Caoilte’s Dual Diagnosis

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Caoilte O Broin

Caoilte O Broin was found dead in the River Liffey on January 2, after going missing on December 29, 2015.

Caoilte had suffered from mental health problems for several years. In addition to this, Caoilte drank heavily so he had what is called a ‘dual diagnosis‘ – something most mental health services in Ireland will not treat, according to Dual Diagnosis Ireland.

Caoilte’s sister Catriona said because of Caoilte’s drinking, his doctor insisted nothing could be done to help him.

Further to this…

Shane Gillen writes:

Many of you may now be aware of Caoilte O Broin’s story. Caoilte died needlessly due to systemic failures that let families all across this country down when someone is suffering from mental health issues.

Caoilte died from his mental illness.

This could have been prevented. We are seeking legislative changes so that no other family will have to endure the suffering that Caoilte and his family have had to. On Feb 19th, we have been invited on to The Late Late Show to speak about Caoilte’s story in more detail.

On the 11th of Feb – just over one month from when we found Caoilte – we will be holding a silent candlelit vigil outside Government buildings. We will be distributing smiling face masks to represent how we tend to hide our mental health illnesses, and we will ask people to wear the masks during the vigil.

Anyone’s brother – a vigil by candlelight for Caoilte (Facebook)

Related: Dual Diagnosis Ireland

Previously: An Avoidable Death

53 thoughts on “Caoilte’s Dual Diagnosis

    1. meadowlark

      Because those in power are elected by the people of Ireland and have a duty of care to them. Health falls under this remit.

    2. ahjayzis

      FG moved the ‘health vote’ back from the HSE to the Dept. of Health – so the fig leaf of ‘that’s a matter for the HSE’ no longer exists. The buck for health spend, policy and deficiencies lies with the decision makers – the government. I can draw you a chart if you like.

  1. Spaghetti Hoop

    I would definitely support more funding allocated to mental health care. However…..this young man killed himself, did he not?

        1. ahjayzis

          Read back on the case – there was no help available for him because of this dual diagnosis. The family were told there was nothing that could be done. That’s a massive hole in the safety net for people with mental health issues – and in this case the absolute worst happened.

        2. Fergus the magic postman

          Erm… if legislation is the difference between somebody getting help for their mental illness and not getting help, then yes, it may very well help prevent suicide.

          That’s pretty obvious stuff. :/

        3. MoyestWithExcitement

          What ahjayzis said. It’s an illness. If you can’t treat your illness, it can/will kill you. Legislation to make that treatment available *will* stop *some* people from killing themselves.

        4. meadowlark

          I have personal experience with mental illness. It has always been in my life. I have experience with the mental health services in Ireland and they are inadequate, to say the least. I’m not certain how legislation will change things, but that depends on how it would change the system. I know someone who was offered methadone as part of their treatment for depression, and then when they were taken off it after it emerged that it was not working, they were offered no support or services of any kind. It’s nonsensical.

  2. Anomanomanom

    I honestly can’t see how this is anyone’s fault. If the rule/law is don’t drink if you want help and you keep drinking and don’t get help that’s your own fault.

    1. Shane Gillen

      This is far more than just that, as you’ll appreciate once you read the articles.

      (The lack of collateral information etc.)

      This article is not claiming his death is anyone’s fault, but we are saying that it did not need to happen, and with simple legislative changes we can ensure it doesn’t happen anyone else in this country.

      1. rotide

        The article (assuming I’m reading the right one) doesn’t mention any legislative changes.

        What changes exactly are needed?

        1. Shane Gillen

          1. ‘Collateral information’ must be a lawful requirement on behalf of any psychiatric care team (if the adult is under the ‘care’ of home, ie. siblings/parents)

          2. Children should legally take priority in a home where there are reports of mental illness/psychotic episodes. In this particular case, social services never visited the house after reporting incidents of extreme violence. This must be managed more carefully and will help deduce cases of filicide in this country (see Una Butler’s case and her subsequent lobbying)

          3. Anyone suffering with mental health difficulties – especially in cases where extreme behaviour is prevalent – must be lawfully assigned a full medical team, this to include GP, psychiatrist, occupational therapist, area nurses, social workers and Gardaí (if necessary). This did not happen for Caoilte.

          4. The terms of ‘patient’ confidentiality must be assed on a case by case basis, and thereafter it should be decided where legal preference needs to fall between receiving ‘collateral information’ and said confidentiality.

          5. A nationwide school programme to be implemented to build better general mental health.

          6. Lawful access to 24/7 crisis support. There are no mental health services that provide 24/7 crisis intervention services as is the norm in all areas. People will mental health difficulties are still sitting in A&E departments – sometimes for up to 8 hours – without getting the immediate support demanded. With Ireland’s high rate of suicide, the gap in crisis services/management persists.

          7. Easy access to counselling. These therapies are vastly under-resourced. Access to counselling services must be prioritised to prevent mental health difficulties escalating to disabling conditions (as happened in Caoilte’s case).

          8. A right to advocacy support. Currently there is no legal right to an advocate to support people with a mental health difficulty in mental health services and to help them get access to health services, housing, employment advice or welfare benefits. After a mental health crisis, people need help to get back their life in the community.

          9. Advance healthcare directives. A more scrutinised look needs to be given toward the patient’s right to treatment, and what treatment. Without access to advanced healthcare directives, people with mental health difficulties are undergoing treatment that they don’t want/understand, even in sound mind.

          1. rotide

            Thanks for that.

            I’m astonished that point 2 even needs to be there. If that isn’t already in place, that is a terrible failing.

    2. Lorcan Nagle

      And if you’re an alcoholic is it that easy to just give up drinking? If you have two serious problems – such as alcoholism and a mental health imbalance that leads to suicide, shouldn’t they both be treated?

      1. Vote Rep #1

        They should and are but you can’t correctly diagnose let alone treat someones mental health if they are on drink or drugs. They need to quit that before they can be properly assessed.

        1. ahjayzis

          If the mental health issue exacerbates the alcoholism and the alcoholism exacerbates the mental health issue – what then? Symbiotic problems. By all accounts that’s what happened here – how can you stand over a policy of ‘sort yourself out’ by a health provider when one can’t fix one problem without tackling the other and they won’t touch you until you ‘heal thyself?’

          Morbidly obese people aren’t told to go off and lose ten stone off their own bat while their kidneys fail or their leg is broken – why is mental health and alcoholism different?

          1. Vote Rep #1

            Morbidly obese people are told to lose weight before they get certain operations though. I knew someone that worked in the special clinic in loughlinstown and that was always the case.

            Regardless of that, it would be very difficult to treat someone mentally who is suffering relating to their addiction as well as other mental issues. How do you differential between the two? What happens if you misdiagnose due to issues from the addiction?

          2. ahjayzis

            “How do you differential between the two? What happens if you misdiagnose due to issues from the addiction?”

            That’s kind of where you need a mental health professional to deal with it rather than packing them off telling to heal half their problem themselves.

            Surely problem drinking in someone with severe and ultimately life-ending depression is a form of self harm. If someone is cutting and suffering from depression they’re not turned away.

          3. rotide

            Not spot on Ahjaysis.

            There is such a large difference between someone cutting themselves and an alcoholic that I don’t know where to begin.

          4. MoyestWithExcitement

            Apart from the physical differences of pouring a liquid down your throat and cutting your flesh, what’s the difference? Some depressed people drink, some cut themselves. Why is one viewed so much different to the other?

          5. Caroline

            Cutting yourself is factually not the same as being an alcoholic, but just because there are differences, doesn’t mean there can’t be similarities. There are certainly people drinking in order to self-harm.

          6. Fergus the magic postman

            Go on then rotide. Aside from the physical differences of cutting to self harm, & drinking to self harm, enlighten me as to some of the other too many mention differences.

          7. rotide

            Seriously. Fupp off Fergus.

            As has been highlighted all over this thread, Alcoholism is a serious impediment to treating mental illness. Cutting yourself is not.

          8. meadowlark

            Actually it is, Rotide. It is tied up with a wish for control, similar to eating disorders, which are also an issue that comes with depression. OCD is another issue which is symptomatic of depression, and is also linked to a need for control.

          9. Fergus the magic postman

            Good man rotide.
            As others have been trying to point out, in many cases, alcoholism is a consequence of mental illness. side from that there are many similarities with alcoholism and other self harming s result of mental illnesses.
            You should try not being the contrarian all the time just for the sake of it. You might learn something.

          10. rotide

            Meadowlark, there’s no denying that all forms of mental illness have secondary issues and symptoms. I’m not saying they don’t. I’m saying that you cannot treat severe depression or any mental illness while the subject is self medicating with any substance for clinical reasons.

            What part of cutting yourself interferes with medication?

            Fergus, Unfortunately I’ve learned far too much about this in the past.

          11. , meadowlark

            I agree rotide. There is not much of a physical impediment to medication from cutting. But the mental issues which come with these issues cannot be discounted. Because it is mental illness. As I mentioned in an above post, I have many years experience, almost 15 years now, dealing with depression and I have seen what it does. To say that an issue like self harm and cutting do not impact on medication is true , but only in the most literal sense. Because it very much impacts recovery, and these side issues are ones which are harder to help because they have been used as a coping mechanism. They are habits which can relapse much easier than depression can.

    3. edalicious

      lol. If you have a drinking problem, just don’t drink and you’ll be grand. Maybe someone should try telling that to all the people who are addicted to drugs, smokes and those with eating disorders too. Can’t believe no one has thought of that yet. Sheesh…

    4. ivor

      If you’re drinking is a result of the underlying mental health condition and they deny you the treatment for the mental health condition because you’re drinking, then you cannot win.

      Mental health conditions – by definition – impair your ability to make wise decisions. If you then bar people from accessing help for the mental health condition, then how will they ever be capable of making an informed decision about unwise behaviours like heavy drinking?

  3. arghonaut

    I had a friend in a similar situation, but rather than being told he couldn’t be helped he was told that the alcoholism had to be treated first. Was this not the case rather than being turned away entirely?

    I can fully understand how if someone is drinking heavily it is impossible to treat them for mental health issues as it is unsafe to prescribe anti-depressants and the usefulness of any therapy is impaired by the alcohol. If Caoilte was not pointed in the direction of alcohol treatment programmes then that is a problem, but there is a logic behind the law.

    Not that this makes me feel anything but sorry for him and his family’s suffering. It is a heartbreaking situation.

    1. Vote Rep #1

      According to a large thread on reddit about this, that is exactly what happened. The family were told that he had to quit the drink before they could do anything. He refused so they couldn’t do anything.

      I think a lot of the smart comments about it all being all the governments fault come from that thread. The op there laid all blame on the state when it was a little more complicated than that.

      1. Spaghetti Hoop

        Drink is a depressant, so I can understand why it would be essential to treat the alcoholism first. The drink itself could have also been a self-destructive tool.
        Terribly sad for the family, but I am still not convinced that legislation will prevent suicides.

        1. arghonaut

          A depressant, or central depressant, is a drug that lowers neurotransmission levels, which is to depress or reduce arousal or stimulation, in various areas of the brain. Depressants are also occasionally referred to as “downers” as they lower the level of arousal when taken.

          Depressant does not = makes you depressed.

        2. inPisces

          You’re a bit too intelligent for this board SH
          You should know by now that you must “feel” the ” government ” is wrong on every single issue populated as it is by “blueshirts”, aided and abetted by “Young fg trolls” and kept in power by “labour sellouts”. You must try a lot harder love

  4. rotide

    What’s all this about Dual diagnosis being something mental health services won’t treat?

    I know 3 people who either have been or are in treatment under dual diagnosis (2 alcohol, 1 drugs).

    Maybe they did it privately? I’m not sure and I’m not about to ask.

    1. ahjayzis

      I think someone mentioned on another thread that it’s a bit of a postcode lottery and depends on the catchment area of the service you’re in?

      1. rotide

        I should point out that all 3 of those people stopped abusing the substance in question. I can’t swear to it, but I’m pretty sure they had to before entering the DD program.

  5. Anne

    Like everything in this country, poo services for people in need..

    Personally I find it difficult to have sympathy for people with alcohol issues, but I still think treatment facilities are needed for them.

    Maybe more education in schools is needed, to bring awareness about the fact that alcohol is a highly addictive substance with bad side effects when misused over a long period, so don’t start.

    People with any inclination to any sort of mental health issues should be made aware that alcohol is going to bring on mental health issue.

    http://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm

    “The evaluation of psychiatric complaints in patients with alcohol use disorders (i.e., alcohol abuse or dependence, which hereafter are collectively called alcoholism) can sometimes be challenging. Heavy drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes. As a result, alcoholism can complicate or mimic practically any psychiatric syndrome seen in the mental health setting, at times making it difficult to accurately diagnose the nature of the psychiatric complaints (Anthenelli 1997; Modesto–Lowe and Kranzler 1999).”

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