FD 24 P 00524 - [2025] EWHC 1030 (Fam)

Dr Ratnam’s report is dated 24 March 2025. Her report is based on a two hour video consultation with M on 21 February 2025 and access to the medical records provided by M. Those records are not complete. M provided a full run of her English medical records (20 or so pages) but only 10 pages of Irish medical records. These cover a period from May 2022 to summer 2024. There are no records predating May 2022 and the 10 pages provided are clearly incomplete. The most glaring deficiency being the records relating to the 5 days in May/June 2024 when M ‘self sectioned’. Dr Ratnam chased for a complete set of records but these were not supplied. It is most unfortunate that M failed to supply complete records to Dr Ratnam.

Dr Ratnam sets out M’s personal history. M described her childhood as ‘chaos’, largely due to her mother’s mental illness. Her parents separated when she was six. Her step father was also ‘a bit chaotic’ and M describes herself as being the adult in the house, caring for her siblings and attending to household responsibilities. For a period she lived with her grandmother. Her grandmother died when she was 14. After that she ‘went off the rails with drugs’. She was sexually abused by her maternal uncle for a long period. She was ‘kicked out’ of school aged 14.

M began consuming alcohol from the age of 12. In her 20s she was consuming it excessively. She started using heroin at age 15. She stopped when she fell pregnant with A. She started using cocaine in her 30s and last used it in April 2024. She says she was prescribed medication for five days to help her off cocaine. In cross examination Dr Ratnam said that no such prescription medicine exists. M began using cannabis when she was 13 years old and used it on and off until May 2024.

M’s first significant relationship was with A’s father. He left when A was about three months old. She says that he became violent and ‘very nasty’. M found parenting A difficult in the first weeks. Her second relationship was with B’s father. The relationship lasted 10 years. On separation, B’s father took B as M could not cope with two children. She then had a relationship with ES’s father which began in 2014 and lasted two years. That man had a ‘major cocaine addiction’ and was ‘mentally’ abusive towards M. She then began her relationship with F. M alleges that F was ‘mentally, physically, sexually’ abusive to her.

She told Dr Ratnam that she would not return to Ireland if DC is required to return.

Dr Ratnam records in detail M’s past psychiatric history. She explained that hearing F’s voice can lead to anxiety. She described the symptoms of her anxiety – she said her “heart is going, stomach doing flips, pins and needles in my face”, along with sweating. Anxiety “drains” her and can cause her to freeze. She described her depression and the symptoms of it including low mood, reduced motivation, reduced interest, reduced appetite, reduced sleep, reduced concentration, poor selfcare and suicidal thoughts.

She described her crisis in May 2024 when she had suicidal thoughts. She was subsequently admitted to hospital for seven days. At the time of the assessment M was taking Sertraline and talking therapies. She was to be referred for more therapy regarding PTSD.

Dr Ratnam’s opinion is in given a series of answers to questions raised in her letter of instruction. The first question is: what is M’s current psychiatric or psychological condition? Dr Ratnam considers that M fulfils the criteria for diagnoses of:

Dr Ratnam considered that M’s account was indicative of ADHD and that further assessment would be required for a diagnosis. She also noted that M did not fulfil the criteria for a personality disorder diagnosis.

The second question was: what would be the psychiatric or psychological impact on M of a return to Ireland? Dr Ratnam says it is likely that M’s mental health will deteriorate if she returns to Ireland. The implication of the answer is that such deterioration would appear to include a risk of suicidal ideation.

The third question was: what would be the psychiatric or psychological impact on M if DC was ordered to return to Ireland and she did not accompany him? Dr Ratnam says it is likely that M’s mental health will deteriorate if DC returns without her. However and importantly in these circumstances, Dr Ratnam said ‘I am of the view that any deterioration can be managed because she is in a location where she feels personally safer and settled.’ Thus, in those circumstances it is plain to me that the risk of suicidal ideation is much reduced.

The fourth question was: if DC was ordered to return to Ireland and M did not accompany him, what would be the impact, if any, on M’s ability to parent her other child, ES, and to support the person caring for DC in Ireland? Dr Ratnam was very clear that although issues might arise, with the support identified in the answer to the third question any deterioration can be managed.

The fifth question was: what treatment does M require? Dr Ratnam suggests continued use of prescribed anti-depressants, engaging with talking therapies and, once the proceedings are over, engaging with therapy for PTSD.

The sixth and final question was: what, if any, protective measures, such as psychological interventions, or any other measure, would be necessary to put in place to safeguard the effect on M’s mental health should DC be returned to Ireland? Dr Ratnam suggested that DC should have regular video contact with M during school term without F being present. She also recommended staying contact during school holidays, facilitation of contact in Ireland but avoiding contact between M and F or his family.

On 6 April 2025, M’s solicitors raised clarificatory questions about Dr Ratnam’s report. As a preface they drew to Dr Ratnam’s attention paragraphs 59 to 62 of Re B (A Child) [2024] EWCA Civ 1595. Those paragraphs dealt with the interpretation of Dr Ratnam’s evidence in that particular case. I harbour some reservations about the utility of directing experts to legal analysis of expert evidence in other cases but nothing turns on this.

There were four clarificatory questions. The first three related to part of Dr Ratnam’s answer to the second question, where Dr Ratnam stated ‘should M return to Ireland it is likely that her mental health would deteriorate’. Those three questions and the answers to them were as follows:

In addition, Dr Ratnam was asked to comment upon any historical and/or current potential triggers for a deterioration in M’s mental health. She explained that she had already outlined triggers for anxiety and PTSD. She stated that triggers for depression have included M’s childhood experiences and relationship experiences as an adult. She pointed out that M’s medical notes indicate that the relationship with F is a stress factor. She also identified the nature of her experiences with F’s family as alleged.

Dr Ratnam gave oral evidence and was cross examined by both parties. She explained that the increase in M’s prescription of Sertraline from 50mg to 100mg and then 150mg was not out of the ordinary. She explained that by the time of the video consultation M was not depressed. She was asked about the impact of a return to Ireland. She said at best M’s mental health would not improve and at worst it might decline with suicidal ideation.

Dr Ratnam was shown M’s written evidence in which she admitted taking cocaine in 2022. This was at odds with M’s assertion to Dr Ratnam that she had not taken cocaine since her late 30s. Dr Ratnam was unphased by this and at some point said it was not unusual for patients not to be entirely truthful. Voice recordings from November 2023 were played to Dr Ratnam. It was suggested to Dr Ratnam that these demonstrated that M could not be telling the truth about being triggered by communication with F. Dr Ratnam seemed very unphased by these recordings and clearly did not consider they altered her views in any way. I am not surprised. The recordings have not helped me.

Mr Jarman asked an important question which went to the question of degree of risk. I was sent an agreed transcript of the question and answer which is as follows (with my underlining):

This demonstrates that Dr Ratnam considers a return to Ireland represents a significant risk for M of deterioration in her mental health. Two points arise. First, Dr Ratnam was equally clear that staying in England in circumstances where DC returns to Ireland did not present such a risk – in those circumstances a deterioration was likely, but any such deterioration would be manageable. Second, M is adamant that she will not return to Ireland.