THE family of a young Askeaton man who hanged himself in the acute psychiatric unit of University Hospital Limerick hope the lessons learned from the tragedy “will lead to the better care of others in the future”.
The HSE made 34 recommendations in the wake of a “comprehensive review” into the circumstances of the suicide of 20-year-old Gearoid Nash, who had bipolar disorder and a history of self-harming behaviour.
Jerry Twomey, solicitor for the Nash family, told an inquest this Wednesday of an incident that occurred a week before his admission to Unit 5B when emergency services had been called to Mr Nash’s city apartment after he had attempted to hang himself.
An open verdict was delivered at Limerick Coroner’s Court this Wednesday in relation to the death of Mr Nash on April 20, 2013.
The inquest heard that it was supper time in Unit 5B when Mr Nash had entered an unlocked dormitory bedroom and taken his own life.
Another patient had cried out “alarm, alarm” and had informed staff nurse Fiona O’Donoghue “there’s a man hanging in there”. Efforts to resuscitate Mr Nash were in vain and he was pronounced dead at 5.45pm.
Mr Nash, the inquest heard, had been admitted to the acute psychiatric unit on three prior occasions before he arrived with his sister on March 24, 2013, when he was admitted voluntarily.
Consultant psychiatrist Dr Seamus O’Flaherty, who was himself on holiday on the day of admission, said Mr Nash had presented on that date with psychotic thoughts.
Dr O’Flaherty said that during his last period in the unit, Gearoid Nash had been kept under “routine observation” and there was “no suggestion of suicidal ideation” in the days leading up to his death.
Mr Twomey put it to Dr O’Flaherty that when Gearoid Nash had been assessed by another doctor on admission on March 24, it was noted that he had suicidal ideation at that time.
But Dr O’Flaherty said his records “state unequivocally that there was no suicidal ideation or self-harm.
“On the admission notes, so far as I can make out, Gearoid had no suicidal impulse, intent or plan,” he said.
Mr Twomey said the admission notes he had suggested otherwise. They referred to a history of self-cutting and to the attempted hanging in Mr Nash’s apartment the week before.
Mr Twomey pointed to other references in the notes to Mr Nash’s history of deliberate self-harm and “concerns about intent to slash and suicidal ideation”.
“In circumstances where deliberate self-harm is recorded and where there were concerns about slashing and self-harm, can you stand over your claim in interpreting these notes that there was no risk of suicidal ideation or self-harm on admission,” Mr Twomey said.
Dr O’Flaherty replied that he had never said there was no risk, but that the risk of self-harm was chronic rather than acute.
He went on to say of bipolar disorder that “suicidal ideation can have fluctuations that come and go day by day, hour by hour and minute by minute; it is not something static”.
Mr Twomey also highlighted the family’s concerns over the fact that bedroom doors were unlocked when it was policy to lock them between 2.30pm and 5.30pm; over the adequacy of Mr Nash’s care plan and how it was reviewed and over the fact that he appeared to have no one key worker designated responsible for his care.
The HSE said it had conducted a “comprehensive review” of Mr Nash’s death and “a wide range of recommendations” had been made.
Chief among these was that “any hazard deemed to be of high risk requires immediate action to reduce or eliminate the risk and all employees must be provided with education and training relating to risk management policies and procedures”.
The HSE had also completed a written policy “on access to dormitory rooms on the unit and all staff must confirm in writing that they have read and understand this policy”.
Speaking on behalf of the family after the inquest, Mr Nash’s sister Edwina said “we are satisfied with the open verdict”.
“My brother Gearoid was very vulnerable on admission to the care of the HSE. We are very happy that as a result significant recommendations and changes have been identified and will be implemented in the future for patients like Gearoid. We are hopeful that the loss of our beautiful brother will lead to better care of others in the future,” she said.
Those coping with issues around mental health, depression, self-harm and suicide can contact the Samaritans (116 123), Console (1800 201 890) or Aware (1890 303 302).