No bed in hospital despite suicide risk

St Vincent’s Hospital was aware no bed was available for a suicidal man having homicidal thoughts when it transferred him on to his local mental health service for assessment, a consultant psychiatrist has claimed.

No bed in hospital despite suicide risk

Raymond Pierce, aged 46, was found by his wife at their home at Broadford Lawn, Ballinteer in Dublin 16 on March 15, 2013, the morning after he presented at St Vincent’s Hospital with “active suicidal thinking”. St Vincent’s transferred the father of two to Cluain Mhuire Services (CMS), the community mental health service for his catchment area, which sent him home with an outpatient appointment after it was unable to secure him a bed.

Consultant psychiatrist and CMS clinical director Siobhán Barry told Dublin Coroner’s Court she did not have a bed for Mr Pierce at St John of God Hospital, where CMS rents inpatient beds, and this was “flagged up from the outset” when contacted by St Vincent’s.

Mr Pierce suffered bouts of depression and anxiety having developed post-traumatic stress disorder after someone jumped in front of a train he was driving in 1997. He tried to kill himself two months before his death.

Psychiatry registrar at the time Barbara Byrne previously gave evidence that she referred him for assessment by a consultant psychiatrist at CMS on the instruction of St Vincent’s consultant psychiatrist Kevin Malone. Mr Pierce had symptoms of a depressive episode with active suicidal thinking and had “thoughts toward” his family, telling her “it would cause less pain if I took them with me”.

Dr Byrne denied knowing what the bed situation was when she referred him to CMS. The family gave evidence she indicated he would be given a bed in St John of God. Dr Byrne said she may have “given the impression that further care would be arranged” but her assessment would be “trumped” by a consultant psychiatrist.

Giving evidence, Dr Barry said when CMS was contacted by St Vincent’s it was told Mr Pierce was “acutely suicidal”. When she saw him in the afternoon his physical agitation was “profound” and she felt he needed immediate admission. She agreed the family indicated they had been led to believe a bed would be made available.

“This came as quite a shock to me because no such commitment could have been possible,” she said.

She said it was “extremely infrequent” that a bed was not available. She sought, via a junior doctor, a bed for him at St Vincent’s but they were told none was available. He did not want to go to Newcastle Hospital in Wicklow or to St Patrick’s Hospital. Mr Pierce went home with a plan that he would be seen the following day in the day hospital, she said.

The jury returned a verdict of death by suicide, as well as recommending a review of hospital procedures for emergency short-term patients who present in an acute psychiatric condition and the creation of a database for bed availability between catchment areas.

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