Graham Dwyer Trial: Elaine O'Hara told doctors she was 'fighting a losing battle' in weeks before disappeared, court hears
Psychiatrist who treated her described this as a 'dip' and felt condition improving overall
ELAINE O'Hara told doctors in the weeks before she disappeared that she felt like she was "about to burst" and that she was "fighting a losing battle."
However, her psychiatrist told the Central Criminal Court she had been in this frame of mind many times before and while this was a "dip", he felt her condition had been improving overall.
Dr Matt Murphy was being cross-examined by the defence in the trial of Graham Dwyer this afternoon.
Mr Dwyer (42), of Kerrymount Close, Foxrock, is pleading not guilty to the murder of Ms O’Hara (36) at Killakee, Rathfarnham on August 22, 2012.
Ms O’Hara, a childcare assistant from Killiney, was last seen alive near Shanganagh Cemetery in Shankill that day.
Her remains were found by a dog walker in undergrowth in the Dublin mountains on September 13, 2013.
The prosecution maintains Mr Dwyer killed her for his own sexual gratification.
Defence Barrister Ronan Kennedy continued to refer to notes from Ms O'Hara's records from St Edmundsbury Hospital.
The court heard on August 6, there was a note that she stated she had a good weekend but continued to seem angry in manner and slept poorly.
She had been working at the weekend but complained of feeling fleeting suicidal thoughts and said she felt safe in the ward.
The next day, August 7, 2012, it was noted that her mood “wasn’t great” and she said: “I didn’t have a good day.”
Read more here: Elaine 'playing dangerous game' with architect, warned friend
Later, she was restless and the note stated she: “wishes she would not wake up in the morning but denies any suicidal plans or intent at present.”
Dr Murphy told Mr Kennedy he believed this was less strong than suicidal ideation and described it as a “passive death wish.”
There were references to things that may have been on her mind such as her exams being deferred.
At this time, Dr Murphy said he was thinking about a lesser dose of medication, which might have suited her better in terms of “less variability in mood.”
Read more here: 'Lonely' Elaine thought she 'wasn't born for life'
This was against the background of her medication having been reduced over a number of years, Dr Murphy said.
Her mood swings were of ongoing concern and it was a case of “trial and error,” he said.
An entry in the notes referred to her taking a rope from her workplace but later discarding it.
Dr Murphy could not recall if this was the first time this was mentioned.
On August 8, 2012, her mood was described in the notes as “flat”. There was a care plan review and Ms O’Hara was asked for her views.
“Mood swings are bad and I feel I am about to burst,” she was noted as saying. “My chest is heavy and mixed up, as is my head. I am frustrated, I am so angry and fed up. I am fighting a losing battle.”
Read more here: A sad history of self-harm, anxiety and depression
Dr Murphy agreed that this was following a weekend of leave. It was noted that she was “minimally improved.”
“From a long acquaintance with Elaine, the feeling was overall that she was improving,” Dr Murphy said. “Her behaviours were not as extreme as previously in the overall context of things. Even though this was a dip, the general feeling was that things were getting better.”
He added that Ms O’Hara would have been in “that place, in that frame of mind many times before.”
“We took it seriously but it wasn’t terribly new,” he said.
Read more here: Elaine O'Hara in her own words
Her risk assessment was put at medium at that time - Dr Murphy explained that there were only three categories and “high” was for someone more immediately liable to harm themselves.
On August 8, she was again expressing suicidal thoughts but denied any intent or plan. She was feeling flat but going on a day’s leave to work.
The next day, August 9, it was noted that she was anxious and agitated and there was a “superficial laceration to her left forearm.”
Dr Murphy did not recall how this happened.
Asked if he considered this an escalation because she had not self harmed for two years, Dr Murphy said he would have had doubts that this was the case.
Another entry stated: “self-inflicted scratch after work to relieve tension.”
On August 13, it was noted she felt OK, her manner was pleasant and she felt safe and comfortable in the hospital.
On August 14, she was “much improved” and another notes said she appeared “irritable but lighter overall.”
In the next care review plan, on August 15, Ms O’Hara was noted as saying: “Things seem to be improving.” She said she was leaving the following week but was not sure she trusted herself. She was “kind of scared.”
She later described her mood as good but she continued to experience some anxiety.
Dr Murphy explained that showed Ms O’Hara “is worried about going home at the weekend but understands it is a step she needs to take.”
Asked if the hospital was “essentially a comfort blanket,” Dr Murphy said: “I suppose so” and explained that while she was getting extra support, the downside was that “she can’t live in the hospital forever.”
The jury then saw a hand-written note penned by Ms O’Hara on the day of her discharge
"I’m leaving today [Wednesday] I am a bit scared and I know this is natural,” she wrote.
"I want to take the opportunity to thank the caterers, the cleaners, nurses and of course doctors. Thank you, Elaine."
Dr Murphy noted underneath that she was happy to be discharged but nervous.
He agreed with Mr Kennedy that immediate period after discharge is seen as a high risk period for self harm or suicide.
He also told the court he was not aware that Ms O’Hara had told another patient the previous day that if she were to commit suicide it would be with a rope that she kept in her apartment.
However he said it "might or might not" have changed his decision to discharge.
"It’s hard to be sure," he said.
"As I say, Elaine did self harm, Elaine had suicidal thoughts and it’s perfectly possibly if I heard of that conversation and delayed her discharge for a week or month would the same level of risk still be there at the end of that time?"
He stressed several people detected a certain degree of maturing and focus and there were "immediate plans to do A, B and C" which she seemed committed to and the balance was to be as supportive as possible while gently urging her to keep her life going.
"The immediate risk was low and the correct decision was to discharge to forge an independent existence. The commonly held view in hospital was that she was making ground."
The psychiatrist said teenage fantasies and preoccupations with play faded by the time he met her in 2007.
Under re-examination, Dr Murphy told Sean Guerin SC, prosecuting, her problems were "more about the practicalities of living and low self esteem".
While her admission sheet marked her as not being in a relationship since she was 18, it also stated "has suicidal thoughts all the time, denies any plan or intent".
A man was never discussed during her care and two "stresses" that came to his mind were the flooding of her apartment and her exams.
In a discharge summary from October 2012, which was never posted to her GP Dr Matthew Corcoran because she had disappeared, Dr Murphy’s registrar noted she was "calm, relaxed, no active suicidal thoughts or plans" and no psychosis.
There was also no suggestion from the records that she did not comply with medication, he added.
The trial continues before Mr Justice Tony Hunt and a jury of seven men and five women.
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