. The time to address this silent crisis is long overdue and requires urgent attention.”

Lottie Winson