It is "troubling beyond description" to the family of the late Jamie Costello that they still do not know how their son was allowed to leave unaccompanied from a mental health unit before taking his own life.
Lawyer for the Costello family, Damien Tansey SC, told an inquest into the death of Galway student, Jamie Costello (25) in Kilrush on Thursday that no one knows who authorised Mr Costello to leave the Galway unit unaccompanied on October 1st, 2019.
Mr Costello suffered from mental health issues and was a patient in the Acute Adult Mental Health Unit at University Hospital Galway.
The alarm was raised that voluntary patient at the unit, Jamie was missing at 4.25pm on October 1st when his mother, Denise arrived to collect him to bring him home for a few hours before his scheduled return to the unit.
Mrs Costello phoned her husband and Jamie’s father, Galway GP, Dr Alan Costello who in turn contacted gardaí. Dr Costello said that gardaí told him that a man was seen jumping off the Cliffs of Moher at 3.45pm that day.
At the inquest on Wednesday, Dr Costello of Ballinduff, Cornadulla said: "I knew that was my son."
HSE apology
In the High Court last December, the HSE issued an apology to the Costello family for the standard of care provided to their son as part of a High Court approved settlement and counsel for the State Claims Agency (SCA) and HSE, Luán ó Braonáin SC repeated the contents of the apology to the Costellos at the inquest on Wednesday.
Mr Tansey said that Jamie Costelloe left the unit unaccompanied the day before on September 30th for ‘a trial run' and his parents only became aware of this after his death.
Mr Tansey said that it is "troubling beyond description" to the Costello family that they still don’t know how their son was allowed to leave the unit unaccompanied.
He said: "We have all the statements and depositions and on two occasions Jamie is allowed to leave and no one knows how he left."
Mr Tansey said that there were four nurses on duty in the ward and there are statements from two security men from September 30th and October 1st that they contacted a nurse before Jamie leaving the unit on each occasion.
There are four possible people that could have authorised Jamie's departure - none of them tell you that they authorised it.
He said: "There are four possible people that could have authorised Jamie's departure - none of them tell you that they authorised it."
Mr Tansey said that Jamie’s mother, Denise told him that if Jamie’s absence had been noticed earlier on the day he could have been intercepted.
The inquest was told that Jamie was due to receive specialist treatment in London in November 2019 from the top specialist in the world in that particular field of mental health.
Jamie Costello was under the care of Consultant Psychiatrist, Dr Camilla Hennelly in Galway and Dr Hennelly told the inquest that it was re-iterated on the morning of October 1st at Jamie’s weekly care plan that he was only allowed out on accompanied leave.
Dr Costello said that his son attempted to take his own life with a planned overdose in April 2019 while he was intercepted on a bus en route to the Cliffs of Moher on June 20th, 2019.
Family
Dr Costello told the inquest: "Our family will never be complete again. No words can express how much we miss our beautiful son and brother Jamie."
Stating that Jamie was the sum of much more than his illness, Dr Costello described Jamie as "an intelligent boy who had a thirst for reading, learning, science and had such an infectious laugh and a wonderful sense of humour".
Dr Costello said that Jamie was the eldest of three boys and had suffered with his mental health since the age of 15.
Mr Tansey said that the inquest is the only public forum in which the Costellos will have the circumstances around "this unspeakable, horrible tragedy" ventilated.
He said the Costellos are concerned to get some answers because something tragic happened and "there was a break in the system and the function of that break is that Jamie is no more".
Dr Costello praised the care that Dr Hennelly provided to his son and under cross-examination from Mr Tansey, Dr Hennelly stated that after hearing of Jamie’s death, she went to the ward "and I demanded to know who let the patient out and I went to security as well and no one seemed to know".
Dr Hennelly agreed with Mr Tansey that it was unacceptable that there was no note detailing how Jamie was allowed leave.
Mr Tansey stated that one of the recommendations that the family would be seeking is an electronic communication system between the nurses and security men.
The HSE appointed a third party to carry out an external inquiry into Jamie Costello’s care. Mr Tansey said that a draft report has been completed but expressed frustration that the final report has not been made available as yet.
The inquest continues on Thursday.
If you have been affected by any of the issues raised in this article, you can freephone the Samaritans 24 hours a day for confidential support at 116 123 or email jo@samaritans.org.
You can also freephone the national Bereavement Support Line run by the HSE and Irish Hospice Foundation at 1800 80 70 77 (Monday-Friday 10am-1pm), and the contact information for a range of mental health supports is available at mentalhealthireland.ie/get-support/.
In the case of an emergency, or if you or someone you know is at risk of suicide or self-harm, dial 999/112.
