Shane O’Connor inquest jury calls for improved HSE mental health protocols

A jury at the inquest into the death of Shane O’Connor has returned a verdict of death by suicide.
The 17-year-old son of musicians Sinéad O’Connor and Dónal Lunny was found dead in an area of secluded wasteland behind Corke Abbey housing estate close to Bray on January 7th, 2022, less than 24 hours after he absconded from Tallaght University Hospital (TUH).
When he escaped from the hospital, Shane – who was deemed a “high-risk” patient by psychiatrists at the hospital following a serious suicide attempt – was not receiving prescribed one-to-one, around-the-clock supervision due to understaffing.
A jury of six men and two women made a series of recommendations at the conclusion of the inquest at Dublin District Coroner’s Court on Tuesday, including that protocols be established at all HSE hospitals for the enhanced care and supervision of recognised vulnerable patients, particularly children.
On the second day of the inquest, the court heard evidence from care workers and psychiatrists about the deterioration of Shane’s mental health in the months before his death, variously manifesting in erratic behaviour, drug-induced psychosis, self-harm and suicidal ideation, among other presentations.
Aoife Scanlon, manager at the Tusla-funded private residential care facility New Beginnings in Newbridge, Co Kildare, said although Shane initially engaged well at the facility when he came to live there in March 2019, his behaviour began to pose challenges in 2021. New Beginnings ultimately communicated to Tusla – the agency responsible for Shane’s care – that they were unable to continue accommodating Shane beyond December 2021, as his needs were “too complex”, that they were worried for his wellbeing, and that they could not guarantee his safety.
After Shane went missing from New Beginnings for some days, he spent the first weeks of December 2021 at Linn Dara, a HSE Child and Adolescent Mental Health Services (Camhs) inpatient facility, one of six admissions to the facility between 2020 and 2021.
As New Beginnings were not in a position to accommodate him, Linn Dara was requested to allow Shane to stay at the inpatient unit until his 18th birthday in March, the court heard. However, it was deemed that this was not appropriate, as Shane was not suffering from an acute mental health disorder as defined by legislation, and he wished to be discharged. Shane was discharged from Linn Dara on December 21st, 2021.
The court heard that various parties involved in Shane’s care – including Tusla, Cahms and New Beginnings – held meetings to plan how Shane would be accommodated and cared for in the months before his 18th birthday, and afterwards.
It was agreed that Shane would stay with family members during the Christmas period, the court heard. On December 29th, Shane’s mother brought him to TUH following a “serious” suicide attempt.
The court heard that Shane’s mental health difficulties were linked to his addiction to cannabis. Ms Scanlon said staff at New Beginnings had no power to stop Shane from smoking. Several professional witnesses testified to Shane’s unwillingness to stop using cannabis.
Separately, Seán O’Connor, Shane’s grandfather, said from the body of the court it was important to say that “[Shane’s late mother] Sinéad and Shane were very, very close”, and “they loved each other madly”.
Joyce Connolly, a principal social worker with Tusla, noted Shane’s relationship with Ms O’Connor was “complex and turbulent”, and that “in some ways”, she believed that they “depended on each other a lot throughout their lives”.
Dr Tara Rudd, a psychiatrist who cared for Shane during several of his admissions to Linn Dara, said that Shane vocalised anxiety around turning 18, and what the repercussions would be for him as he transitioned out of childcare services.
She said Shane also described having a “great love” for his family, and that “spending time with his family and getting his own place was all he wanted”.
Shane’s three half-siblings, Jake Reynolds, Róisín Waters and Yeshua Bonadio, were present in court on Tuesday, along with Shane’s uncle Joseph, father, grandfather and other extended family.
Coroner Dr Cróna Gallagher extended sympathies to Shane’s family, stating that her court was “all too aware” of the “devastating impact” that the death of a child can have on a family.
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