Army's delay in finding soldier's body in barracks ‘unforgivable'
Father-of-three Lance Corporal Bernard Mongan's decomposing body was discovered on January 23 2020 in his bedroom at Catterick Garrison, North Yorkshire.
An inquest at North Yorkshire Coroner's Court heard the 33-year-old's medical cause of death was 'unascertained' as decomposition made it difficult for doctors to determine.
On Thursday senior coroner Jon Heath said it was 'not possible to determine' whether L/Cpl Mongan died from suicide or natural causes and recorded an open conclusion.
The conclusion said there was nothing found at the scene or in the post-mortem examination to explain how he died, adding: 'The cause of death is unascertained and it is not possible to determine how he came by his death.'
L/Cpl Mongan's widow Beth Mongan, who was separated from him at the time of his death, said the conclusion was 'an enormous disappointment' and that he was 'very badly let down by the Army'.
The inquest heard L/Cpl Mongan had complained of being bullied by senior officers and that five junior soldiers and two senior non-commissioned officers had informed the chain of command that he was being treated differently.
Former corporal Stephen Timmerman said 'bullying would be an understatement' as he described how L/Cpl Mongan was 'shouted, screamed and swore at', made to clean senior officers' cars in his own time and 'forced' to do extra runs in his lunch break without being given time to eat.
Three other witnesses said he was 'spoken to in a despicable manner,' '100% victimised' and 'never spoken to respectfully'.
Mr Heath said in his findings following the inquest that L/Cpl Mongan was 'on occasions treated and spoken to by his chain of command in a way that caused him distress'.
The coroner said L/Cpl Mongan was not checked on in his accommodation block over the Christmas period, and had been due to start a deployment with 77 Brigade in January, but was not reported absent by them 'as he should have been' from January 7.
The Centre for Military Justice, which represents Ms Mongan, said the last person to speak to L/Cpl Mongan in the early hours of January 2 described him as distressed, crying and drunk.
They said: 'Bernie was supposed to be checked on over the Christmas period while he was staying alone in his Army accommodation – astonishingly one of the men Bernie had accused of mistreating him was assigned to do those checks and he admitted at this inquest that he did not perform a single one of them. For that failure, he was ordered to perform an 'extra duty' as punishment.'
The inquest heard he had attempted to kill himself several years earlier when his marriage was breaking down.
In the days before he was last seen in January 2020 he gave away his Nintendo to a friend's son, told another friend he 'had bought pills but not taken them' and made two donations to a suicide charity.
Mr Heath said: 'However I also find his previous attempt to take his own life was caused by feeling he was not going to see his children again – this was not the case at this time.'
He also said L/Cpl Mongan was looking forward to his new deployment and had made a list of 'things to do in 2020″ on a post-it note which was found in his room.
The inquest heard the two most likely causes of death were considered to be self-inflicted poisoning, after barbiturates were found in L/Cpl's system – one of which was bought illegally – or a sudden abnormality of the heart, but a Home Office pathologist told the inquest he could not say which of these was the most likely.
Dr Nigel Cooper said: 'I've thought about this long and hard but I just don't think I can, I don't think I have enough positive evidence to go in one direction or the other.'
Speaking after the inquest, Beth Mongan said: 'I was expecting (the open conclusion), mainly due to the Army's failure of leaving him for so long but I've come to my own conclusions over the years. It's hard not having it for the kids.'
She told reporters: 'Knowing Bernie, and he did suffer with his mental health over the years and his treatment in the Army, I believe he took his own life.
'I believe (the Army) failed him, they didn't investigate the bullying accusations they way they should have done.'
Ms Mongan said the fact that L/Cpl Mongan was undiscovered for three weeks on a military site was 'unforgivable,' adding: 'I know they've apologised but that doesn't take away the fact that they failed him on that front. It forever will be unforgivable.'
An Army spokesperson said: 'Our deepest sympathies remain with the family and friends of Lance Corporal Bernard 'Bernie' Mongan. His loss has been profoundly felt throughout the Army, but we recognise that no one has felt this tragedy more deeply than those closest to him.
'The Army accepted and is actioning all of the recommendations identified by the Service Inquiry report into Bernie's death. We deeply regret and apologise for the shortfalls in our duty of care towards him, which were clearly unacceptable. We're grateful to HM coroner for the thorough and diligent examination of the circumstances surrounding his death.
'Bernie's service will not be forgotten, and we owe it to his memory, to his loved ones, and to all who serve to ensure that we consistently and diligently provide the duty of care our people need and deserve.'
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