The family of a Galway man say he was “let down” by the health service in the weeks leading up to his death in November 2021.
The remains of Stephen Cunningham (33) were discovered on April 9th this year close to a lake at Maam Cross in Galway, following a five-month search involving thousands of volunteers and rescue workers.
An inquest at Galway County Building on Friday heard that Mr Cunningham was diagnosed with schizophrenia in 2018 and suffered a serious psychotic episode on July 5th, 2021.
On that day he called his sister, Tara O’Loughlin, in a distraught state and said he believed she was being raped.
Ms O’Loughlin drove to Galway from her Dublin home in an effort to have Mr Cunningham admitted to the Acute Psychiatric Unit in Galway.
“He insisted that there was someone there beside me,” she told the inquest.
“He was adamant that I was being raped. I told him that I was all right and I convinced him to stay in his apartment until I got there.”
The inquest heard Mr Cunningham became increasingly distraught while waiting to be admitted to an overcrowded Emergency Department at Galway University Hospital.
During this time Mr Cunningham attempted to leave on a number of occasions but was convinced to stay by his sister.
After waiting for more than three hours to be seen, Mr Cunningham became convinced that his sister had been possessed by a devil and at one point grabbed her by the arm and attempted to grab her by the neck saying: “I won’t let the devil get you”.
Mr Cunningham was admitted to the Acute Psychiatric Unit and underwent treatment for a number of weeks. The inquest heard Mr Cunningham had a strong religious belief and a fascination with fasting and walking.
Speaking at Friday’s inquest, Consultant Psychiatrist, Doctor Leona Spellman, said Mr Cunningham was “feeling well” and had suffered “no recent bouts of psychosis” when he was discharged on August 3rd, 2021.
Speaking on behalf of Mr Cunningham’s family, solicitor Johan Verbruggen questioned Dr Spellman about the level of care received by Mr Cunningham after he was discharged on August 3rd.
He focused in particular on an assessment and care plan undertaken by Dr Spellman and her multidisciplinary team on August 6th. This assessment highlighted key warning signs that indicated Mr Cunningham was approaching a relapse, including disengaging from contact with the treatment service.
Mr Verbruggen said that several of these key warning signs were present in the two months between Mr Cunnigham’s discharge and when he was last seen on November 6th, and that the mental health team “did not follow its own plan”.
He requested that the Galway West Coroner, Ciaran McLoughlin, consider a finding of death by medical misadventure in the inquest and asked him to consider a number of recommendations including the introduction of a bespoke admissions section in emergency departments for people in acute psychiatric distress.
Returning an open verdict, Mr McLoughlin said that this was a “tragic case” and that the “sense of grief and loss in the room is palpable”.
Speaking after the inquest, Tara O’Loughlin said that her brother was an “intelligent, handsome, caring brother, nephew and friend” who was “let down” by the mental health service.
“What we heard today was frustrating – inconsistencies in the assessment of Stephen’s condition and issues, risks and warning signs being missed, and a plan of intervention not being implemented. This has all led us to where we are today,” she said.
“When Stephen needed help, the health service let him down. We all relied on help from the health service for Stephen.”
Mr Cunningham’s family extended their thanks to the thousands of volunteers who helped search for him in the five months between November last and April 2021.
“Without you we may have never found Steve and we would be facing another Christmas with more questions than answers,” they said.