A woman who suffered catastrophic, life-long injuries after her son attempted to murder her has hit out at "inadequate" community health services that she said are unable to deal with complex mental illness.
Mary Coughlan almost died when her son Gearoid, who has been diagnosed with schizophrenia, beat her and repeatedly stabbed her.
She has previously said that she was unaware of the risk her son posed to her and her family prior to the near-fatal assault.
The Central Criminal Court heard that Gearoid Coughlan is deemed by the probation service to be at a high risk of reoffending in a community setting.
Speaking outside court on Monday after Gearoid was sentenced to 10 years in prison, Ms Coughlan said: "Unfortunately the mental health services in Ireland are inadequate to care for complex mental illnesses in the community."
She said schizophrenia has "robbed my son of so much and caused untold sadness in our family."
"We hope that all families in a similar situation get their required help before it becomes too late," she added.
Last December, Coughlan (32), of Ballycoughlan, Inishannon, Co Cork, pleaded guilty to attempting to murder his mother Mary Coughlan on June 4th, 2021, at her home in Ballycoughlan.
When he finishes his 10-year sentence, Coughlan will undergo six years of supervision by probation and psychiatric services.
Passing sentence at the Central Criminal Court on Monday, Mr Justice Paul McDermott said Coughlan will require further treatment before he can safely be reintroduced into society.
Mr Justice McDermott said Coughlan lacks insight into his illness and does not understand that to avoid further relapses he needs to take prescribed medication and avoid alcohol and illicit drugs.
The judge noted that Coughlan has been aggressive and violent towards numerous people, including his father, mother and hospital staff.
Lucky to be alive
The "appalling" attempted murder of his mother left her with catastrophic and life-long, physical and mental injuries and she is lucky to be alive, the judge said.
Mr Justice McDermott said Coughlan had opted not to pursue a defence under the Criminal Law (Insanity) Act which may have resulted in him being found not guilty by reason of insanity.
He said Coughlan had chosen to plead guilty to attempted murder because he would prefer to have a definite prison sentence rather than the indefinite period of detention in the Central Mental Hospital (CMH) that would be imposed if he were found not guilty by reason of insanity.
The judge noted that it is not possible under Irish law for him to impose a hospital order and said this is a matter that has yet to be addressed by the Oireachtas.
Before Monday's sentencing, Coughlan's barrister Alice Fawsitt SC told the court that her client wants to be returned to prison rather than the CMH.
His reasons, counsel said, include that he cannot smoke in the hospital and he has only restricted access to the gym. He promised to take his medication and to undergo urinalysis to establish that he is drug-free, she added.
Mr Justice McDermott said the case gives rise to a number of difficulties posed by Coughlan's "deep, continuing mental health issues".
It is up to the prison authorities as to where Coughlan spends his sentence but Mr Justice McDermott said the CMH appears to be the appropriate place for him.
The judge noted that the attempted murder and other episodes that resulted in involuntary committals to psychiatric wards were preceded by periods when Coughlan reduced his medication and used alcohol and illicit drugs including cannabis and ketamine.
High-risk
While he has made progress in hospital, Mr Justice McDermott noted a probation report which states Coughlan is at a high risk of reoffending in a community setting. He has no real insight into his illness and continues to justify the attack on his mother based on delusional reasoning.
He does not appreciate the benefits of medication and does not understand that previous failures to take his medication led to relapses.
He also believes that cannabis use is beneficial. Given his lack of insight, Mr Justice McDermot said there is a high probability that on release into the community Coughlan will deteriorate and pose a risk of violence to others.
The judge noted Ms Coughlan's victim impact statement, which he said showed both the concerns of a victim but also the "deep concerns of a mother for her son and her deep and abiding concern that his problems be addressed in a meaningful way".
The judge said the available services did not provide the "intensive attention" Gearoid required.
The judge added: "Her statement is full of love and forgiveness and positive thoughts for the future and it is full of the strength she has indicated she derives from her faith and from the care and love of family and friends."
Among the aggravating features of the offence, the judge noted that the assault took place in the victim's home where the defendant was "cherished, cared for and supported".
The attack violated Ms Coughlan's sense of security in her home and was a "gross breach of trust following decades of support and endeavour".
Mr Justice McDermott said the intent was clear from the use of a knife "to inflict the most serious injuries possible". In sentencing, Mr Justice McDermott said he wants to protect society, but preventive detention can only be used sparingly.
The features of the case, he said, justify a headline sentence of 21 years. Taking into account the guilty plea and Coughlan's reduced moral responsibility due to his mental disorder, the judge reduced that to 12 years.
He further suspended the final two years for six years with 18 conditions, including that Coughlan abide by all directions of the probation and mental health services and take his prescribed medication.
'You're not my mother'
At a sentencing hearing in March, Det Gda Peter Nolan told Tom Creed SC, for the Director of Public Prosecutions, that on June 4th, 2021, Ms Coughlan's daughter Joanne became concerned after her mother texted her to say that Gearoid was at her house, appeared to be "quite down", and was saying: "You're not my mother."
Joanne's husband, a GP, immediately went to Ballycoughlan, where he found Ms Coughlan lying face down in a pool of blood on her kitchen floor, grunting and struggling to breathe.
He cleared her airways, stemmed the bleeding and called emergency services.
Garda Nolan agreed that an emergency medical consultant said that Ms Coughlan would have died within minutes were it not for the doctor's intervention.
Gardaí found Gearoid at a bus stop about 4km from his mother's home. After being cautioned, he asked twice: "Is she dead?"
During interviews, he repeatedly denied being at the family home that day but, the garda said, his claims were contradicted by CCTV, mobile phone data, eye witness evidence of family and neighbours, and forensic evidence that showed his clothes were stained with his mother's blood.
Gardaí also retrieved a recording made by Coughlan's mother five days prior to the assault in which Gearoid "voiced his intention to kill his mother, father and brother".
Gda Nolan said Coughlan could be heard calmly saying, "I will kill all of you".
A medical report detailed the injuries to Ms Coughlan, including a 25cm incised wound to the neck and multiple open wounds to the face. When paramedics treated her, she had lost cardiac output and required three weeks of treatment in a critical care unit.
She suffered a traumatic brain injury and continues to undergo speech and language therapy. Although she is at an advanced stage of recovery, she will never make a full recovery, Garda Nolan said.
After his arrest and detention, Gearoid was sent to the Central Mental Hospital where he remains.
At the same hearing, Ms Coughlan said she is frustrated that people with paranoid schizophrenia are allowed to live in the community without the care they need, in particular, to ensure they stick to their prescribed medication.
Ms Coughlan said that a lack of communication regarding the level of risk posed by her son's disease left her in an "unexpected, dangerous situation where I endured a horrific assault that almost cost me my life and will continue to impact my life forever".
"The assault by my son, who I never feared before, resulted in severe injuries including a traumatic brain injury," she added.
Admissions
In her victim impact statement in March, Ms Coughlan said Gearoid is the youngest of her five children.
She explained his struggles with schizophrenia began in his first year of college in Limerick, and resulted in 11 admissions to the psychiatric unit at Cork University Hospital over a 10-year period.
"My experience with the mental health services is that it appears effective in certain crises when an immediate threat to life or limb is present, but it falls short in treating mental health conditions and preventing crises, particularly in schizophrenics where patients often resist medication due to the nature of the disease and their lack of insight," Ms Coughlan said.
She added she is frustrated that the mental health services allow people with paranoid schizophrenia to live in communities "without the care they need to stay well, specifically by sticking to their medication".
Ms Coughlan said she understands that the health service is working within the Mental Health Act but, she said, the lack of coordination between primary care workers and the hospitals impacted her son's health and her family's safety.
She described her survival as a "miracle" and said without the intervention of her son-in-law the outcome "would have been drastically different".
She added: "I refuse to let this episode define me. I constantly seek new adventures, drawing strength from my husband, family, friends, neighbours and my community."
Since leaving hospital, she said she has refused to be "trapped in my own body", to hide away or be isolated.
"I pushed myself to get about and reengage with my community, to embrace life once more. Despite the visible wounds, I feel so lucky I am alive. This has been a poignant and humbling reminder that in the blink of an eye life can undergo irreversible changes."
She finished by saying that she had been asked what she would say if she were sitting with Gearoid in front of her in a safe environment.
"I replied without hesitating that I would give him a big hug and tell him we all love him. I understand that his illness was the cause of this."
