Daniel McConville inquest: jury finds bullying by prison officers and lack of mental health assessment contributed to Lurgan man's death

Mr McConville was found unresponsive in his prison cell at Maghaberry on the night of August 29, 2018 and despite efforts to revive him he was pronounced dead shortly after midnight. The jury at the inquest into his death said it was ‘satisfied’ Mr McConville died by his own hand.

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He was a troubled youth having spent time in custody as a minor and was diagnosed with ADHD. He also had a history of depression, self-harm and drug abuse.

Mr McConville was a kitchen porter who lived in Lurgan when he became a remand prisoner housed at Maghaberry Prison on June 20, 2018 accused of being involved in burglary with intent to commit grievous bodily harm and theft. He was refused bail as he couldn’t provide a suitable address.

During the five-day inquest, the court heard from prison officers and senior officers plus a prison governor as well as one of the prisoners who claimed he knew Mr McConville. Also giving evidence was a nurse who carried out an initial assessment and a mental health nurse.

The prisoner, who gave evidence via video link from jail, claimed that Mr McConville was being bullied by a number of prison officers but this was denied by officers who said there had not been any bullying.

On August 29, 2018 a senior officer was dealing with a situation in one cell when she heard Mr McConville crying in the next cell. She said he was very upset and was pleading to be moved to another block, Donard, which was regarded as more suitable to prisoners with mental health issues. This senior officer opened a Supporting Prisoners at Risk (SPAR) process, which would mean Mr McConville was observed every 30 minutes. She also spoke to a governor on the Donard block who had no objections to taking Mr McConville.

However, another senior officer disagreed and claimed it was only for prisoners who were ‘acutely’ mentally unwell. It also transpired that Mr McConville had not been taking his medication and had handed his supply back to a nurse on August 28 – the day before he died.

The jury said it was ‘satisfied’ that Mr McConville died by his own hand but couldn’t reach a unanimous decision as to whether he intended to die.

They did point out a number of ‘acts, errors and omissions’ by the NI Prison Service and the South Eastern Health and Social Care Trust which the jury believed caused or contributed to Mr McConville’s death.

From the NI Prison Service, the jury outlined the following as causing or contributing to his death

• Bullying of Mr McConville by prison staff. Inappropriate level of professionalism.
• Mr McConville was denied a move to Quoile landing, Donard House. There was unsuitable reasoning for the denial of the move to Quoile landing. The level of care and respect towards Mr McConville was insufficient, unsatisfactory and lacking respect and dignity.
• Documentation was inadequate and unacceptable.
• There was a failure to document important information. Communication was insufficient and inadequate.

From the South Eastern Health and Social Care Trust, the jury cited the following as causing or contributing to the death of Mr McConville:

• There was a failure to see Mr McConville face-to-face to make a full assessment of his mental health. There was inadequate recording of returned medication and assessment for supervised medication needs.
• There was an omission of healthcare information on page 5 of the SPAR. There was an unsatisfactory level of care and detail when opening the SPAR. There was unacceptable, inadequate and insufficient use of computer records for ascertaining Mr McConville's medical history.
• Failure to visit and have face to face interaction with Mr McConville on August 29, 2018.

Portadown native Paul McConville, father of Daniel, speaking on behalf of his family, said: “This inquest has been a difficult journey. We do not want another family to go through the suffering that we have. We hope that the prison service and prison health care sit up and listen to the findings of this Inquest. Lessons need to be learned. There needs to be a proper review of all prisons so that further deaths are prevented. We miss you Dan and always will.”

Owen Beattie, Paul McConville’s solicitor, said: “The inquest into the circumstances into the death of Daniel McConville brought a spotlight to and exposed concerning allegations around the treatment of Daniel in Maghaberry Prison. During a week-long inquest in Armagh courthouse we heard evidence from a variety of witnesses which included prison officers, prison healthcare staff, a sentenced prisoner and indeed Daniel’s father Paul.

"This inquest gave a platform to examine the weeks and days leading up to Daniel’s death. This inquest was presided over by the senior coroner for Northern Ireland, Mr Joe McCrisken. Given the death of Daniel while in prison custody the law dictates that this Inquest and its findings must be determined by a jury.

"After five days of evidence, the jury returned verdicts that there had been acts, errors and omissions on the part of both Prison Service and the South Eastern Health and Social Care Trust which contributed to the death of Daniel.

"The findings by the jury concluded that there had been bullying by prison staff towards Daniel, and that the documents held in relation to Daniel’s treatment were inadequate and unacceptable.

"The findings were extensive and highlighted a variety of concerning failures on the part of the prison regime.

"If there is a takeaway message from this inquest is that there needs to be a full root and branch analysis of the conditions faced by prisoners not just in Maghaberry, but in prisons throughout the country. The only appropriate forum for this is through a public inquiry.”