Darren* is 36 years old. Born with an intellectual disability, he has been lovingly raised by his parents, and subsequently by his sister and her family. He enjoys word searches, and roast beef dinners. He has also battled epilepsy most of his life, with regular disabling tonic-clonic convulsive seizures, despite multiple medications. He developed psychosis and violent behaviour three years ago, prompting psychiatric admission and medication. He started attending Beaumont Hospital in 2017, where he first attended the Accident and Emergency Department eight times there, and he has had five admissions to an acute neurology bed. He has had five neurology clinic visits and eight telephone encounters with the nurse-led telephone advice line. He has developed osteopenia (thinning of the bones), kidney stones, and falls, as a result of medication.

During one of these admissions, his sister was unable to take him back – dedicated and caring, an unsung hero of our healthcare system, she couldn’t cope anymore whilst waiting two years for community placement. He remained on the neurology ward awaiting transfer to a managed care setting for 166 days. As a result of being confined to the hospital ward he developed a pulmonary embolism requiring blood thinning treatments, and also a degree of institutionalisation resulting in the development of non-epileptic psychogenic seizures. These resulted in further visits to the Accident and Emergency Department and over-treatment with anti-epileptic drugs. Finally, a care package worth 250,000 euros per year was approved and he is now in a managed care environment, and much more stable and content. Darren is one of our most vulnerable members of society, with complex neurological and medical needs, who is now thriving in a managed respite environment, but having gone through intense excessive and inappropriate utilization of healthcare and financial resources to get there.

*Not his real name.