Prevention of Future Deaths reports · 2014

Farres Ikken

Regulation 28 report to prevent future deaths, reference 2014-0310, written 2 Jul 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report2 Jul 2014
Reference2014-0310
DeceasedFarres Ikken
CoronerAndrew Walker
Coroner areaLondon (North)
CategoryOther related deaths
Organisation namedCentral and North West London NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

Her Majesty’s Coroner for the 29 Wood Street,

Northern District of Greater London Bamet ENS 4BE

(Harrow, Brent, Barnet, Haringey and Enfield) Telephone 0208 447 7680

Fax 0208 447 7689

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

Department of Health
Richmond House

79 Whitehal

London

SWI1A 2NS

CORONER'S LEGAL POWERS

3 | INVESTIGATION and INQUEST

CORONER

lam Andrew Walker, senior coroner, for the coroner area of Northern District of Greater
London

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

On the 16" August 2013 | opened an inquest toughing the death of Farres Ikken , 34
years old. The inquest concluded on the 4" June 2014. The conclusion of the inquest
was “open”, the medical case of death was 1a Hypoxic Brain Injury, 1b Hanging

CIRCUMSTANCES OF THE DEATH

Farres Ikken was arrested on the 7 August 2013 at his home and brought to Wembley
Police Station. At the time of his arrest he stated that he wanted fo kill himself. Mr Ikken
was visited by the Mental Health Crisis Team in his cell at the police station. Mr Ikken was
not sectioned under the Mental Health Act.

Mr Ikken was taken to Hendon Magistrates Court and was bailed and taken to Park Royal
Centre for Mental Health on the 8 August 2013 where he was assessed as not falling
within a category of patient that could be treated at the Centre . Mr Ikken was discharged
on the 9th August 2013 for follow up by his GP and for a referral from his GP to the
psychological service.

Mr Ikken left the building and shortly after hanged himself in the grounds of the hospital
within sight of the unit he had just left.

North London Coroners Court,

Her Majesty’s Coroner for the
Northern District of Greater London

q

(Harrow, Brent, Barnet, Haringey and Enfield)

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to concern. In
my opinion there is a risk that future deaths will occur unless action is taken. In the
circumstances it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows. —

That staff at the hospital could not themselves, on discharge, refer Mr Ikken to
community psychology services.

7 | YOUR RESPONSE

8 | COPIES and PUBLICATION

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you
[AND/OR your organisation] have the power to take such action.

You are under a duty to respond to this report within 56 days of the date of this report,
namely by Tuesday 26" August 2014. |, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out
the timetable for action. Otherwise you must explain why no action is proposed.

| have sent a copy of my report to the Chief Coroner and to the following Interested
Persons;-

Members of Mr Ikkens family,

Central and North West London NHS Foundation Trust

fam also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary
form. He may send a copy of this report to any person who he believes may find it useful
or of interest. You may make representations to me, the coroner, at the time of your
release or the publication of your response by the Chief Coroner.

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