A little girl’s suicide may have been averted if there had been better resources
When Milly Tuomey’s mother first brought her to see her GP, the child stated clearly that she had thought about suicide.
“We would often see children with anxiety or low mood. This was a relatively young age to present with unhappiness of the physical appearance.”
The GP told the court that Milly “admitted to no obvious trigger for these feelings”.
He discussed two options with the family at this point: the clinical route, which would likely involve medication; or the ‘talking route’ which would involve cognitive behavioural therapy.
Talking therapy could help get to the root of the problem, the GP said. “There may have been something there that she wasn’t willing to discuss with me, her parents or her friends,” he said.
The Tuomeys were left to make the decision. They explored the public health route, which involved a waiting list and found the private route was faster.
Their GP recommended a clinical psychologist at a private clinic, An Cuan Centre for Psychological Services in Rathgar. Upon contacting the clinic, the Tuomeys were advised the recommended psychologist was not taking on any more patients and they were offered an appointment with the first available therapist.
They had an initial meeting with an art psychologist, who was not qualified to make clinical decisions, on November 17.
Asked what he intended for Milly by orally referring her to the private clinic, the GP replied: “A psychological assessment about where these thoughts were coming from and tools to deal with these thoughts.”
However, the GP was not made aware that the art therapist was not qualified to conduct a clinical assessment. The family were left struggling to fathom the origin of their daughter’s distress. “Milly had written notes about hating herself, about wanting to die,” her mother told the inquest.
Asked by the coroner if Milly had ever been exposed to the concept of suicide, Mrs Tuomey replied no.
“There was no family member that died by suicide or had attempted it. There was no movie or information, celebrity or otherwise that put it in her head. This was a bolt out of the blue,” she said.
Parents Fiona and Tim sat down with Milly and tried to explain the finality of death: “We explained to her the concept of dead being dead. That there was no coming back.”
Milly began a course of hour-long weekly appointments with the art therapist on November 24.
The aim was to encourage the child to talk about her issues through verbal and visual means.
However, the ‘talking therapy’ process was overtaken by events as Mrs Tuomey made the terrifying discovery of a “suicide diary” under her daughter’s bed. It contained entries about Milly’s desire to die and details of different methods she had attempted.
Her mother learned that her daughter had cut her arms and legs with scissors and written in biro across her stomach the words, ‘Beautiful girls don’t eat.’ The Tuomeys immediately contacted Milly’s therapist, who advised they seek an appointment at the HSE’s Child and Adolescent Mental Health Services (CAMHS). The referral on December 8 saw an appointment scheduled for January 30, 2016. This was brought forward to January 5.
Milly had her last appointment with her art therapist on December 22.
“Her mood had lifted. She was still a little sad. But she was looking forward to Christmas,” the art therapist told the inquest.
From December 22, the Tuomeys were facing a two-week period where their only option in a crisis situation was to bring their daughter to the emergency department. Six weeks on from Milly’s initial Instagram post stating her intention to die on a certain date, there still had been no clinical assessment of her psychological state.
The coroner’s expert witness, psychiatrist Dr Antoinette D’Alton, told the inquest that there are long waiting lists for many public and private services and most suicidal cases enter the health system through the emergency department.
“Years ago this would have been unimaginable. Now suicidal ideation is increasing in children as young as seven,” she said.
Asked if it was fair to say the system hasn’t kept up with developments, Dr D’Alton said the existing care pathway is under resourced. “There aren't existing resources to man an out-of-hours services. A nine-to-five service is not gold-standard,” Dr D’Alton said.
On New Year’s Day, 2016, Milly made a lethal attempt at self-harm. She died four days later at Our Lady’s Children’s Hospital in Crumlin. Her CAMHS appointment was scheduled for the following day.
If you have been affected by the issues above contact:
Samaritans: 116 123
Pieta House: 1800 247 247 or text HELP to 5144
Bodywhys: 1890 200444
Childline: 1800 666666 or text TALK to 50101