Mentally ill woman indicates opposition to contraceptive implants

An application by the HSE for court orders permitting contraceptive implants to be administered to a mentally ill young woman has been adjourned for future consideration. The woman has indicated opposition to such implants, the court heard.

The woman’s first baby was delivered last month by Caesarean section, following court orders permitting that form of delivery due to her not engaging with doctors concerning her pregnancy. Because she does not, at this point, want contact with her baby, it has been placed in foster care.

Her treating doctors consider that pregnancy was "catastrophic" for her mental health, the president of the High Court, Mr Justice Peter Kelly, noted.

‘Very serious’

Her medical team also consider another pregnancy would mean “very serious” consequences for her mental health and, because of “life-threatening obstetric complications”, her physical health.

Because the woman is a ward of court found to lack the necessary capacity to make informed decisions about her welfare, Mr Justice Kelly must decide what is in her best interests.

On Monday, David Leahy BL, for the HSE, sought various orders, including permitting the woman's continued detention in a psychiatric facility, and, if necessary, for her restraint in line with procedures approved under the Mental Heath Acts.

As of now, there is no intention to use restraints but the treating team asked for them in the event the woman becomes a risk to herself and others, counsel said.

The HSE application for orders permitting contraceptive implants could be put back for reasons including that the woman appears to be expressing a contrary view and her court-appointed solicitor needed time to address the position, counsel said.

Counsel for the woman’s solicitor said the woman seems content where she is, but dissatisfied it was proposed to detain her until late July.

Because it is difficult to ascertain her views and the clear view of her treating psychiatrist is that she is still suffering from a mental disorder and is of unsound mind, the solicitor supports detention notwithstanding the concerns of the woman about its length, counsel said. The detention appeared to be improving her condition, she added.

‘Deeply unwell’

Continuing the detention orders, the judge said this was a “distressing” case and the woman is “deeply unwell”. While there was some improvement, her condition had “not improved all that much”, she has limited communication with her treating team, is restless on occasions and sometimes resists attempts to help her, he said.

She has indicated to her solicitor she is opposed to contraceptive implants, he was told.

The evidence of her treating team is that she does not have the necessary capacity to consent to sex and that oral or barrier contraception would not be effective in her case, he said. They wanted to be allowed, if and when necessary, to administer a three-month contraceptive implant. A contraceptive coil might also be a possibility.

He did not have to decide the contraceptive issues now as it was recommended the woman remains detained in the psychiatric facility until July. The issue will arise if her condition improves to the extent it is considered she should be permitted, as her team recommends, to visit her partner and relatives, he said.

Informed decisions

While it seems long-term contraception is indicated until the woman can make informed decisions concerning her fertility and it would be “highly unlikely” the court would order otherwise, that did not have to be decided now, he reiterated.

Described as physically frail and with a long history of mental illness, the woman was a victim of sexual abuse in the past. She was hospitalised earlier this year due to intensifying concerns about her physical and psychiatric state.

The court previously heard her responses to her pregnancy had been inconsistent and a consultant psychiatrist considered the deterioration in her mental condition attributable to the pregnancy.