The son of an man who died by suicide after he left a major psychiatric hospital unaccompanied said the family had “always slept well” when his father was there, “thinking he was safe”.
Dublin District Coroner's Court heard on Friday that Brian Arrigan (77), a retired Garda from Ballinteer, Dublin 16, had been a voluntary in-patient in St Patrick's University Hospital Dublin on May 20th, 2018.
The inquest heard he told nursing staff his son, Paul Arrigan, was waiting downstairs to bring him out for "accompanied leave", when in fact he was not. His son found him later that night.
Professor Declan McLoughlin, research professor of psychiatry at St Patrick's, who treated Mr Arrigan, told Coroner Dr Myra Cullinane that Mr Arrigan had made a serious suicide attempt in 2017. His depression, dating back 27 years, had become "treatment resistant".
Mr Arrigan was admitted on May 2nd, 2018 to undergo a course of electro-convulsive treatment (ECT) - a step taken when all pharmacological treatments have been exhausted, said Prof McLoughlin.
Initially, on admission, he could not leave the ward. By Thursday May 17th, however, he “seemed brighter and more reactive” and it was agreed he could have five hours’ accompanied leave at the weekend.
Mr Arrigan’s son collected him from the ward on Saturday May 19th.
“He was ok, a bit anxious. We would have gone for a stroll in Marlay Park…and we went to his house and cut the grass,” Paul Arrigan said. They spent most of the rest of the day at his family’s home nearby.
“I brought him back to St Patrick’s at about 7.45pm. I dropped him to the ward and let the staff know he was there.”
Marie Lawlor, a nurse on duty the following day, said Mr Arrigan had asked her for a 'green slip' to leave and said Paul was downstairs.
She gave him the ‘green slip’. She did not see him leave, however, or whether he was with his son. She advised the night shift Mr Arrigan was due back “at approximately 8pm”.
Paul Arrigan got a call from the hospital around 11pm “asking when we were going to drop him back in. That was the first we knew he wasn’t there…I said: ‘How could you lose him?’”
He went to his father’s house. “The first thing I saw was his coat and hat…I thought, ‘He’s home’...I expected him see him sitting on the chair watching TV - hoping rather than expecting. I had a quick look in the kitchen and then I went upstairs. That when I found him.”
The hospital’s policy on accompanied leave was cited. Dated 2017, it states that before a patient goes on such leave, the terms should be reviewed “with the person designated to accompany”, and the time, date and “if they were accompanied and by whom” should be recorded.
Prof McLoughlin agreed this had not been adhered to but added Mr Arrigan was not detained under the Mental Health Act 2001. “He was secure but not incarcerated.”
Dr Cullinane, returning a verdict of suicide, added a recommendation that: “The agreed therapeutic leave policy must be fully and robustly implemented in particular in relation to accompanied leave to include completion of the use of the Mental Health Act 2001 Section 26 form and ensuring that the patient is in fact accompanied at the time of leave.”
Speaking after the inquest, Paul Arrigan, accompanied by his wife Fiona and daughter Ellen, welcomed the recommendation. “There was only myself and himself. My brother died when he was 15 and my mam had passed away before that. So we were very close. We bounced off each other. I was always worried about him. When he was in the hospital we always slept well thinking he was safe there.”
