Doctors wanted Deirdre Morley to be admitted to psychiatric hospital two months before tragedy but she refused — (Sunday World)

To view original article click here

Sunday World

Shane Phelan Legal Affairs Editor

Sat 22 May 2021 at 02:03

Andrew McGinley, Deirdre Morley and their children

Doctors wanted Deirdre Morley to be admitted as an in-patient to a psychiatric hospital just two months before she killed her three young children, but she refused to go.

The 44-year-old paediatric nurse resisted the urgings of her local mental health service who sought to refer her for in-patient treatment at St Patrick’s Hospital in Dublin in November 2019.

Ms Morley told the service she did not want to be away from the children, her trial heard this week.

The issue is likely to be central to any investigation into her diagnosis, treatment and medication prior to the horrific tragedy. Her heartbroken husband, Andrew McGinley, has sought an inquiry after Ms Morley was found not guilty of murder by reason of insanity by a jury at the Central Criminal Court on Thursday.

She had admitted smothering Conor (9), Darragh (7) and Carla McGinley (3) at their home in Newcastle, Co Dublin on January 24 last year while her husband was away with work. Two psychiatrists concluded she was legally insane at the time.

Mr McGinley only discovered after their deaths that his wife’s GP had written to Clondalkin Mental Health Services about a possible referral to St Patrick’s two months before the killings.

He has said it is not clear to him what happened between then and the date the tragedy unfolded, and that he had received no contact from the HSE since then.

Ms Morley’s trial heard she kept the full extent of her illness concealed from those closest to her, including her husband.

She had been on anti-depressant drugs for over two years and had previously spent a short period at St Patrick’s in July 2019 after expressing suicidal thoughts.

The disclosure of Ms Morley’s tortured mental health history at her trial has put the spotlight on the professional care she received.

In the two years before the killings she attended her GP, Clondalkin Mental Health Services, counselling, cognitive behavioural therapy and St Patrick’s.

The court heard that during that time, she was prescribed at least five different anti-depressant drugs at various stages and the diagnoses she received were less serious than those reached by consultant psychiatrists after the killings, when it was determined she had slipped into delusion and psychosis.

Ms Morley convinced herself her children had been damaged as a result of her mental illness and had no future.

She later expressed regret and remorse but told gardaí she had been unable to stop herself. “I just want them back,” she said.

Mr McGinley has said that if his wife’s diagnosis was questionable prior to the tragedy, then surely so too was her treatment and medication.

It appears the decision on whether to refer Ms Morley to St Patrick’s in November 2019 was left up to her, even though under the Mental Health Act 2001, a patient can be encouraged to have an advocate, such as their spouse.

In the week before the GP’s letter, Ms Morley’s mental health had deteriorated to the extent she had been unable to bring the children to school and was in bed all day.

Her GP noted she had a passive death wish. “I just want to evaporate,” she told the doctor.

Clondalkin Mental Health Services agreed she should be admitted to St Patrick’s and diagnosed her with “a moderate depressive episode”.

When she refused to go to St Patrick’s, she was advised to continue on her current medication and to also attend a day hospital. This was an alternative to an in-patient admission, where a patient presents every day at a mental health setting to be seen by psychiatric doctors and engage in therapies.

However, by the end of November, she no longer wanted to continue in the day hospital. Her trial heard she was advised to draw on the skills she had learned at cognitive behavioural therapy and to continue on her medication.

Much of this evidence was outlined to the court by forensic psychiatrist Dr Brenda Wright, a witness for the defence, who found Ms Morley had been suffering from bipolar affective disorder.

Dr Wright reviewed all available documents regarding Ms Morley’s medical history.

Words such as “worthlessness” and “guilt” were repeatedly recorded in the medical notes. These, Dr Wright said, were red flags for an emerging psychotic illness.

The court heard Ms Morley had various difficulties with her mental health stretching back to in 1996. She began to receive counselling in 2009 due to work-related stress after she became a clinical nurse specialist at Crumlin Children’s Hospital.

She began attending counselling again in 2014, when Darragh was aged two. Her second child was much more boisterous and would lash out.

Ms Morley fretted she was not giving him enough or the right kind of attention and would not accept reassurances this was just a phase. “When I was in the thick of it, there was no talking to me,” she said during one consultation.

She continued to attend counselling following her mother’s death in 2015.

In March 2018, she took 12 weeks off as she was finding work “very stressful”.

According to GP records, she began to have difficulty sleeping and couldn’t enjoy things.

Her mood ebbed and flowed in the following months.

By that June, her GP had recommended anti-depressants but she did not begin taking them until October.

That month she was recorded as being “tearful” during a consultation.

She felt overwhelmed looking after the children and later that month, described being anxious and agitated.

At that point, she was referred to Clondalkin Mental Health Services. It was later recorded she recalled losing 10lbs over six weeks.

After her referral, her anti-depressant was changed and she was diagnosed with mixed anxiety depression.

By January 2019, she was considering returning to work.

The following month, she described having a fantasy. “That I am in an apartment in Paris. No children. Just me.”

She returned to work that month, but managed only two days as she felt overwhelmed and couldn’t make decisions.

At that time, she was also seeing a psychologist and an occupational therapist weekly.

Her anti-depressant medication was changed again and by June 2019, she was reported to being doing well at work.

However, the following month her GP noted she felt increasingly flat and distant, with no motivation. She couldn’t concentrate and her thoughts were jumbled.

She was having constant thoughts of suicide but had made no plan or attempt.

This was the first mention of suicidal thoughts in her medical records. It was also documented at that time: “Doesn’t want to be around the children. Doesn’t feel she can go back to the house”.

She was admitted to St Patrick’s on July 6, 2019, but was discharged after a short period. Doctors concluded she had suffered a moderate depressive episode.

She was put on a combination of two antidepressants and a sedative to help her sleep.

It was noted she displayed excessive guilt and poor self-worth, with early morning wakening and extremely poor concentration, but her suicidal thoughts were gone.

“Those features of early morning wakening and poor concentration would be highly suggestive of a significant depressive illness,” Dr Wright told the trial.

“They would be symptoms a psychiatrist would routinely check for in establishing the presence of a depressive illness and its severity.”

Just four months later she was urged to return to St Patrick’s but refused.

It is impossible to know whether things would have been different if she had.

However, Mr McGinley hopes an inclusive investigation will be launched which will inform clinicians in their practice and help avoid tragedies like this happening again.

The HSE said it could not comment on individual cases but that if Mr McGinley wanted to speak to a member of Mental Health Services, it would arrange this.

In a statement, St Patrick’s Hospital said it supported his call for an independent inclusive investigation into Ms Morley’s treatment, and any other factors which may be pertinent.

“It is imperative that we identify what can be learned from this tragic event.

“This includes fully and sensitively investigating if anything could have been done to prevent the deaths of three innocent children, and to help avoid any family in the future suffering a similar fate,” it said.