Man detained after GP wrote letter without ever seeing him

TOM KELLY was stressed out and burned out.

His marriage had broken up after 16 years and the pressures from family and work — a veterinary practice in Donegal — were mounting.

Despite all this, he was happy; Kelly, an American woman he had been chatting to on the internet for several years was coming to visit.

They had become acquainted through a food safety discussion, fell in love, and had became engaged.

So it was that in late November 2008, Kelly was on her way to Cork, where Tom, 49 at the time, had arranged to pick her up and bring her home to meet his family.

A month later, Tom found himself locked up at a psychiatric unit in Cork city. Detained against his will, he remained there for almost three months. His family had become concerned at his behaviour, they felt he was acting strangely, was manic and needed to be medically assessed and treated.

Tom admits to be being unsettled in himself, and recognises his family felt they were acting in his best interest, but believes what happened to him violated his human and constitutional rights. By speaking out about what happened to him, he hopes to highlight what he deems to be the serious inadequacies in the law around involuntary detention and treatment.

“I was indeed a bit burnt out, I think that might be the best way to describe it, but also, since May 2008, enjoying a peace I had never known before. It is difficult to explain, but I certainly was neither clinically elated or depressed.”

Tom had not lived in Cork for more than 20 years, although he did visit occasionally to see his family.

“My family had neither observed me in my daily life, nor had any direct knowledge of my personal or professional life for more than 20 years. I attended three GPs at my family’s request during 2008 for an independent assessment, but not one thought there was any evidence to support the need to section me.”

So how did Tom end up being committed? Documents seen by the Irish Examiner show over a period of weeks, as Tom’s family became more concerned about his behaviour, pressure mounted to have him brought to hospital.

Correspondence between the family and a GP, whom they hoped would help admit Tom, shows their concerns were well-intentioned but primarily based on the break-up of his marriage; the fact that he was constantly talking about God; and had become involved with an American woman over the internet.

Tom had also been texting veterinary colleagues regarding religious matters, and, according to his family, he had a “history of bipolar” and had stopped taking his medications.

“I had a most unfortunate 11-year-old past misdiagnosis of bipolar disorder, and the plan was to visit with Kelly and her family, enjoy a much needed holiday and, while there, consult with a doctor who specialised in neurotransmitters and who might once and for all put aside the false diagnosis of manic-depression on the basis of an adverse reaction to a previously prescribed anti-depressant medication,” he says.

On November 17, 2008, before this could happen, and indeed before Kelly and Tom had even arrived in Cork to meet his family, the GP in question wrote a letter about Tom which was used as a basis for committal. It stated “Mr Kelly is in a manic phase of his bipolar disorder”.

This letter was written simply on the say so of his family and without him having examined Tom.

In correspondence seen by the Irish Examiner, the GP wrote, again without having seen Tom, that from what he had been told it “sounds like he needs to be sectioned”. This again formed part of the backdrop of Tom’s eventual detention during which he was physically restrained and forcibly injected, refused access to his phone and personal assets in order to contact Kelly, then his fiancée, or his own solicitor.

When this GP did eventually meet with Tom in early December he wrote: “Prior to meeting Thomas last week I thought it was very likely that he would be sectioned. However in the hour-and-a-half or so that I was with him I could not find any symptoms or signs to justify such a move. I know Thomas is very clever but when someone is manic he or she generally cannot hide a delusion, for example, because he or she genuinely believes that the delusion is real.

“If someone can hide certain emotions or ideas then the person is in control and knows exactly what he or she is doing. Thomas’s behaviour may be described as hypomanic and of course may progress to mania.”

During his detention in two hospitals in Cork city, Tom, who obtained his medical records through the Freedom of Information Act, was heavily medicated, and notes show a sibling requested his Valium be reduced so he could read.

He maintains the damage and distress resulting from his detention resulted directly in the demise of his private veterinary practice. He says he was forced to leave Ireland in order to live in peace free from the threat of detention for failing to comply with the system.

The GP concerned also subsequently admitted in correspondence seen by the Irish Examiner that “with the benefit of hindsight, perhaps the best thing to do at the time would have been to do nothing”.

He said he would not repeat his actions should a similar situation arise in the future.

Since going to the US, Tom has had three consultations with two doctors both of whom rejected a diagnosis of bipolar.

One wrote in August 2010: “It is my opinion that our evaluation fails to reveal concrete evidence of depression or mania one year-and-a-half year without medication. His initial symptoms in 1996 might be linked to an overwhelming work load and responsibilities and is a reaction to stress. At that point, he might have benefited more from cognitive behavioural therapy and counselling to mitigate his stress reaction.

“He would have benefited as well from life style counselling. He has carved out a new life in California with a new and very supportive wife and step children. He appears to be thriving and for all appearances is very happy. In retrospect, since he is doing so well without medications, might his symptom complex from 1997 to 2008 be linked more to the side effects of the strong psychotropic medications be was given at that time?”

Following his release from hospital in Cork, Tom says he was a “physical wreck” and it took many months for him to recover.

The reason why he wants his case to be highlighted in such detail, is to show how easily a person can be involuntarily detained, and all their rights taken away, and when they are, the treatment very often is a cocktail of powerful drugs and very little in the way of psychological intervention.

Documents timeline

EXTRACTS from the document trail leading up to Tom’s admission and doctors notes during his detention:

Family member to GP:

* 21/11/2008: “We have agreed that no matter how calm he seems and however well things go, we’d like you to see him... we plan to talk to him to tell him we feel he needs help... X feels very strongly he needs to be committed and put on medication.

We know he will be very opposed to medication... how do you feel about trying non-medical alternatives? What do you think the chances are that the assessing doctor at the Mercy would be open to recommending something other than medication? Or if we get there will it inevitably mean medication and a hospital stay?”

* 22/11/2008: “Thomas and Kelly seem to be getting on very well with the parents and together... We are less anxious now that he might suddenly vanish.”

* 24/11/2008: “All has been so calm and happy since they’ve arrived. Kelly is staying here and we lunched with parents. He seems utterly calm, fine, grand.”

GP to family member:

* 27/11/2008: “I can understand your point of view but for the duration of the time I was with Thomas I did not find mental disorder sufficient to justify involuntary admission.”

GP notes:

* 05/12/08: “Prior to meeting Thomas last week I thought it was very likely that he would be sectioned. However in the hour-and-a-half or so that I was with him, I could not find any symptoms or signs to justify such a move. I know Thomas is very clever but when someone is manic he or she generally cannot hide a delusion, for example, because he or she genuinely believes that the delusion is real. If someone can hide certain emotions or ideas then the person is in control and knows exactly what he or she is doing. Thomas’ behaviour may be described as hypomanic and of course may progress to mania.”

Details of admission:

* On Saturday December 20, a SouthDoc doctor was called to the family home in Cork, along with the guards and Tom was confronted and told he was being brought to hospital. This doctor had never examined Tom before and the detention was based on a letter written by the family GP in November, before he had even seen Tom. The doctor and the guards confronted Tom, who was removed to hospital against his will.


* 25/12/08: “Kelly appears to be a calming influence on Thomas when she is with him but she does not seem to acknowledge mental illness.

“As this is his first hospital admission we think it is a real opportunity to fully assess his mental health condition and work out best treatment for him. He is anti-lithium, he has been on it but has never been properly monitored and our opinion is that he was high when he was on it. We think he could benefit from some kind of talk therapy in the long term.”


* 28/01/09: “In the interests of Tom’s recovery... we fear Kelly’s actions may not be driven purely by concern for Tom. She has expressed her opinion that he can be healed without recourse to medication. Unfortunately at the moment Tom appears to trust her judgment completely in all things.

“We therefore support the hospital staff’s decision to deny her any access to Tom. We hope you can continue to enforce this policy with the cooperation of every staff member — administrative medical and security.”


* 30/01/09: “I am seriously concerned about Tom having contact with this woman until he has regained enough insight and judgment to critically evaluate her motives.

“This is the first time he has been properly subjected to psychiatric treatment and I am very hopeful that he will gain enough insight into his condition to be compliant with his drug treatment and to lead an independent life in the future.

“If contact with Kelly cannot be controlled in the Mercy can he be returned to Carraig Mor? I know he is much more comfortable in the Mercy but I feel that continued contact with this woman could be enough to render all his treatment so far a waste of time.”

Doctor X:

* “It is disappointing that your brother’s phone calls cannot be monitored. We [Carraig Mor] can offer your brother a bed or at least we will try to oblige your brother as far as possible. He may not give his consent to being transferred back to CM and then it will be up to the medical staff to make a decision on the matter.”

On January 30, after discovering Tom was being prevented from contacting Kelly, another doctor noted:

Doctor XX:

* “This man has a legal right to associate with who he wishes. Many individuals are anti medication and/or dispute the truth of mental illness.

“We cannot prevent contact with such individuals. We cannot interfere with a patients legal rights despite families requests for such actions.”

Second opinion in March:

* 05/03/09: “I examined Thomas Kelly for the purposes of a second opinion with regard to his ongoing detention under the Mental Health Act. The staff all report that Thomas is much improved since his admission. For a considerable period of time he has been quite unobtrusive on the unit and has been sleeping well. As the reason for admission was a manic episode, I placed significant importance on his unobtrusiveness and good sleep pattern.

At interview Mr Kelly clearly presents as an unusual man who is very talkative and quite concerned by a number of issues which might not bother other individuals.

I can see no evidence to support the current diagnosis of mania. Throughout the interview I could see no evidence of any psychotic process. In my opinion it is likely that he still has some degree of hypomania but there is certainly no evidence of serious likelihood of Mr Kelly causing immediate and serious harm to himself or others.


* “In my opinion Mr Kelly no longer meets the criteria for ongoing detention in hospital under the Mental Health Act. I would however recommend he have a gradual discharge from hospital beginning with one or two overnight passes. It is clear to me from my discussions with Mr Kelly if his detention is revoked he intends to leave hospital as soon as possible.”

‘Whilst lying quietly in the bed, and before being admitted, I am held down and injected’

A FIRST person account of being detained:

A grim-faced man and two gardaí, one of them female, appear at the top of the garden steps.

Dark overcoat, dark suit, dark briefcase: must be a shrink from some local hospital.

Obviously been told I’m manic. And dangerous. Come to collect me. Won’t be going away without me. Christ Almighty! This cannot be happening. This is happening.

No matter what happens now, do not let yourself be provoked. Do not retaliate. Show no anger. Anger is exactly what they are waiting for. Anger is what they are hoping for.

In a heavy foreign accent, the old fellow tells me that my family have told him that I have problems — would I like to discuss them with him now?

Calmly, I ask if he has any problems himself. No, he has none, none at all, he assures me.

Sick panic turns to sick rage.

In that case, I assure him, unable to keep the contempt from my voice, then I have nothing to discuss with him.

The old doctor now looks more than worried — he looks frightened.

Defuse. De-escalate. Steady!

Drag this out as long as you possibly can, Tom. These gardaí are your only possible independent witnesses. To everyone else, you already are and you will be a mental patient, and you will soon be drugged out of your mind.

Act normal. Normal? What is “normal” — under these circumstances? Who would not be agitated, at least? Yeah, but if you show the slightest agitation, Tom, they’ll call it mania. Yeah, but if I act calm the guards will think me a total psycho.

I suggest we all go inside. Warm up. Have a nice cup of tea. This is agreed to, but both guards want to stay outside in the garden. I need my witnesses. I insist they come into the kitchen, too. They take a fair bit of persuading. Inside, my brother and the doctor sit in the adjoining dining room. I chat and tell jokes, trying to engage the gardaí. After probably the better part of an hour, I say I’m going back upstairs for a lie down.

My brother approaches, and grabs both my hands in front of me. I offer not the slightest resistance. The male garda handcuffs me. I announce that I will not be speaking to anybody until I am looking into my fiancée, Kelly’s, face.

I’m led out to the waiting police car and driven across city to the Mercy University Hospital.

I refuse to speak, eat or take drugs by mouth. After some hours, whilst lying quietly in bed, and before being officially admitted, all unresisting, I am held down and injected. As they hold me face down, I turn, look into the eyes of the African doctor who is supervising the nurses, and break my silence:

“Lord, please help these good people who are trying to help me, and help me to do your will.

“Lord, please help these good people who are trying to help me, and help me to be your will.”

The young doctor now looks more than worried — he looks frightened.

‘Insensitive, inept professionals add to stress of patients and families’

MY son’s experiences of the mental health services:

September 2002

He went to college as a happy young boy full of enthusiasm and looking forward to his future. He did not have an easy life due to ADD but always took on many challenges cheerfully. I first noticed, approximately after six weeks, that he was more anxious but he assured me all was okay.

December 2002

He started hearing things and got strange ideas, went to the GP who referred him to a psychiatrist. I had no idea that this might be psychosis although I am from a medical background myself.

He was diagnosed with psychosis and commenced on medication. After a few weeks he settled and continued back to college. I found the psychiatrist helpful and positive at this clinic and hopeful of a full recovery. However, a nurse at this clinic was very brutal and uncaring when she informed me in an indifferent way “he has schizophrenia and the low amount of medication he is on won’t touch it”.

That was the first shock, I did not ask for her opinion it was as if she was giving me good news instead of breaking my heart. I continually asked that he would be kept on the lowest amount of medication and eventually that was agreed to reluctantly.

The psychiatrist said that he would have to stay on medication for two years. This apparently is standard treatment. He has been on medication for eight years to date. During these visits to the psychiatrist, I never got any positive encouragement or hope that he would get well soon.

With comments such as “he was unlucky that the medications were not working”, I asked the GP for a referral to another psychiatrist. He attended there for a few months with no improvement and then recommended going back to the 1st consultant psychiatrist, who he said had a “back-up team” to help, but the consultant psychiatrist was enraged because we had changed.

At a few meetings with him, he was rude, sarcastic and unpleasant in every way, on one occasion he demanded that I sign a document stating that he was “in charge of my son”. I refused to sign this statement. During this time medicines were increased and different medications tried but no real improvement.

He often recommended hospital admission and told me very implicitly “your son has schizophrenia and he will always have it”.

At these clinics the atmosphere was very tense, the psychiatrist would aggressively walk in and out of the room and see the patients including us in the waiting area, without acknowledging our presence. One would feel very nervous just sitting there waiting.

Unbelievable that people at a psychiatric clinic should have to endure more stress and fear in addition to their own situation. Have they no compassion for the upset patients and their relatives? A kind word or a smile of encouragement would mean so much.

Side Effects

These were so severe he attended several specialists at outpatients clinics where I continually requested that medication be reduced, or kept to a minimum. Thankfully, he was never hospitalised. He attends clinics every few months, which usually amounts to 10 minutes, write the prescription and out the door.

There would sometimes be significant turmoil in the person’s life but the psychiatrist would not ask the relevant questions. I would also have to request blood tests from time to time. I asked for a psychologist or psychotherapist and was told that “there was not enough in the area”, so he has not had any interventions only medication. He has had psychotherapy privately during all these years.

Conclusion in 2011

I find this sad serious situation so utterly upsetting when I compare the fantastic caring nurturing, sensitive treatment that my animals get from our vets. The care and attention to the smallest little animal regarding reports of treatment given or required is second to none.

No time is spared on any treatment suggested to make the animals better and prolong their lives. I can’t praise them enough. Could the mental health service begin to imitate even in a small way the wonderful service and kindness and attention our animals get?

I have no confidence in the uncaring, insensitive, dismissive irresponsible, unprofessional mental health practitioners — have they no conscience to neglect and take advantage of vulnerable helpless persons?

Where does one complain about this mistreatment?

Why don’t they learn from tragedies? How many more have to happen?

One should be able to report in confidence.

As a support for the patient, I feel there should be a regular review with the relatives about on-going progress.

Some GPs have been helpful but the psychiatrists I have met have closed minds.

‘I am shocked and traumatised by my mistreatment’

I WAS admitted to the hospital XX in 2005 suffering from psychosis, having been previously diagnosed with bipolar disorder. My history of acute psychosis goes back to a first episode occurring when I was travelling in Thailand in July 2003. In 2005, I was admitted on three different occasions for various periods.

On first admission I was kept in the observation area. I was suffering from severe insomnia and my symptoms were largely due to the fact I hadn’t slept in several days.

The staff response to this was to leave me in a lit area even at night and to periodically arrive and shine a torch in my face so that if at any point I was near sleep they would wake me again. I was kept in this state of insomnia for three to five days.

It is documented that persons with no mental illness, but subject to this kind of sleep deprivation, can develop psychotic symptoms. In fact, similar methods are used on prisoners of war to aid interrogation. I find it extraordinary that this kind of treatment could be handed out to people suffering from mental illnesses.

When I was admitted to hospital in Bangkok in a similar condition a staff nurse sat with me in the room while I slept in darkness. This would have been even more feasible to man in the ward where there were several beds occupied in the observation area but the nurses seemed to prefer to sit in the office nearby.

On a number of occasions I was deemed to be psychotic. Despite not displaying any intention of violence either to myself or members of staff, I was man-handled by members of staff and carried against my will while being restrained to a small room where I was forcibly stripped naked and had my clothes taken away from me.

I was put into a denim-like beige dress and put on a leather bed with a triangular head rest and then given an injection so I slept for many hours. I was locked into the small grubby room with only one thin blanket and had no idea how long I would be expected to remain there.

This degrading experience, which I believe is euphemistically referred to as ‘seclusion’, happened on at least two occasions, though on one of them I was allowed to keep some of my clothes. On one such occasion, I was carried by three staff members upside-down while progressing along a corridor and I had two legs and an arm pinned so I was completely unable to even reach should I have tried to strike a staff member.

Despite this, a consultant took my one free arm and placed it in an arm lock and continued to hold me in this uncomfortable, painful fashion as they ran along the corridor. I must stress again at this point that this is despite the fact that I had not in any way shown the slightest sign of violence towards any member of staff or other patients.

I feel that this was a very dangerous thing to do, particularly while moving at speed, as was the case here. Furthermore, a male doctor remained present while my clothes were forcibly removed.

On release back into the ward, I discovered when my mother arrived that they had not even been informed that I had been subjected to this brutal and humiliating procedure. Staff never discussed their actions with me either before or after, when I was back on the ward. For months I was too shocked to speak of these events.

When I finally decided to ask about it, my doctor told me that I had been secluded. Even though he was the main consultant I saw he had not been told of these incidents by the nursing staff.

I did not find him sympathetic and when I asked that a note be added to my file stating that I was neither prone to self-harm nor violent to others and, therefore, should any situation arise again in which seclusion was favoured by the nurses there would be a clear contradiction on my file. He refused this request.

On a latter appointment with the doctor he wanted to place me on a higher dose of Seroquel. When I pointed out that I was feeling well and that I had already been on the higher does of Seroquel and found it strongly sedating he told me that he would admit me to hospital if I didn’t take the higher dose.

I am shocked and traumatised by the mistreatment I received. I would simply have not believed these kind of practices went on in our hospitals in this day and age.

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