Ailish* struggles to remember how many times her son Brendan* has knocked her unconscious. It might be three of four. Or it might be more like four or five, she says.
She’s similarly unsure how many windows he’s broken, but it’s a lot. Since 2014, Brendan* has had about “40 or 50 episodes”, Ailish recalls.
Sitting in the lobby of a hotel in the midlands with her daughter Maura*, Ailish is quick to follow up accounts of Brendan’s violence with stories of the boy he was before the crash — a bright, kind teenager who liked drawing and wanted to be a vet when he grew up. “He loved animals.”
On a Friday evening in 2014, Brendan finished up his shift at a local restaurant and headed out to an 18th birthday party. Ailish says she never knew him to have a drink but that he drank that night and, in the early hours of the morning, ended up in a car being driven by an older teenager. The car hit a wall, killing the driver instantly and throwing Brendan through the back window.
He was brought by ambulance to Limerick University Hospital where he was put in an induced coma; a hole was drilled in his skull to allow doctors to monitor the pressure on his brain.
It was determined Brendan had a bleed on the brain. He was discharged from hospital one week later, two days after coming out of the induced coma. Ailish says she knew he had a brain bleed but says no one mentioned anything about brain damage at the time.
Over the next several weeks Brendan’s family noticed small changes. He was clumsy, forgetful and “walking different”, Maura says. “You could see his personality change, he was more withdrawn.”
However, the changes were subtle and his family was not overly concerned. Ailish put it down to post-traumatic stress of some sort and, at Brendan’s check-ups, doctors assured them he would improve.
He continued to get worse and was starting to become aggressive. Ailish sought more help and, a year after the crash, she secured an appointment with the National Rehabilitation Centre in Dún Laoghaire in Dublin.
Over the course of a week, staff assessed Brendan before bringing the family in. Ailish remembers the doctor’s exact words: “Your son has sustained a significant amount of brain damage.”
When the car hit the wall, Brendan’s brain impacted against his skull, causing damage to the frontal lobe, she was told. “That was the first time I heard he had any sort of brain damage,” his mother says.
Doctors told her that because his brain was still growing, the injury would grow along with it and his symptoms were almost certain to get worse. Like his mother, until then Brendan had no idea he might have brain damage. When he was told, he fled from the hospital and was missing for several hours before gardaí brought him back.
This was when the family’s problems truly started. Brendan returned to school but could not settle in class. “He’d be up and wandering around and doing odd stuff and he’d be sent home,” Ailish says. He sat his Leaving Certificate but got poor results.
“He’s extremely intelligent. He’d be getting books from the library to read about brain injury. It’s the behaviour side of things that’s the problem.”
The first violent episode occurred when Brendan was 17. He broke doors and windows in the house and chased his mother with a knife, accusing her of interfering with his life. “I had to ring the guards, which is an awful thing to have to do on your own son.” It was the first of many times.
Brendan was taken by ambulance to an adolescent psychiatric unit. He was discharged a week later when he turned 18, Ailish says, and given a prescription for medication.
The medication helped calm Brendan. But he learned that, because he was now 18, he could refuse any more medication and his episodes became more frequent and more violent.
“Without his meds he became very delusional. He would think he was Jesus Christ,” Ailish says. “He would go out in the torrents of rain in nothing but a T-shirt and shorts and come in and blend grass and muck up in a blender, saying it was what he ate because he was a Neanderthal,” Maura says.
Brendan’s family began to notice the warning signs of an episode before it happened. “You know by the look of his face, his eyes change,” his mother says. “He would literally stare at you, it’s like he was looking into your soul.”
The teenager had grown into a strong, 6ft tall young man. “If he wants to do something, he’ll do something,” Maura says.
After a violent episode, Brendan would sometimes go to the Acute Psychiatric Unit in Ennis General Hospital in Co Clare. At first his treatment there had a positive impact, Ailish says. Brendan would sometimes be like his old self, or at least more manageable.
But the hospital was also struggling to handle him due to his violent outbursts. Ailish says he assaulted staff and patients. She says staff told her Brendan’s problems were related to a brain injury and not mental health and that Ennis was not the right place for him.
But there was nowhere else for him to go. While Acquired Brain Injury Ireland offers residential facilities for people with brain injuries, these are non-secure units, where people can come and go. Brendan had fallen between two stools.
Ailish would try to get her son in-patient treatment whenever she feared he might harm himself or others. But Brendan soon became wise to this. “He got clever. When the guards or [mental health] nurse would approach him he would say ‘no, I’m fine’. But he’d be telling us ‘I’ll see you in the next life’.”
On one occasion she tried to have him admitted to Ennis, only for medical staff to say it was not required, she says. Then Brendan sent her a photo of a rope on her phone. Ailish thought he had taken his own life. “I actually went screaming into the [Garda] barracks. It was after that that his own GP sectioned him involuntarily.”
The next morning she says she was told a doctor had overturned the committal order and Brendan had been released.
Brendan’s condition deteriorated further after his grandmother, Ailish’s mother, was diagnosed with cancer. “They were extremely close. He was aggressive and violent towards everyone else in the family but never, not once, with our grandmother. She could talk him round,” Maura says.
His behaviour “notched up”, Ailish says, and he started to make frequent suicide attempts, saying he wanted to get to heaven so he could meet his grandmother there.
“These were serious attempts. He wasn’t taking a handful of tablets, he was taking hundreds,” says his mother. There followed multiple hospital admissions to Ennis and Limerick University Hospital. “I don’t know how he is still here,” his sister says. The violence also continued. Ailish holds out her hand to show a scar where Brendan “sunk his teeth” into her.
During this period, the family came to rely more and more on the local gardaí. Some of the same gardaí had been at the scene of the crash in 2014 and knew what the family had been going through. “The guards have been the most help to us as a family. They’ve seen the changes in [Brendan].”
In February 2021, Ailish agreed to drive her son down the shop to cash in a scratch card he had won some money on. When they arrived, Brendan couldn’t find the scratch card and became aggressive.
He accused his mother of stealing it before bending the car door back on his hinges. Ailish had her young grandchild in the back of the car and was forced to drive off. Afterwards Brendan was brought back to the psychiatric unit where he was briefly kept as an in-patient. Ailish then got a barring order on the advice of gardaí, who said it would make it easier to get Brendan treatment in future.
This meant he could not stay at her home when he was released. “He was off his meds so I couldn’t let him back in. To do that to him, it was just so terrible. You couldn’t even imagine what it’s like, to know he’s out in the cold,” Ailish says, breaking down in tears.
Gardaí gave Brendan a tent and Ailish gave him jackets, socks and sleeping bags. Brendan would still come into the house for tea and food.
In March 2021, Ailish had allowed her son back into the home after another suicide attempt. She was cleaning the kitchen and asked Brendan to move so she could wipe down a counter. “He just stood up, said ‘you’re an evil woman’ and punched me straight in the face and knocked me out.”
She ran to the bedroom and held the door closed. On the other side, Brendan threatened to murder her and burn the house down.
He was arrested and brought before the courts before being bailed to the psychiatric unit in Ennis. However, it could not admit Brendan and gardaí brought him back to his hometown.
A week later he was sent to Limerick Prison on remand, his first time in custody, where he remained for 21 days. On his release he attacked his sister Maura’s house, breaking a window, setting fire to the curtains and forcing her to barricade herself in the bedroom with her children.
Almost every day since then Brendan has been in some form of institution, either as an in-patient or a prisoner. During one period in Limerick Prison he was on 23-hour lock-up and would only be released from his cell in the company of several officers in riot gear.
Last September, a local judge dealing with one of his cases said it was “scandalous” there was no secure medical facility capable of dealing with Brendan. Since then his family has been trying to highlight his case and to secure a place for Brendan in the Central Mental Hospital (CMH), the only secure facility in the country for dealing with mentally ill people involved in the criminal justice system. The issue has been raised twice in the Dáil by Labour’s Alan Kelly who said Brendan is being kept in prison because of a lack of places in the CMH. “It is scandalous that the State is letting him down. It is also costing a fortune.”
Simon Coveney replied that the situation seemed substandard and promised to look into the matter.
Last autumn, Brendan’s family got the news they were hoping for — a bed had opened up in the CMH. On arriving there his condition improved significantly, Ailish says.
The doctors could legally force him to take his medication and he was getting round-the-clock secure care. “They started from scratch with him and were giving him the treatment he should have got in the first place,” she says. “They were doing things like music therapy with him. And [Brendan] loves music.”
In recent years, there has been an increased understanding of the link between acquired brain injury and criminal offending. One UK study of 200 male prisoners found 60 per cent had suffered a traumatic brain injury. The figure for the general population is between 10 and 12 per cent. Last year, a report from the UK Inspectorate of Probation called it a “silent epidemic” in the prison system.
In some ways it is no surprise that those who suffer traumatic brain injury are over-represented in prison. Many people with acquired brain injuries have a lack of impulse control and a lack of insight into their condition, says Barbara O’Connell, chief executive of Acquired Brain Injury Ireland.
“I had a guy who was an absolutely lovely man. But he kept stealing. He literally stole my phone and my charger under my nose as I was watching. I laughed and said, ‘do you know you just stole my phone?’ He was so repentant and so sorry. But he still stole my phone.”
In some situations a secure treatment setting is required, “or at least a setting that has limits on it,” says O’Connell, who was speaking generally and not specifically about Brendan’s case.
People in such situations often do quite well in prison, she says, because they benefit from the routine and restrictions on their impulsivity. But prison is not suitable as the staff there are not equipped to deal with the condition.
Treating patients in the community is also difficult as they will often disengage from services, O’Connell says. “If we do social training, for example, they might come the first week and the second week but not the third week because they believe they are fine.”
What is needed is a secure facility specifically tailored to treat people with a brain injury which causes extreme aggression, ideally one close to the patient’s home. The problem is there are relatively few people with such complex needs in Ireland, making it hard for the HSE to justify the large investment this would require, O’Connell says. The only options remaining are the CMH or sending patients to specialist centres in the UK.
It is an issue which has come up before. In 2014 it was reported a man with a severe brain injury, who was subject to violent outbursts, was being kept in the Acute Psychiatric Unit in Ennis under 24-hour security at a cost of €408,000 a year. The only other option was a private facility which would cost €750,000 a year.
Several weeks after our meeting, Ailish is anxious to talk again. She is worried she has painted an overly negative impression of her son. “In between all the bouts of negative stuff, he can come back to himself in a way. The old him would come out in him. He’d give you hugs he’d make you coffee,” she says. “He loved singing before the crash. And he still sings.”
A short time later, she calls again. Brendan had rung her saying: “They’re trying to send me to another country and I’ll never see you again.”
Medical staff in the CMH believed it was not equipped to treat Brendan and wanted to send him to St Andrews, a medium-security facility north of London which specialises in complex cases of acquired brain injury, she says.
Ailish agrees the CMH cannot provide long-term care but is worried Brendan will not ever be well enough to return home. “On the other hand, what’s going to happen if they can’t take him?” There should be a facility for him in Ireland, she says.
Brendan has been assessed by staff from St Andrews and the family are waiting on a final decision.
Irish people have been sent to facilities like St Andrews before and have made significant progress, says O’Connell of Acquired Brain Injury Ireland. People can come home, she says. “But they don’t come back cured. What you get is a programme for how to manage them.”
Brendan’s mother says she has asked the doctors if he will return home. “Hopefully, they told me.” Comment has been sought from the HSE.
*Names have been changed
