Urgent improvements in NHS mental health are needed to prevent more tragic children’s deaths by suicide

Urgent Improvements In NHS Mental Health Are Needed To Prevent More Tragic Children’s Deaths By Suicide

Nadia Persaud, the east London area coroner and the coroner who led the inquest about the suicide of Allison Aules, 12 in July 2022 has warned the health secretary that preventable child suicides are likely to increase unless the government provides more funding for mental health services.

Nadia Persaud told Steve Barclay that the suicide of Allison Aules highlighted the risk of similar deaths “unless action is taken”.

At the conclusion of the suicide Allison’s inquest, coroner Nadia Persaud highlighted a series of failures by North East London NHS foundation trust (NELFT) that contributed to her death. In her verdict, Persaud said: “Allison didn’t receive the mental health care which she should have received and I find that the absence of care contributed to her death.”

In a scathing report, Persaud has identified the under-resourcing of child and adolescent mental health services (CAMHS) as a significant contributing factor to the death of Allison. The report, which was addressed to Barclay, NHS England, and two royal colleges, expressed concerns about delays in Allison’s assessment by the mental health team due to the under-resourcing of CAMHS.

An inquest into Allison’s death found that the North East London NHS foundation trust (NELFT) was responsible for a series of failures that contributed to the tragedy. The delays and errors uncovered during the inquest, according to Persaud, shed light on wider concerns about funding and recruitment problems in mental health services.

Persaud’s report highlighted that the under-resourcing of CAMHS was not limited to the local trust responsible for Allison’s care but was a national issue of significant concern.

The inquest revealed that Allison’s situation deteriorated dramatically during the Covid lockdown. Her school referred her to NELFT in May 2021 due to concerns about self-harm, low mood, anxiety, and bed-wetting. However, she was not assessed for a period of nine months and never received face-to-face treatment.

Persaud’s report further stated that the delays experienced by Allison were unfortunately not uncommon within CAMHS teams across the country. She noted that there was a lack of evidence of any consultant psychiatrist taking charge of the team and highlighted difficulties in recruiting qualified psychiatrists.

The inquest also revealed that Allison was inappropriately discharged just weeks before her death, with input from a management team tasked with clearing a backlog of cases that had accumulated during the pandemic. The coroner criticized the poor funding of CAMHS, given that the region was facing 140 referrals of children and adolescents each week compared to only 10-12 in the 2010s.

Dr. Persaud expressed concern that if the ongoing under-resourcing of CAMHS services persists while demand continues to rise, similar future deaths may occur. The report called for immediate action to prevent such tragedies from happening again.

Barclay, along with the NHS, has been given until 25 October to respond to the report. Under the Coroners and Justice Act 2009, both entities must outline the actions taken and proposed to prevent similar deaths in the future, along with a timeline for implementation. If no action is proposed, an explanation must be provided.

The Department for Health and Social Care expressed condolences to Allison’s family and highlighted their commitment to investing in mental health services for children and young people. They mentioned an additional £2.3bn per year to be allocated to mental health services by 2024, which will allow an additional 345,000 children and young people to access NHS-funded mental health support. The government stated that they are carefully considering the coroner’s recommendations and will respond within the required timeframe.

If you’ve experienced the loss of a loved one due to inadequate mental health care, we might be able to assist you in pursuing a claim and guiding you through the inquest procedure.

Our skilled medical negligence solicitors will conduct a thorough investigation into the circumstances surrounding your loved one’s suicide, seeking to determine how and why it occurred.

We will strive to secure an acknowledgment of the mistreatment your loved one endured and obtain the compensation you rightfully deserve to address any financial charge you have encountered.





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