Today I attended the inquest of Jake McGill Lynch, which concluded with the Coroner returning an open verdict. Firstly, amid all the legal argument, there was an infinitely more important factor; Jake..
In 2012 Jake was diagnosed with aspergers syndrome; he was just that ‘little bit different’ ye see. He was a little too intelligent; too good; too kind; too perfect to be perceived as a ‘normal’ disruptive adolescent. I often wonder why psychiatry gets to define what is ‘normal’, considering the lack of any scientific tests to determine otherwise. Are we not all individuals with traits that others would see as abnormal? Are our strange and weird traits not what makes us likable, or even unlikable? Sure, Jake liked routine and things to be in order, a place for everything and everything in its place – not a bad trait I’d say, but nowadays it’s ‘diagnosable’. This extraordinarily intelligent young man was diagnosed, labeled forever, for being just that little too perfect.
Jake was an articulate, handsome young man. He had an online girlfriend, loved to play with his Lego and like ‘normal’ 14 year olds, spent hours on his beloved Xbox. He had joined a gun club with his mam and idolized his big brother and little dog Charlie (equally). He loved his native language and was a fluent Irish speaker.
Jake was primarily a happy camper with few problems, apart from feeling a little anxious on stressful occasions. He was attending a counsellor to help with his feelings of anxiety. When the counsellor decided that Jake didn’t need any more sessions as he was “the happiest she had ever seen him”, she referred him to a psychiatrist. His mam thought that this referral was in order to sign Jake off. Inexplicably, instead of signing Jake off, the psychiatrist prescribed Jake an SSRI Fluoxetine (aka Prozac), to ‘help with his exams’. Neither his mam or dad were given a patient information leaflet (PIL) or any information on side effects – suicidality or otherwise. Therefore, they were not told that SSRIs, including Prozac, doubled the risk of suicide.
Jake’s medication was doubled after a week, without seeing the prescribing psychiatrist. He became increasingly restless and had a meltdown in school which was totally out of character. 46 days after his prescription for Prozac, Jake’s parents found him on the floor of his bedroom – he had shot himself in the head with his legally held rifle. He was rushed to hospital but declared dead a short time later.
The psychiatrist had previously testified that she prescribed Jake with Prozac ‘to help with his exams’ because he had had ‘a meltdown’ while doing an Irish exam. This off label prescribing is truly shocking, but what is worse is the fact that Jake’s ‘meltdown’ occurred 5 days AFTER he was prescribed Prozac, not before. Why would a doctor get this so wrong? Is covering their own backsides more important than revealing the true circumstances surrounding the death of a 14 year old child? Do Jake’s parents not deserve to be presented with all the facts, not a cover-up? The HSE’s barrister spends a lot of time in the Coroner’s Court – he’s obviously very good at what he does. Personally I think an apology would be far cheaper. Jake, the 14 year old child in the middle of all this, seemed to get overlooked in copious legal argument.
The Irish drug regulator, HPRA, states that ‘Prozac is not for use in children and adolescents under 18’ here. The HPRA further states that if Prozac is prescribed off-label to a child over 8 (Sweet Jesus) with ‘moderate to severe major depressive disorder’, that it should be offered only in combination with psychological therapy. JAKE DID NOT HAVE DEPRESSION! In 2005 the Committee on Human Medicinal Products, CHMP, advised that SSRIs ‘should not be used in children and adolescents except within their approved indications – not usually depression – because of the risk of suicide-related behaviour and hostility’. If prescribed off-label, the CHMP recommends that patients should ‘be monitored carefully for the appearance of suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment’. Why then was Jake’s prescription for 10mgs of Prozac doubled the following week, without even seeing the psychiatrist? I would not call that careful monitoring.
What was particularly grueling for the family, was the 13 appearances in the Coroner’s Court, mainly for legal arguments over whether the family had a right to call an expert witness (David Healy). Not surprisingly the HSE barrister was vehemently opposed to David Healy taking the stand, stating that if he was allowed to be the family’s ‘expert witness’, they (the HSE) had an ‘expert witness’ who would say the opposite. I’m sure they had! The coroner refused the family’s request, referring to the limitations of the Coroner’s Act 1962 and the case of Eastern Health Board v Farrell, but said he’d have no objection to the family having an expert to ‘advise’ them on the day. By this stage Dr Healy was in the US, so Declan Gilsenan (retired assistant state-pathologist) came to the rescue and stepped in to advise Jake’s family. He has publicly stated “Based on my experience of doing postmortems on people where anti-depressants have been started fairly recently I would have concerns about the link to suicide”.
It is of particular significance, that in May 2012 Dr Gilsenan attended Leinster House with Dr Healy, warning that these drugs were causing many deaths and asking for an investigation to be initiated. Nothing was done – NINE months later Jake was given a prescription for Prozac and the cycle continued.
What was awful today, apart from hearing the circumstances of Jake’s death, was looking into the faces of his grieving parents. That familiar look of unbearable pain etched on their faces, the unbelievable loss of their son who had so much to give – all totally avoidable. Another Irish boy lost through psychiatric drugs and another doctor being permitted to recollect ‘facts’ that just don’t add up; another mom and dad left bewildered and lost; another year, another death and still our Ministers avert their eyes and do nothing. Shame on them and the Irish Government.
The coroner, having heard arguments for the rights and wrongs of prescribing Prozac in children, said that it was “beyond his capabilities to adjudicate on Fluoxetine” but could not ‘beyond reasonable doubt’ say that Jake intended to take his own life. He then rejected a suicide verdict and returned an open verdict.
Dia leat Jake. Ní dhéanaimid dearmad ort go deo.
The last word must go to Jake. It clarifies exactly what his family have been fighting for. In an e-mail the night before his death, he said (verbatim).. “The ‘anti-anxiety’ stuff is actually an anti depressant which they didn’t tell me. Probably doesn’t make much of a difference, but I feel like I’m drugged to the point that it suppresses everything bad until it suddenly spills out.”