A 14-year-old autistic girl was unlawfully detained in hospital and restrained in front of scared young patients, a high court judge has found. On one occasion last month the teenager managed to break into a treatment room where a dying infant was receiving palliative care. She was restrained there by three security guards, Mr Justice MacDonald said in a judgment in the family court that ordered Manchester city council (MCC) to find the girl a suitable community care placement instead of what he described as the “brutal and abusive” and “manifestly unsuitable” hospital environment. Nurses witnessed the girl screaming “very loudly” and sounding “very scared” when repeatedly held down on her hospital bed so that she could not move her legs, arms or head, before being tranquillised. Other children on the ward were frightened to witness the frequent battles between the girl and security guards, the judge said. The girl, who cannot be named for legal reasons, was brought to hospital on 15 February by her distressed father, who said the family could no longer care for her. The court heard that his other children had begun locking themselves in their bedrooms for safety and that he and his wife had resorted to locking the girl in the dining room to stop her escaping. The judge noted that the teenager made “regular and determined” efforts to run away, sometimes using screwdrivers to try to unlock doors and windows, and running away from her family on walks. She was particularly vulnerable in the community, he said, because she lacked “any road sense or stranger danger and was previously found to have entered a stranger’s house and was found hiding in the bed”. He described the teenager as having an autistic spectrum disorder and a learning disability. She demonstrated “complex and extreme behaviour” that could not be controlled even within a school environment involving six adults to one child supervision, he added. Despite this, the council and NHS trust decided to have the girl be detained in hospital on a general paediatric ward “solely as a place of safety”, without applying for the necessary court order to do so, the judge found. She did not require any medical treatment, the judge said. After her admission, the local authority employed a private company to provide two security guards and two carers to supervise the girl. The firm was engaged on a five-day rolling contract, leading to a high turnover of staff watching the girl night and day, resulting in “her waking up to unfamiliar adults and being scared by that change, further adversely impacting on her behaviour and wellbeing”. She was unable to leave the locked ward, and the lock had been removed from her en suite bathroom door so that she had to keep it open even when using the toilet. She stayed there for a month. Ordering her release from hospital into local authority care, the judge said: “It does not take expert evidence for the court to understand the adverse impact of the current regime, with its uncertainty, its concentration on physical contact and its location in a loud and unfamiliar environment, on a child who is autistic and learning disabled. What this must be like for [her] is hard to contemplate.” In his judgment, MacDonald refused to grant a request from MCC for the local authority to remain anonymous. He criticised the council for failing to find her a suitable placement throughout the month she was unlawfully detained in hospital, accusing the council and unnamed NHS trust of having “comprehensively failed in this case”. After the hearing, MCC identified a bespoke, short-term placement for the girl and said it continued to search for a residential educational placement for her. A spokesperson for Manchester city council said: “We fully accept the judgment and its findings and together with the NHS trust are reviewing our role in this distressing case to make sure nothing like this can happen again. “All our staff involved in the care of this young person have been spoken to and action taken where it has been needed. Although staff from each of the partner organisations involved in the young person’s care sought throughout to make decisions in the best interests of the young person, we acknowledge that the situation which arose, exacerbated by the national shortage of suitable accommodation for children with complex needs, was deeply unsatisfactory.”