A jury in Leicester has delivered a critical narrative verdict at the inquest into the death of a woman in mental health detention. The family of Laura Dickins was represented by Stephen Simblet.
An inquest jury in Leicester made critical findings in a narrative verdict returned after a two-week inquest into the death in hospital of a detained patient, Laura Dickins. The inquest heard that Laura, who was detained in the Bradgate Unit, Leicester under section 3 Mental Health Act 1983 had a history of self-harm, including of overdosing on the same medication from which she died. She had been sent home on unescorted leave within days of deliberately cutting herself and without her parents (to whom she went home on leave) having been informed of that. While on leave, she had secretly removed some of her step-father's cardiac medication and taken it back to hospital with her. She had not been searched when she returned to hospital (despite having previously brought the same medication in and overdosing on it, as was documented in the notes and despite self- harming with razor blades and other implements). The following day, she took an overdose of that medication. She disclosed the fact of the overdose to the nursing staff, who contacted an on-call psychiatrist. That doctor, who had other clinical demands, never came to see Laura and advised that her blood pressure and pulse be taken. Nobody called 999 or sought any form of emergency response at that stage. An hour and a half after the doctor had been contacted, Laura deteriorated, then collapsed. An emergency call was made as well as a 999 call, but only after her collapse. The response of the medical staff to the emergency call was only partial.
The jury found that there were missed opportunities to obtain treatment for Laura and that these played a part in her death. The inquest heard from several witnesses that the correct thing to have done once the overdose was disclosed was to send Laura for emergency treatment; the Hospital Trust procedure had now changed. The coroner is now considering rule 43 reports in relation to resuscitation arrangements and emergency cover at the hospitals.
Press coverage of the inquest can be read here.