Andrew McGinley: People are dead who might be alive if families had been involved in their treatment
‘Not one clinician has spoken to me about the life Deirdre shared. Who could have provided them with more detail than me; the person sharing that life, sharing a house, sharing parenthood?’
Andrew McGinley with his three children Conor (aged 9), Darragh (7) and Carla (3) McGinley, whose bodies were discovered at the family home in Newcastle, Co Dublin on January 24th last year. Photograph: Supplied byAndrew McGinely through the Garda
During the trial that led to my wife, Deirdre, being found not guilty by reason of insanity for the murder of our three children, many details of her psychiatric care and treatment came to light to us for the first time.
Looking at each new piece of information that emerged we – her family – thought through the logical steps that we would have taken at the time had we been aware of these details. In every scenario we believe the outcome would have been different and, in each case, there is an increased probability that Conor, Darragh and Carla would be alive today.
Many people have written to me in recent days stating the same thing in relation to their own tragic cases. Lost lives – and many of them.
According to William Flannery, president of the College of Psychiatrists of Ireland (Opinion, June 2nd), the majority of its members are of the view that the involvement of family members should be encouraged in the treatment of someone with a mental illness. This is indeed what is in the recommendations of the Mental Health Act. Recommendation 134 states: “Where it is deemed appropriate, there should be proactive encouragement for the patient at all stages to involve his/her family/carer and or/chosen advocate in the admission process and in the development of the care and treatment plan with the patient’s consent.”
Dr Flannery has argued that family involvement cannot be made mandatory. While I agree with him in principle, it is clear the current approach adopted to involving families cannot remain in place either.
According to Dr Flannery, the college strongly supports family education and involvement in a patient’s care, where both parties are happy with that involvement. Such support is welcome but worthless if there is no proactive encouragement of a patient to involve their family in their treatment plan. Proactive encouragement is encouragement at every single meeting, at every single opportunity.
There will always be difficult circumstances in every family and not all may be as supportive as the family group that surrounded Deirdre. But no clinician will know that if they don’t engage with both the patient and the family. As I write this, not one clinician has spoken to me about the life Deirdre shared. Who could have provided them with more detail than me; the person sharing that life, sharing a house, sharing parenthood?
This mine of information, which could have assisted with Deirdre’s treatment and care, was never tapped into. This could have served only to assist the clinicians treating Deirdre’s illness. Doing so would have required me to breach the confidentiality of our relationship, which I would have done with the view that it could only be of assistance in Deirdre’s return to health.
I am not comfortable with a single death occurring when I know there is a greater possibility of avoiding deaths through an inclusive approach
Dr Flannery makes the point that if family involvement was mandatory, it might deter some people who need support from seeking it out.
I have a problem with the use of the word “might”. As things stand, we know that people are dead who might be alive if families had been involved in the treatment of a psychiatric illness. We do not know about patients who might be deterred from seeking support. That is the hard truth.
I am not comfortable with a single death occurring when I know there is a greater possibility of avoiding deaths through an inclusive approach. I do not feel that “long-established customs and practices” cannot be challenged – and this is a practice that needs such a challenge. Currently there are actual deaths happening versus an argument of possible deterred patients. Statistics for actual deaths on one side of the argument. No actual data that I can find on the other side. If the college has other evidence, it should provide it.
The challenge for the College of Psychiatrists is to now find a balance between these two arguments. The solution has to be mandatory and adhered to by all clinicians at all stages throughout the treatment plan. The mental health treatment plan for the patient has to be the responsibility of the clinician. With responsibility comes accountability.
I would prefer to have collective responsibility for the treatment of a loved one and to be accountable in part for their successful recovery. Collective responsibility is collective accountability. If unsuccessful, then it is a collective burden and not a case of distraught families desperately seeking answers. I, for one, am distraught. I also have many, many questions. I, for one, would have carried more than my share of collective accountability had I been included.
It is very much in the interest of the college to find a solution. Mental health illness is by definition an illness of the mind. Is there not a concern for psychiatrists that every response and decision by the patient might be impacted by the illness? If there is no family involvement to provide context, the responses and decisions made by an ill mind are the only source of information for clinicians.
My hope is that the deaths of Conor, Darragh and Carla are the last which can be in some way attributed to a lack of inclusion for the treatment of a mental health patient
I have addressed the issue of patient confidentiality in a number of interviews. No matter what the condition or disease, every patient has a right to keep that information confidential.
However, if a clinician checked in with the family or advocate after every appointment with the patient to see what the patient had told them, it could provide a solution.
The clinician could ask the advocate or family member what the patient had told them when they got home. If the clinician was of the opinion that the patient was not relaying important information – information that was in the patient’s best interest for the partner to be aware of – then a quick and simple follow-up with family could only benefit all parties.
My hope is that the deaths of Conor, Darragh and Carla are the last which can be in some way attributed to a lack of inclusion for the treatment of a mental health patient. Treatment has to focus as much on that as the welfare of the patient and I hope the college will find a way to get the balance right so as to save lives. At present it does not.
Andrew McGinley’s wife, Deirdre Morley, was found not guilty last month by reason of insanity of the murder of their children Conor, Darragh and Carla.