A 16-year-old Newfoundland girl who compulsively ingests sharp metal objects is cowering under high security at a St. John's hospital as staff wage a desperate battle to save her from herself.
A short distance away, a courtroom battle over the girl's competency to refuse treatment commences this morning - a hearing that psychiatrists predict could transform the way mentally ill patients are committed for forced treatment.
The unusual hearing was launched six weeks ago, after a judge ordered that the girl be prevented from leaving St. John's Waterford Hospital.
Over the past two years, she had been confined and treated 49 times for swallowing objects ranging from razor blades to a bread knife and a metal protractor. On nine occasions, she underwent surgery to remove objects, causing doctors to recently warn that she may not survive another operation.
John Bradford, associate chief of forensic psychiatry at Royal Ottawa Hospital, predicted yesterday that the case will lead to psychiatrists losing their broad discretion to refuse to certify involuntary patients as incompetent on the basis that they do not suffer from a major mental illness. This effectively means that the patients are competent to make their own treatment decisions.
He said too many psychiatrists "manipulate" diagnostic criteria in order to duck tough cases that involve self-injuring youths. "Psychiatrists see this as a kind of nightmare of management," Dr. Bradford said in an interview. "They try to avoid having to deal with those patients."
He said that psychiatrists who want to release patients into the community typically find that they do not suffer from a designated major mental illness.
At today's court hearing, lawyer David C. Day - who was appointed by the court to represent the girl's interests - is expected to present two psychiatric assessments of her competency.
Kenny Handelman, a child psychiatrist at the Oakville Trafalgar Memorial Hospital near Toronto, said it's extremely rare for a competency case to make it into the court system.
He said that a natural friction point commonly develops when mentally troubled youths reach an age - often 16, although it varies from province to province - at which the law considers them competent to make their own treatment decisions.
"It comes down to this little dance," he said. "Parents say that you have to go and get help, but the teenager says: 'I don't think there's anything wrong and I don't want to get help.' "
Since being forcibly confined, the Newfoundland teen has refused books, music or any other form of stimulation. Despite being under constant surveillance, she is so determined to ingest sharp objects that she managed to obtain and swallow a safety pin shortly before Christmas.
"We have got to protect this young lady," said Robert Buckingham, a lawyer representing her mother. "She is wallowing away in despair at the Waterford. This is an urgent situation."
Mr. Buckingham criticized hospital authorities for certifying and then decertifying the girl numerous times prior to her turning 16: "She would harm herself within hours of being out," he said.
"We are going to get proper psychiatric treatment for this lady if we have to fight every single psychiatrist in this province," Mr. Buckingham said. "It is an important case for her, and raises significant legal issues nationally. In my view, there are more kids in the system falling through the cracks than is public."
Should Newfoundland Supreme Court Judge Richard Leblanc decide to designate the girl as incompetent, he can potentially appoint a guardian - likely the girl's mother - to make treatment decisions on her behalf.