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Documenting a suicide

A family’s struggle to get help for their clearly suicidal only child

This article is derived from diary extracts from Carole Murtagh, Jon-Paul Faulkner’s recollections and testimony of events to the inquest, and the official (redacted) medical file eventually released after Trevor Murtagh’s death. There is no reason to believe anyone involved in Trevor’s treatment behaved negligently or otherwise unprofessionally.

I was living up in Dublin. Trevor was at home in Louth. We were close cousins who had lived next door to each other our whole lives – he was my brother really, to be honest. Trevor, apart from my Mum, was the closest person in my life, he was my family. So, yeah, we were close.

I always thought Trevor was fine, he was honestly the most positive and encouraging person I had ever met, he seemed to have a philosophy on life that was all about living and having fun and loving. In all my life I never once heard Trevor say he disliked anyone, and that was the kind of person he was; it was the kind of person I aspired to be.

Whenever I felt down, I’d be really quiet; Trevor was the opposite: he could always talk ‘til the cows came home and was really outgoing. This made me think that Trevor was happy.

He had changed a little since he had had a bout of depression in 2011, just after he finished his Master’s in Psychology. His family and friends knew about it. He was still Trevor, positive and outgoing, but when we’d go socialising he would sometimes be more hyperactive than usual, talking non-stop, but still so, so much energy, so outgoing, clever, and apparently happy.

I got a phone call from his parents to say Trevor had been admitted to hospital. His friends had found a suicide note crumpled up in a basket and he had been hospitalised. I couldn’t believe it. It came as a complete shock. I had seen him the previous weekend, and he seemed ok, though not his usual cheerful self, certainly a bit quieter than usual. Trevor was admitted to hospital on 20 June 2014 and was discharged nine weeks later on 22 August.

It took me a long time to write this, mainly because we wanted to wait until Trevor’s inquest before telling our story, and that didn’t happen until 3 November 2015, but also because, going through in detail what happened to Trevor during his stay in hospital is so, so painful for me: I don’t want to remember him that way. I think of Trevor from the moment I wake up to when I lie in bed at night, but I try to remember the real Trevor, the happy one – of those memories I have so many. The perverse images of Trevor, once so full of life, lying in a coffin, these memories come to me and I struggle to push them away and think of happier times.

Trevor’s family, and particularly his Mum, Carole, struggled in vain to get help for her only child. We thought we were lucky that Trevor was actually admitted to a psychiatric hospital, but unfortunately we were not lucky with a minority of his healthcare professionals, including his head consultant. His mental health actually deteriorated during his stay in hospital.

When I came in to the hospital that evening of 20 June it broke my heart. It was surreal; Trevor wasn’t Trevor, he was manic, he was so distressed, he kept rubbing his fist against the side of his head, “there’s nothing, there’s nothing in here”, he was saying. “I’m nothing”. It didn’t make sense, Trevor thought he had nothing in his head, nothing to say, the guy could talk for two hours straight about most topics, he was an intelligent guy! He was also saying he had no friends, yet Trevor had such a huge number of friends, and they were ‘real’ friends, they all really loved him, and they were from all walks of life. Trevor was delusional. I tried to comfort him. “Trevor”, I said, “look, you’re going to get better, trust me, these doctors are the best in Europe, this is one of the best hospitals in Ireland, they’re going to find out what’s wrong with you and you’re going to get better, soon, trust me!”.

Trevor upon admission to hospital
Trevor upon admission to hospital

But I was wrong, and it didn’t take long to realise it.

The following day, 21 June, Trevor’s Mum Carole went in to see the head nurse on duty. The nurse told her to sit down. She then said that the consultant on call thought that Trevor was suffering from schizophrenia. Trevor’s Mum was alarmed: “What?”, she said. “It’s not as bad as it sounds”, said the nurse – “there’s medication that can control it, and depending on how things go, the medication might need to be changed”. However, the nurse said that the consultant on call couldn’t start Trevor on the medication until he was seen by the official consultant after the weekend.

I remember the wait for Monday as being so, so long. Trevor had nothing to do in this place, except endure his constant racing thoughts, and his tormented mind! Little did I know that Trevor would mostly be left on his own with nothing to do during the whole nine weeks he stayed in the hospital. His main treatment was a depression programme that lasted for two-and-a-half weeks, leaving six-and-a-half weeks with nothing to do! He would see a psychologist for an hour twice a week, and I assume his head consultant also once or twice weekly though I could only find five recordings of such a meeting in the medical files. He also saw an occupational therapist for cooking lessons, even though Trevor was a competent cook, three times, but that was it.

He was supposed to also receive Cognitive Behavioural Therapy as documented in his medical file but this never happened. Trevor had no structure to his day and, in his condition, structure would have been a necessity in order for his mind to recuperate. This lack of activity no doubt contributed to Trevor’s rapid deterioration.

At one point I wrote up a timetable for Trevor in order to provide some structure for him: wake up 9am, have shower and breakfast 9-9.30am, go to gym 9.30-10.30, listen to radio or music 10.30-11.30, read a book 11.30-12.30, have lunch 12.30-1.30, watch a documentary 1.30-2pm etc. It was ridiculous.

On the following Monday, 23 June, Trevor’s Mum rang up the hospital and found out from Trevor’s official team consultant that he had been diagnosed with deep depression. So it wasn’t schizophrenia after all!

However, Trevor continued to report no change in his condition. On 1 July, he started to see a psychologist for a one-hour session twice a week. The official, psychologist’s report documents, “no improvement in mood since admission” in almost all of the twelve entries detailing Trevor’s sessions. The phrase “no change” is consistently reported throughout Trevor’s medical report, including the day of Trevor’s discharge, 22 August, where it is stated that there is “no change to presentation. For discharge today post family meeting” [p158].

Source: Console
Source: Console

On 10 July Carole got talking to a registrar at the hospital. She was worried sick and frustrated that he’d been in there since 20 June, and the depression programme hadn’t started. She explained to him how Trevor was doing nothing all day, and how her niece and nephew had to make a timetable for Trevor because he had nothing to do. “It’s not up to them to make a programme, it’s up to the hospital”, she said to him. She also told him that the tablets he was on weren’t working. The registrar responded that they expected the tablets to start working in the next couple of days and that Trevor’s ‘Head Consultant’ had said, “if they worked three years ago, they’ll work again!”.

Trevor’s stress and agony continued and continued and the family were sick with worry. On 12 July Carole records in her diary how Trevor took a panic attack when they brought him home on weekend leave. But he was making an effort, he made dinner for everyone that day. But later that evening the family found Trevor searching on the internet, looking up articles about suicide and the afterlife.

This wasn’t the first time this had happened. I had caught Trevor looking this stuff up on a number of occasions, in the hospital. He was honest, he wouldn’t hide anything any more. He couldn’t, he just wanted to be better. He would tell you straight what he was looking up and he would continually talk about the afterlife.

This became more and more regular as time went on, until eventually, from probably about mid-July onwards, every day the family came to visit he’d be on the internet looking up suicide or afterlife articles on the internet on his own laptop or often right in front of reception, like a plea for someone to pay him attention, to take him seriously, and he constantly talked about how he wanted to die. Obviously we told staff about this constantly, but they didn’t seem to think it was anything to be concerned about. We asked Trevor’s head consultant what we should do when Trevor talked like this, to which he responded that we should, “just ignore it”.

On 16 July Carole records that they took Trevor out for something to eat in a pub near the hospital and Trevor was acting manically, he was standing in the middle of the pub, doing that thing where he was rubbing his head. It was horrific, he was trying to reach a friend on the phone but couldn’t get through. We were all worried sick, we didn’t know what to do.

Carole rang and rang the hospital but she could never get talking to Trevor’s head consultant. On 18 July she got through to a male nurse on Trevor’s team, who told Carole that, in his opinion, Trevor was not clinically depressed, and in fact had a personality disorder. This was for us in effect a third diagnosis. When Carole went into the hospital that evening she asked the nurse if there was a personality test scheduled for Trevor, and the nurse replied, “of course there is!”, but no test of any kind was ever carried out on Trevor. This same male nurse actually described Trevor in the medical report as “annoying”, “provocative”, and while Trevor was “still insisting that ‘nothing has been done for him since he came in’”, this nurse “didn’t rise to the bait” [page 143].

Source: Samaritans Suicide Statistics Report 2015
Source: Samaritans Suicide Statistics Report 2015

I knew Trevor was serious. To me it was impossible not to know, just looking into his eyes you’d see the torment. His behaviour was a lot of things, but was certainly in no way “annoying”, if anyone had an ounce of empathy in their body they could see that. On 25 July there was a family meeting with Trevor’s head consultant (one of three over Trevor’s nine-week stay). At this meeting the family told Trevor’s head consultant explicitly what he was doing, how he was looking up articles on suicide and life after death, to which his consultant simply replied, “Trevor, you have to stop doing that!”.

The indifferent manner in which this was said stunned the family. And that was the end of that.

However, later at the inquest, when this consultant was asked whether he had been aware that Trevor had been looking up articles about suicide and the afterlife, his consultant replied that he had not been aware.

Then he was asked whether Trevor’s treatment would have changed if he had been aware of this, to which he replied: “Yes of course his treatment would have changed”. Inconveniently, the evidence of Trevor’s behaviour is documented by his psychologist in the official file from the hospital, and the consultant must be deemed to have had knowledge of the contents of the file. In the end the inquest report made nothing of this, and the verdict was simply death by suicide and hanging.

On page 138 of the medical file, Trevor’s psychologist reports that on 25 July Trevor “describes fleeting thoughts of harming himself (cutting) at the weekend”, and [on page 147] she documents that on 7 August Trevor “reported that he is continuing to investigate information about the afterlife as it seems as if this is the only escape from his distress”. There are numerous references in her reports, and indeed those of others, to Trevor’s suicidal ideation. On page 127 a registrar notes, “he sometimes reads articles about suicide and the afterlife”.

This behaviour continued, and Trevor went on to feed his obsession with suicide within a mental health facility, while the staff were fully aware of what he was doing. They let it continue. They were letting Trevor die right before our eyes.
In despair Carole called Trevor’s old educational psychologist, who had diagnosed dyslexia years earlier, wondering if he had Attention Deficit Disorder (ADD). The psychologist asked what were his symptoms and Carole called them out:
1. Cannot focus for any length of time
2. Will commence several tasks – but never finishes any
3. Disorganisation
4. Forgetfulness
5. Chronic lateness
6. Losing items, e.g. Wallets, driving licence, documents, money
7. Impulsive buying
8. Not being able to manage finances
9. Driving accidents – numerous fines – forgetting to put money into parking meters
10. Envious of peers’ achievements
11. Hyperactivity when socialising.

“That sounds like classic ADD”, said the psychologist. The family had already broached the matter of getting Trevor tested for ADD with the staff at the hospital on countless occasions but they had said that he couldn’t be tested because he was depressed. In any case, no tests were ever carried out on Trevor, no personality tests, nothing, despite Trevor’s condition not improving.

This list of symptoms was emailed to Trevor’s head consultant.
At the next family meeting, Trevor’s Mum asked had the head consultant seen her e-mail about Trevor’s symptoms, to which he replied: “Please enlighten me!”. He said Trevor’s psychologist would be interested in those symptoms and that was the end of that. His head consultant said that Trevor, “didn’t have ADD because it would have been picked up as a child”. Trevor’s team continued to refuse to admit that Trevor might be suffering from an alternative condition, and his treatment remained unchanged.

Trevor’s Mum rang his team psychologist, and the psychologist actually admitted to his mother that the symptoms sounded like ADD, and said that in her opinion Trevor wasn’t depressed. She told Carole that they couldn’t test Trevor for ADD because he was being treated for depression, in other words, she couldn’t go against the consultant’s decision, and so Trevor was left to continue his treatment that wasn’t working. Trevor wasn’t depressed but couldn’t be tested for ADD because he was…depressed!

She then recommended another psychologist outside the hospital to test Trevor and she gave Carole his number. A date was arranged for 24 September.

In desperation and, while keenly aware of the hierarchies in the hospital and the dangers of anecdotal diagnoses, on 13 August Trevor’s Mum ended up talking to a nurse in the hospital – one who wasn’t on Trevor’s team. At this time Trevor’s consultant was on holiday.

The nurse told Carole that in her opinion the programme hadn’t worked because Trevor wasn’t depressed. The nurse said things were desperate with Trevor, and that she should get a second opinion. She told Trevor’s Mum that the tablets he was on could be making his condition worse and that she should make sure to get Trevor away from his head consultant. The nurse said that if Trevor had been with the consultant psychiatrist on her team, they would have realised he had been on the same medication for seven weeks with no improvement, and they would have changed Trevor’s treatment.

While Trevor’s Mum was talking to this nurse there was a knock on the door. It was another nurse looking for Trevor’s file for the registrar consultant on duty while Trevor’s consultant was on holidays. The nurse talking to Trevor’s Mum said: “Hold on Carole, I want a word with the registrar”, and she took the file herself and left the room.

After a while the nurse came back, she told Trevor’s Mum that the registrar hadn’t a clue what was wrong with Trevor but that it wasn’t depression, and the registrar said that she would put it on his records that a personality test should be done as soon as possible. The redacted file makes no mention of doing the personality test, however, and no personality test on Trevor was ever carried out.

The nurse asked Carole to ring her on Saturday 16 August at 7pm, and she would be able to tell Carole when his personality test would be performed. Carole remembers going into Trevor’s room, Trevor’s Dad Séamie was there too. She took hold of his hands, and she said: “Trev, with every breath I have left I promise that I will find out what is wrong”. Trevor said: “Do you promise Mom?”. Carole replied that the nurse she was talking to had said that the tablets he was on might be making things worse but we’d soon get to the bottom of it! Trevor became hopeful again. Trevor then decided to go home with his parents and they went for something to eat. Trevor was a bit like his normal self again, apparently happy that maybe things were turning for him.

Carole rang the nurse at 7pm as requested. The nurse had told her not to say who she was but just to say that she wanted to talk to her, Carole wasn’t supposed to be talking with a nurse outside Trevor’s team at all. The nurse went into another room; Carole could tell she was switching phones. She said to Carole that she couldn’t understand this, she had looked at his file as she knew Carole would be calling back but there was nothing about a personality test being carried out. In the end all she advised was to get a second opinion.

On 18 August Carole decided it was time to confront Trevor’s consultant. She went to the hospital and told the staff that she wasn’t leaving until she had seen him. Carole went down to where the man saw his patients and asked him could she just speak to him for five minutes; he simply said no and walked away.

Carole had been advised by a friend that consultants in such a situation are obligated to attend to family members in distress. Carole said to him: “Are you refusing to see me?”, to which he replied: “Pardon?”. She repeated: “Are you refusing to see me?” and he said: “Yes, I am. I will see you on Friday at the family meeting”. “Friday is no good, I want to see you now!”, Carole said. The consultant ignored her and walked away.

Carole was so frustrated and angry that this man couldn’t even give her five minutes of his time. She went down to the nurses’ station and she cried and cried. The nurse who was there apologised generously. Trevor came out of his room with tissues and gave her a hug. “Don’t be crying mom”, he said. “I never want to see that man again”, Carole said.

A nurse recommended we file a complaint with the complaints officer who was thoroughly professional and advised that we change Trevor’s head consultant by terminating him and readmitting Trevor under a new head consultant. Though unusual, she felt this would not be a problem in this particular case. She undertook to, and subsequently did, raise the matter with the director urgently. We thought about talking to the hospital’s director who was respected and who, in fairness, was generally available, but he wasn’t immediately available. In the end the director undertook to get a second opinion and, as I understand it, reprimanded the head consultant.

We did get a second opinion for Trevor. On 19 August Carole received a phone call to say that Trevor was being transferred to another consultant. “But he can’t be”, Carole said. She had previously been told that the second opinion wasn’t due until the next day, but Carole was reassured, “if you want you can ring [Trevor’s consultant’s] secretary because it’s being signed as we speak”.

Trevor’s Mum couldn’t believe it. “Is it really the truth?”, she asked. The answer was yes. “Personally speaking”, the nurse said, “I don’t think [the doctor] will keep [Trevor] in, he will see him as an outpatient, but if he does he will have to change the medication and he will keep him in for a week if at all”.

Carole was so delighted, she thanked her very much and immediately phoned Trevor, and Trevor was over the moon as well. That evening myself and my friend went into Trevor and we took him out for a pint – it was a beautiful sunny evening, and we sat outside having a pint by the canal.

Trevor was relaxed, more relaxed than in seemed like an eternity, he was quiet for a while, letting myself and my friend talk, listening, but then all of a sudden he started talking and telling us some stories, it was great to hear him talk about something that wasn’t his condition and how his mind was.
Maybe, just maybe, Trevor was getting better I thought. This is my last memory of Trevor, not happy, but at least with a certain peace, and I will treasure the memory forever.

Our happiness was short-lived. Trevor rang his Mum at 3pm the next day to tell her that the new consultant wasn’t taking him on. We were heart-broken yet again. Although the second opinion disagreed with the diagnosis that he was depressed, nevertheless the psychiatrist would not take Trevor on!

The notes reported that the psychiatrist determined that:
“The extent of biological depression [was] unclear… a 2nd opinion was sought on Trevor’s case due to poor response to medical and behavioural intervention.

The conclusion was that Trevor presents mostly maladaptive personality traits with secondary dystiomya but no evidence of biological depression at time of assessment” [page 50].
Nevertheless, the second opinion also, “noted the extensive inputs to TM’s care plan and the plan of care following discharge”. These two statements seem contradictory to me.
On 21 August Trevor was worse than ever, I think he had finally given up all hope of recovery, the medical notes record on that day that there is: “No change to note. Continues to feel there is no difference since admission” [p158].

Trevor was to be discharged the next day. At the discharge meeting Carole sat down with her eyes to the ground and said nothing, she didn’t want to have anything to do with Trevor’s consultant, she had booked Trevor in to a clinical psychologist as soon as there was an available time, which was to be 24 September – to finally find out what was really wrong with Trevor.

During the meeting Trevor’s consultant said that Trevor’s mood had improved and he was “great”! Trevor disagreed and said there hadn’t been any improvement since his admission. A nurse then said: “Come on now Trevor, you have improved”, despite no record in the medical files or from Trevor or his family to suggest this.

It was discussed that Trevor was to continue to see his consultant as an outpatient, but Carole had no intention of ever letting her son near this man again.

On the date of discharge, Trevor’s medical notes record, “no change to presentation” [p158], yet Trevor’s consultant records on the very same day, the day of discharge, that, “Trevor notes an improvement in mood and is happy with discharge” [p 158].

The final thing that Trevor’s consultant said was to query who would be Trevor’s outpatient psychologist in his locality of Dundalk. Carole responded “Oh it’s Francis McGivern”. Trevor’s consultant said enthusiastically: “She’s wonderful!”. Trevor’s mother looked up for the first time during the entire meeting and said: “She is a he”. Trevor’s consultant said nothing. A small thing, but a perfect example.

Trevor’s appointment to see the clinical psychologist was for 24 September. It was too late. Trevor had died by suicide the evening before.

It was the day after his 29th birthday.


Editor’s note: Trevor interned in Village for a period in 2013. He is sadly missed.

Readers who are affected by the events and issues described in this article should consider calling the Samaritans on 116123 or 018727700