This recent case concerned the care plans in place for an individual, AB, given the risk of her self-harming. Further points surrounding her capacity to access the internet and social media were also considered within the case, as well as her ability to access implements that could be used to inflict self-harm.
History:
In September 2022, a standard authorisation was granted by the Local Authority (Gloucestershire County Council) in respect of AB’s care and support arrangements within Placement A, following her reaching the age of 18.
The same was challenged by the Official Solicitor who, on behalf of AB, challenged several matters such as whether the mental capacity requirements had been met, whether the best interests requirements had been met, and asked the Court to consider the period during which the standard authorisation was to be in force and the conditions subject to which the standard authorisation was given. Observations were also made regarding the relevance of Article 2 European Convention on Human Rights, and a duty which had arisen for the Local Authority that would require them to take reasonable steps to provide protection to AB from a real and immediate risk to life.
A hearing was listed for 28 and 29 September 2022, and the parties and the Court had identified the issues for determination as follows: whether AB had capacity to access the internet, and if AB did lack capacity, what was in her best interests in this regard and was the best interests qualifying requirement met in respect of AB’s care and support arrangements.
Whilst preparing for the hearing, it was revealed that the AB was self-harming. AB was subject to significant levels of restraint when her self-harm was of concern to her care staff. There was an incident on 18 August 2022, whereby AB self-harmed by cutting her neck region. This resulted in a “Safe Self Harm Care Plan (Cutting)” being prepared by the care provider.
Hearing
On 28 September 2022, the Court heard evidence from a registered mental health nurse who had implemented the care plan and an independent expert, Dt Ty Glover.
On 29 September 2022, the Senior Judge attend upon AB via Microsoft Teams, and it was noted that AB expressed confusion about the “lack of consistency in how she was permitted to self-harm and when she was not, and a feeling that she was not properly supported whilst at the same time overly restricted.”
Following various pieces of evidence provided by several parties, it was agreed that a risk assessment, an immediate review of practices, and consideration in relation to whether tolerating a degree of self-harm from AB was clinically appropriate and in her best interests needed to be undertaken urgently.
The Official Solicitor stated that the practice in which the carers were able to implement their own care plans was “clinically, ethically and legally unsustainable”. Also, the Official Solicitor questioned the legality with regard to whether a self-harm arrangement could be authorised by way of a schedule one.
Following this, an applicant at the Local Authority submitted that a social worker would be appointed for AB urgently. In addition, it was noted that the Deprivation of Liberty Safeguards Assessor and best interests assessor were not aware of the support arrangements around restraining AB and wider support provisions in place.
It was discussed and considered between the parties whether AB’s care arrangements should revert to how they were previously or whether a new approach should be implemented. The Senior Judge invited the parties to consider a hybrid approach.
In relation to whether AB had capacity to access the internet and social media, it was put forward by the Official Solicitor and the other parties that in the particular circumstances of AB, it was unknown whether AN would be subject to self-harm videos and encouragement of the same.
Outcome
At the outcome of the hearing, it was ordered that the standard authorisation dated 26 September 2022 was terminated.
It was ordered and directed in the interim that:
- AB would reside in Placement A conforming to the arrangements set out by the Local Authority and under the care plans made in September 2022.
- AB’s access to social media and the internet may be restricted when in distress
- AB’s access to items in which she could use for self-harm would be limited in her best interests
- Any changes to make AB’s care plan more restrictive must be brought before the Court
- That the restrictions in place pursuant to the care plan in place for AB amounted to a deprivation of her liberty, authorised as being in her best interests and as necessary to prevent harm to her
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