A teenager with a history of self-harm was repeatedly refused care by the HSE’s Child and Adolescent Mental Health Services in Ballymun in the months before she took her own life in August 2018, an inquest has heard.
A sitting of Dublin District Coroner’s Court heard evidence that the referral of the teenager, Tyann Lee, to Camhs in Ballymun from its counterpart service in Wicklow only arose because her foster family wanted to reduce the distance that she had to travel from her home in Santry to see a psychiatrist.
Tyann (14) had been receiving ongoing care from Camhs in areas other than Ballymun since the summer of 2017 after she had required four emergency admissions to Tallaght University Hospital over a period of seven months as a result of several incidents of self-harm.
However, the inquest was informed that Camhs in Ballymun ruled that Tyann had not met the criteria for accessing its services.
Tyann was found in an unresponsive state after trying to take her own life in the bathroom of the home of her foster family.
Paramedics were alerted to the scene but the teenager was formally pronounced dead a short time later on August 5th, 2018 after being brought to Children’s Health Ireland at Temple Street.
A consultant psychiatrist with Camhs in Ballymun, Farzana Sadiq, told the inquest that she had received a referral about Tyann from Camhs in Wicklow in January 2018 which she had not regarded as a request for transfer of care.
Dr Sadiq said she has asked the girl’s social worker to arrange a referral letter from her GP as she did not believe Tyann met the criteria for accessing Camhs services at the time.
The inquest heard Tyann’s GP, Dr Aliya Rahim, believed that the teenager warranted care from Camhs because she regarded her as “vulnerable” and she was receiving a large number of calls from different parties about her mental health.
However, Dr Sadiq said she had concluded that Tyann was not suffering from moderate to severe mental illness on the basis of the GP’s letter which she received in April 2018.
Evidence
She gave evidence that she had recommended to Tusla that the girl should contact her GP or other service providers like Pieta House.
Dr Sadiq said she still held the view that Tyann did not meet the criteria for receiving care from Camhs after being asked to review her decision by the girl’s social worker in July 2018.
“She had complex needs that were not necessarily ones that were going to be met by Camhs,” said Dr Sadiq.
The psychiatrist said she believed Tyann required “long-term psycho-therapeutic interventions.”
However, the coroner, Aisling Gannon, noted that various other healthcare professionals had all believed that Camhs was the appropriate service to provide care for the teenager.
Dr Sadiq denied that Tyann was being refused treatment but that further information was required and Camhs should be informed if there was any change in her mental health.
She claimed the girl was “at a different point” when she had attended Camhs in Wicklow but admitted that Tyann had not been personally assessed by Camhs in Ballymun.
However, Dr Sadiq said she had “no acute concerns at the time” about Tyann’s mental health as she was “relatively stable.”
Tyann’s foster parent, Pat Bellew, said: “We would not have asked for her to be moved if we thought she would not be seen by another [Camhs] service.”
Another of her foster parents, Brendan McCarthy, said Camhs had “passed oversight” of Tyann’s mental health back to her GP and social worker.
Mr McCarthy – who spoke on behalf of two of Tyann’s siblings, Chelsea and Jason, who attended the inquest – pointed out that there had been no issue when Tyann had earlier been transferred between Camhs in Kildare and Wicklow while moving foster homes.
Tyann’s foster mother at the time of her death, Linda Bellew, said the girl was originally only to be placed with her family for six weeks when she first arrived in October 2017 but she had stayed on as she had fitted in well and appeared settled.
Ms Bellew said she had agreed to foster Tyann until she was 18 so long as she attended school and that she had done very well in her Junior Certificate exams just two months before her death.
Her son, Carl Robinson also gave evidence that his foster sister “did not get the help she needed.”
Senior social worker with Tusla, Ciara Murphy, acknowledged that there were difficulties with the consistency of care provided to Tyann because she had frequently moved foster homes.
Ms Murphy said Camhs in Wicklow was asked but “could not do anything” after she was not accepted by Camhs in Ballymun as the teenager no longer lived in its catchment area.
She gave evidence that Tusla and the HSE were currently working together on developing a policy on how vulnerable children in the care of the state could access mental health services.
However, another Tusla social worker, Glenda McCormack admitted such discussions had been ongoing since 2014 but a protocol had been agreed in 2020 that allowed for joint meetings about complex cases.
The inquest heard Tyann, who had been placed in foster care since around the age of 9, had suffered childhood sexual abuse.
A consultant child and adolescent psychiatrist, Michelle Clifford, who treated Tyann at TUH, said she had assessed the girl as having “a complex reaction to significant childhood experiences” but had shown no signs of delusion or acute psychosis.
Dr Clifford said Tyann had recurring flashbacks of childhood trauma and regularly experienced voices in her head as well as having a history of self-harm.
Although Tyann had been seeking to change foster home in 2017, Dr Clifford recommended that she should remain with her foster mother at the time with whom she appeared to enjoy a good relationship.
'Delicate balance'
In reply to questions from the coroner, Dr Clifford acknowledged the decision was “a delicate balance” but believed the girl would come under the care of Camhs to receive the consistent therapeutic care on an ongoing basis that she had recommended on discharge from hospital.
The inquest heard evidence from witnesses which described Tyann as a “sporty, creative and very social” teenager who was “incredibly pleasant” who wanted to complete her education and dreamt of becoming a social worker so that she could help others.
She also loved GAA and basketball. However, she told one care provider that while she smiled on the outside, “inside there is a lot of pain.”
Garda Kevin Fenton said he was satisfied that Tyann’s death was an intentional, self-inflicted act carried out without any influence from a third party.
Ms Gannon advised the jury that it was “not appropriate to sit on the shoulders of people who provided care to Tyann” in reaching their decision.
Recommendations
The jury of four women and two men returned a narrative verdict based on the evidence.
It also issued a number of recommendations including that Camhs should evaluate its criteria for accepting transfers of patients moving between catchment areas.
Offering her sympathy to Tyann’s siblings and foster parents, the coroner said she would bring the recommendations to the attention of the appropriate authorities.
If you have been affected by any of the details in this article, please contact Samaritans on 116 123, Aware on 1800 804 848, Pieta House on 1800 247 247, Jigsaw on 1800 544 729 or text TALK to 50808
