Dual diagnosis protocols could have saved man (28), family believes

Seán O’Keeffe died of an overdose after ‘desperately’ seeking psychiatric help

A young Dublin man who died a year ago next week, while suffering with chronic addiction and mental illness, could be alive if health services had had protocols to respond to his needs, his family believes.

Seán O'Keeffe (28), from Glenageary, died of a heroin overdose on October 8th, 2018, having "desperately" sought psychiatric help in previous months. Every time he attended an emergency department, however, he was told he had to address his drug addiction before being assessed for psychiatric services.

Advocacy groups say his death is the latest of many among people with a “dual diagnosis” of addiction and mental illness turned away by health services that won’t treat these issues together.

Mr O'Keeffe's family will be supported by Mental Health Reform and Dual Diagnosis Ireland (DDI) at a vigil next week, calling for integrated mental health and addiction services in a dual diagnosis pathway protocol.


Ruth McCrudden, speaking on behalf of the family, says her younger brother was “really struggling” by age five.

“He would get really frustrated. He went through child mental health services but his needs were never adequately met. We know he was dyslexic and had autism but he never benefitted from a diagnosis.

“From his teens his anxiety was extreme and he was using cannabis from age 12. By his mid-teens, he had psychotic episodes. The drug use was really self-medication and when it got really serious he wasn’t able to manage. By his 20s he was using everything, anything he could get. He started using heroin about three years before he died.

“Seán was really clever, bright, witty, sharp and really charming. He was very loving and very loveable. But he wasn’t coping with his heroin addiction. He knew that,” says Ms McCrudden.

“He was attending a methadone clinic and really trying to access mental health services.

“About three months before he died I sat all night with Seán in A&E waiting for the on-call psychiatrist. The psychiatrist was compassionate but he was clear: ‘Addiction is the only conversation.’ Seán had to make the decision to stop, but Seán was too weak and too ill. He was dying.

She went to get help from a neighbour. They tried to resuscitate him; so did the ambulance men

“He left incredibly frustrated, fiercely fighting his corner yet being told: Yes, you’re desperate but within our system we can’t do anything. He just couldn’t find a pathway out.

“In his last months, he was very distressed a lot of the time – really crying, really sorry for the impact he was having, angry, frustrated and acknowledging the hopelessness of his situation. He knew he was deteriorating and in my last conversation with him, I feel he knew he was not going to get better.”

Discharged from hospital

In the 48 hours before he died he was in hospital twice – firstly for an infection and again following a psychotic episode – and was discharged at about 9am on October 8th.

His mother brought him home and he went to his room, says Ms McCrudden. When Ms O’Keeffe went to check on Seán she couldn’t fully open the door. “She went to get help from a neighbour. They tried to resuscitate him; so did the ambulance men, but he was dead.” A toxicology report indicated that there were toxic levels of heroin and painkillers in his bloodstream.

The HSE counts neither the numbers of people with dual diagnoses nor their deaths. Carol Moore, co-founder of DDI, says this data must be gathered.

A Health Research Board report, entitled "Treatment services for people with co-occurring substance use and mental health problems: a rapid realist synthesis", which was published last month, is clear on the need to integrate addiction and mental health services in a nationally consistent way.

It comes 15 years after a report, Management of Dual Diagnosis in Ireland, published by then minister of state for drugs Noel Ahern, concluded: "Clinically effective service models and treatment approaches need to be developed that fit the context of people in Ireland with dual diagnosis and Irish healthcare provision."

Minister of State at the Department of Health Catherine Byrne said her department was working to ensure those affected would "receive an assessment, an onward referral and timely access to appropriate treatment . . . The Department of Health has allocated funding of €1.5 million for dual diagnosis services in 2019."

There is "too much talk and no action", says Ms Moore. "The ongoing stigmatisation of drug users allows authorities not to prioritise their needs. They're just seen as junkies, as a problem, not as people."

Even with a dual diagnosis protocol across the HSE Seán may have died, says his family.

“But we would have loved if he had had the chance of living and at the very least for him to have felt a bit of dignity, hope and respect as a sufferer rather than feeling so judged and unworthy. We hope that as addicts and their often anti-social behaviour are more understood in the context of their debilitating mental health, society will become more compassionate towards these incredibly vulnerable people.”

The vigil for Seán and for anyone affected by the lack of dual diagnosis services will take place at 11.30am, October 9th, outside St Michael's Church, Marine Road, Dún Laoghaire, Co Dublin.

If you have been affected by anything in this article support services are available, including:

* HSE Drug and Alcohol Helpline, freephone 1800-459459, Monday to Friday 9.30am to 5.30pm

* Narcotics Anonymous, which holds more than 200 meetings a week across Ireland, can be contacted at na-ireland.org or on 01-6728000

* The Samaritans freephone service can be reached at 116-123, 24 hours a day

Kitty Holland

Kitty Holland

Kitty Holland is Social Affairs Correspondent of The Irish Times