Prevention of Future Deaths reports · 2015

Sian Armstrong

Regulation 28 report to prevent future deaths, reference 2015-0019, written 21 Jan 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Jan 2015
Reference2015-0019
DeceasedSian Armstrong
CoronerMaria Voisin
Coroner areaAvon
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Child Death (from 2015)
Organisation namedNorth Bristol NHS Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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North Bristol

NHS Trust

Trust Headquarters
Southmead Hospital
Southmead Road
Westbury-on-Trym
Bristol
BS10 5NB

Tel:

42 March 2015 Website: http:/Awww.nbt.nhs.uk

Coroners Court
The Court House
Old Weston Road
Flax Bourton
BS48 1UL

Dear Ms Voisin
Re: Sian Armstrong

Thank you for your letter dated 22 January 2015, in which you have set out your
concerns under Schedule 5 of the Coroners and Justice Act 2009 and Regulations
28 and 29 of the Coroner (Investigations) Regulations 2013.

| have reviewed your concerns with our Community Children’s Health Partnership
(CCHP) and can confirm the following actions/plans in place for future management
of young people who require therapy.

e Firstly, | would confirm that appropriate Psychological therapy is available
through the CAMHS services; however Sian refused treatment from CAMHS
service. Sian was informed about other services available to her for example
from the voluntary sector and later made an informed choice to self-refer to
Off the Record for counselling.

e We have developed a new protocol to assist CAMHS clinicians who are faced
with young people do not want to engage. (attached)

e Whilst we have to be cognisant of young people's consent and competency in
relation to involving parents and carers, we will invite parents to contact
CAMHS if they have ongoing and or additional concerns. We will listen to
them and consider their concerns. This principle will be introduced into all
correspondence with families / carers and young people from 1 April 2015.

e Bristol and South Gloucestershire Clinical Commissioning Groups (CCG)
directly commission Tier 2 services from Off the Record. We are working with
our two CCG’s, to involve Off the Record in our CAMHS intake meetings

Peter Rilett A University of Bristol Teaching Trust Andrea Young
Chairman A University of the West of England Teaching Trust Chief Executive

where we triage and assess all referrals for young people. This collaborative
new model of working aims to provide appropriate resource for mental health
problems, more choice for young people and ensure timely access to the right
service to meet the needs of young people. Work has begun to finalise
governance arrangements for cross organisational working. Agreement was
reached in February 2015 that Off the Record staff could attend CAMHS
locality intake meetings.

e For young people who are hard to engage we have been working with the
Bristol Clinical Commissioning Group (CCG) to develop a Crisis intervention
team model. A Project Lead has been appointed by Bristol CCG and is
currently scoping local services in order to recommend a best model of
practice. This will improve the response to young people who self-harm. The
crisis intervention team is currently being planned for implementation in June
2015. An assertive outreach project is planned to deliver services to hard to
reach young people for example those with forensic difficulties and substance
misuse. The implementation of this will take place following the re
procurement of the Community Children’s Health Partnership in 2017.

| would like to reassure you that the Trust is continually working to improve its
services at the present time and for patients in the future.

Yours sincerely

Andrea Young
Chief Executive

Peter Rilett A University of Bristol Teaching Trust Andrea Young
Chairman A University of the West of England Teaching Trust Chief Executive

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Also filed under 2015-0019: Armstrong-2015-0019.pdf
REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

4. North Bristol NHS Trust

CORONER

| am Maria Voisin, Senior Coroner, for the area of Avon

CORONER'S LEGAL POWERS

I 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.

INVESTIGATION and INQUEST

On 11" June 2014 | commenced an investigation into the death of Sian Leigh
ARMSTRONG, Aged 17. The investigation concluded at the end of the inquest on 44"
January 2015. The conclusion of the inquest was as follows:

Medical Cause of Death

1a) Hanging

Conclusion

Sian Armstrong had a history of depression, she was under the care of the mental
health service and on the balance of probability took her own life.

al

CIRCUMSTANCES OF THE DEATH

Sian had a history of depression. In March 2014 she made an attempt on her life by way
of an overdose. Following this she had been seen by the Mental Health Team. Sian was
assessed as needing to receive CBT but from the time of the assessment in March 2014
until her death in June 2014 she had not received CBT

CORONER'S CONCERNS

Serre eee

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. —
1. There was a delay in Sian receiving CBT which she was assessed as requiring.
2. At the inquest | indicated that | would ask North Bristol NHS Trust for

reassurance that steps will be taken to ensure that this therapy is available to
children who are assessed as needing it in a timely manner

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you have the
power to take such action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,

namely by 18 March 2015. I, 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.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner and to the following Interested
Persons — the family - and to the LOCAL SAFEGUARDING BOARD.

| am 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
response, about the release or the publication of your response by the Chief Coroner.

21.1.15 M. E. as

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