The mother of a young man diagnosed with schizophrenia has expressed concern about her son, whose life she believes is at risk, due to his discharge from mental health services.
The woman, who wishes to remain anonymous to protect the identity of her son, has spent over four years advocating for him to receive adequate treatment.
The 23-year-old is homeless.
Described as a somewhat sensitive child, the young man – who we have given the pseudonym ‘Tony’ – grew up as a healthy boy who thrived physically.
At 15, he told his mother he had experimented sharing a joint (cannabis) with his friends. He admitted that it had lessened his anxiety and his body completely relaxed.
Tony didn’t show signs of a habit but his mother took action by securing therapy sessions for him.
At 18, he refused the support that was being offered and his mental health declined.
When the Covid-19 pandemic hit, Tony found it increasingly difficult to get out of bed and became “distressed in himself”. His mother was worried.
Then, one morning he emerged from his bedroom onto the landing and asked: “Where’s my mum?”
Alarmed, she told him she was his mother. Tony was in the midst of a psychotic breakdown.
In the early stages of psychosis, he continued eating and grooming himself, but his paranoia was extreme.
Tony questioned whether his mother had been coerced by the CIA to put a chip in him. He plucked the air and spoke to things that were not visible to anyone else.
Believing he was in danger, he disappeared into the Dublin Mountains “to protect himself” and lived in a tent for a time.
A bed was eventually made available to him in homeless services.
‘Schizophrenia with pronounced symptoms’ diagnosis
Following the episode on the landing, Tony was taken to a hospital emergency department numerous times over an 18-month period.
His mother was told by mental health consultants that he was not going through psychosis and it was possibly a personality disorder.
“I was told it was ‘a dynamic issue between a mother and a son’. I was told we might need to put some geography between us. I was guaranteed I was not at risk.
“I would keep trying to bring him to A&E, but they would refer to the consultants’ notes, which said he was not psychotic, and they would discharge him.”
In January 2024, Tony was admitted to hospital for a third time.
At 8pm on a Monday night, his mother got a call to say his involuntary order had been revoked and that he had taken his own discharge that day.
During the phone call, she was informed that her son was “gravely ill” and that he had a life-enduring, severe case of schizophrenia.
At this stage, Tony’s mother had spent almost three years seeking help.
She had to process that her son was not psychotic; that he had “schizophrenia with pronounced symptoms and a poor prognosis for the future”.
He would never live a normal life.
Having felt like she had been “gaslit” for years, Tony’s mother felt so much time had been “wasted”.
The opportunity of early intervention – recognised as leading to better outcomes – was gone.
“I can only equate it to bringing your kid with Stage 1 cancer to the doctor who says come back when it’s Stage 4.
“You’re going back again and again because early intervention is key, and eventually the doctor says it’s now Stage 4 and there’s nothing that can be done,” she says.
Involuntary admission order revoked
Early Intervention in Psychosis (EIP) is an evidenced-based approach that can transform the experience and outcomes of young people facing psychosis.
This was acknowledged by Minister for State with responsibility for Mental Health Mary Butler in a written reply to a parliamentary question last year.
She said the EIP programme was funded by over €5m annually, with a number of multi-disciplinary teams operational. However, they’re not available in every area.
If that’s the case, it must be questioned if many other young men and women have failed to get early intervention.
During an admittance to hospital last September, Tony was put on a different medication to a three-month injection that he had been on.
After four or five weeks, there was a “minuscule” change when he asked his mother how she was.
Taken aback, she said that she was fine and asked how he was doing. It was the closest to a normal conversation she had had with her son in years. It was “gold”.
Then, Tony’s involuntary admission order was revoked.
‘He’s treated like someone with agency over his life, yet he’s like someone with Alzheimer’s in many ways’
Detention is a legal process and in this case, when gardaí picked him up in September, he was brought to the station where a GP referred him for involuntary admission.
His psychiatrist deemed Tony to be detainable, and as is the case in these situations, it went to a tribunal where it was ruled lawful.
However, just as he was showing slight signs of improvement, the order was revoked and he was informed that he was “voluntary”. The 23-year-old knew he could leave the hospital, and so he did.
For four years, Tony’s mother has been writing to mental health services, to politicians, to anyone who could possibly help, with no results.
“He’s treated like someone with agency over his life, yet he’s like someone with Alzheimer’s in many ways.
“If he thinks I’m going to keep him in hospital, he will withdraw consent to have me involved at all.
“Then, if I ring the hospital to see if he needs anything, I may discover that he has taken his own discharge and they were unable to inform me.”
Tony needs to be admitted involuntary – mother
What happens in a 24-hour period at the moment is “unmanageable”.
Due to members of the public contacting gardaí about Tony’s wellbeing, she receives calls “several times a week”.
She spends nights searching for him on the streets. If she gets him into the car, he will sometimes jump out in traffic.
Tony’s illness and paranoia are at such a level that, since last July, he has regularly refused to enter the homeless shelter where he has a bed.
He also has a tendency to lose coats, resulting in his mother replacing up to two a week, otherwise he will wander the streets in a t-shirt.
The recent wet weather and any cold snap consume her with worry over potential hypothermia.
“He’s walking and pacing a lot. He might go to a bus stop, sit down for a short while, and then keep moving again. He remains outdoors for days.”
‘He needs a secure ward long enough to be stabilised and he’s never been given the chance’
Exploration of the private system informed her that Tony would have to take his own discharge from the public system to do so – an impossible task when a person doesn’t believe they are unwell.
She believes that he should be admitted involuntarily, which she acknowledges is “cruel”, but is what her son requires.
“He needs a secure ward long enough to be stabilised and he’s never been given the chance.
“It takes months and months to get him committed and then he is not kept for long enough. So, he comes out as bad as he went in and the cycle begins again – trying to get him into hospital for stabilisation.”
‘Comprehensive’ involuntary admission criteria – minister
Tony’s mother believes that his autonomy and rights as a patient do not facilitate the treatment of his illness.
New mental health legislation, due to be enacted this year and designed to replace the 2001 act, has been described as “person centered”.
The legislation seeks to “modernise involuntary admission criteria and strengthen patient rights”.
The Department of Health says that any deprivation of a person’s liberty is an infringement of their rights and must be accompanied by robust legal safeguards.
However, people like Tony’s mother are of the view that the criteria takes little account of what individuals and their families are dealing with in practice.
The department says that the decision to make an order to involuntarily admit a person – under the Mental Health Act 2001 – is a clinical one that may only be made by a consultant psychiatrist.
Tony’s mother points out that the family’s voice has no part in the process, yet they are the caregivers and provide crisis supports between hospitalisations.
“We know the person and their day-to-day presentation best. We love them and want help for them,” she says.
The department says that a consultant psychiatrist must believe that, because of a person’s mental disorder, there is “a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons”, or where, without detention, there would be a serious deterioration of their person and that the detention and treatment of the person would alleviate his or her condition.
“If a person does not meet these criteria, he or she cannot be involuntarily admitted. If a person cannot be involuntarily admitted, he or she can access mental health care and treatment either in the community, or in an approved centre on a voluntary basis.”
Despite Tony being taken by gardaí (who his mother has greatly commended) on multiple occasions to a garda station for his own wellbeing, it’s not enough for him to secure the mental health support that he needs.
‘We know the person and their day-to-day presentation best. We love them and want help for them’
Unable to comment on individual cases, Minister Butler described the criteria for involuntary admission and treatment, as set out in the Mental Health Bill, as comprehensive and legally robust.
She believes it strikes an appropriate balance between ensuring timely access to care while respecting that involuntary admission and treatment must be a last resort.
That “balance” is questionable when people like Tony, who are severely ill, are wandering the streets, not knowing they are unwell.
His mother points out that he has been given agency over his life when he can’t keep himself safe and sheltered.
“He has been exploited into giving his disability payment away several times in the past year.
“What about the compassionate and humane approach of treating psychosis as a medical emergency – not as something where someone often has to become violent towards themselves or another to get treatment.”
People ‘end up homeless or in prison’, says Tony’s mother
The Department of Health says the bill contained “many complex ethical and legal issues, particularly in relation to involuntary admission and the criteria under which you can deprive a person of his or her liberty”.
It says the process governing involuntary admission and the criteria for circumstances where a person lacks capacity to make decisions about their own treatment were considered in great detail by officials.
The closure of congregated settings over the last 20 years has broadly been welcomed from a human rights perspective, resulting in people with severe mental health difficulties being treated in the community.
However, when the illness is severe, they are unable to engage with community supports or the assistance is not substantial enough to enable people, like Tony, to live safely.
His mother says there are not enough inpatient psychiatric beds or long-term residential supports for people like her son.
“So, he and others like him end up in the homeless system, where drug use is rife, or they end up in prisons.”
In a statement, the Health Service Executive said that acute hospitals and mental health services work together to ensure safe, timely and person‑centred discharge for individuals admitted with mental health needs.
It said that discharge planning starts at, or as soon as possible after, admission and is coordinated by the multi-disciplinary team in line with the Mental Health Commission’s Code of Practice on Admission, Transfer and Discharge.
But what are the options for someone like Tony, other than homeless shelters, when they are no longer able to manage living with family.
When his recent involuntary admission order was revoked, he told staff that he would go to a shelter where he rents a bed. However, he ended up outdoors again.
Despite his mother explaining this outcome, the discharge went ahead.
Requirements over ‘capacity and consent’ – HSE
The HSE said that for individuals experiencing homelessness, specialist teams such as the Assertive Community Care Evaluation Team (ACCES), which is a homeless mental health service, work closely with hospital and community partners to provide follow up, medication support and practical assistance.
Tony’s mother acknowledged that the ACCES team has been excellent, but believes it is limited in what it can do.
“People like Tony need greater residential care and support in the community,” she says.
Like the Department of Health, the HSE points to requirements over “capacity and consent”.
“Services cannot detain or treat individuals against their will unless criteria under the Mental Health Act are met. This integrated approach helps maintain continuity of care and supports recovery in the community.”
Similar to other parents in support groups she attends, Tony’s mother has witnessed her son falling through gaps in community services.
Professor of Psychiatry at Trintiy College Dublin Brendan Kelly said the revision of legislation needed to consider the full range of rights: right to liberty, right to treatment, and right to live a dignified life.
While this has many benefits, he said, he pointed out that it also meant many people with serious mental illness end up in prison for minor offending, rather than being treated promptly.
Ideally, Prof Kelly believes the revised legislation should facilitate prompt treatment and support for people who are so mentally ill that they lack capacity to make decisions for themselves.
“While it would need to be accompanied by robust safeguards, effective treatment should not be delayed.”
Read more:
RTÉ Investigates: Surge in actively psychotic patients held in prisons
Tony’s mother is one of many people in the State battling a system of red tape.
What is often forgotten is that parents like her face unimaginable grief for the children who have changed so dramatically due to mental illness.
Sadly, grief is paused and unaddressed for years due to the day-to-day struggle in keeping their adult children alive and from decompensating even more from harming themselves or others.
Tony’s mother will continue to advocate, although she is exhausted from the relentless grief and chaos.
“My son lived for 19 years without psychosis, he engaged fully in life. He would be horrified if he could understand what is happening to him.”
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