Prevention of Future Deaths reports · 2017

Dean Rowland

Regulation 28 report to prevent future deaths, reference 2017-0208, written 27 Jun 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report27 Jun 2017
Reference2017-0208
DeceasedDean Rowland
CoronerMargaret Jones
Coroner areaStaffordshire (South)
CategoryCommunity health care and emergency services related deaths · Hospital Death (Clinical Procedures and medical management) related deaths · Suicide (from 2015)
Organisation namedSouth Staffordshire and Shropshire Healthcare NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses published2

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.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:
1. The Senior Partner, Peel Medical Practice, Tamworth, Staffordshire

2. South Staffordshire and Shropshire Healthcare NHS Foundation Trust,
Stafford, Staffordshire

CORONER

| am Mrs Margaret Joy Jones Assistant Coroner for the Coroner area of
Staffordshire South.

CORONER’S LEGAL POWERS

| 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 27 March 2017 | commenced an investigation into the death of Dean Mark
Rowland, 27 years of age. The investigation concluded at the end of the inquest on
27 June 2017. The conclusion of the inquest was suicide.

CIRCUMSTANCES OF THE DEATH

The deceased had a history of two recent previous self-harm attempts. He had
been depressed due to his domestic situation. His GP had treated him with
sertraline and he was referred to the Community Mental Health Team. A mental
health assessment on the 19th August 2016 identified that he was coping and that
no special risk prevention was required. He was discharged back to his GP on the
25th August 2016. On the 21st March 2017 family had been unable to contact him
and so visited his home address at iS Tamworth. He
was found hanging from the bannister and death was certified at the scene at 11.00
hours. He had left a note indicating his intention to take his own life. There was no
third party involvement.

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 —

(1) The deceased wished to discuss an increase in his antidepressant medication
with a doctor. He was unable to get an appointment or speak to a GP on the
telephone for nine days.

(2) He was referred to a community mental health team having made two serious

previous suicide attempts. He was discharged after only one consultation with no
follow up plan other than for him to refer back to primary care. The family perceived
he would have benefitted from a further appointment. He was very willing to engage
with services.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you and
your organisation 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 23 August 2017. |, the Assistant 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. | have also sent it to members
of the family who may find it useful or of interest.

| 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.

Date: 27 June 2017 Signed: Mids

Margaret Joy Jones
Assistant Coroner Staffordshire (South)

Coroner's Office

No 1 Staffordshire Place
Stafford ST16 2LP

Tel No: 01785 276127
Fax No: 01785 276128

www.staffordshire.gov.uk
sscor@staffordshire.gov.uk

Responses

2 responses published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Peel Medical Practice (PDF)
Peel
Court
\ 2 Aldergate
| Tamworth

/ Staffordshire B79 7D]

Tel: 01827 50575
Fax: 01827 31891]

At July 2017

Ms M J Jones

Assistant Coroner

Her Majesty’s Coroner Staffordshire (South) Coroner's Jurisdiction
Coroner's Office

No | Staffordshire Place

Stafford

ST16 2LP

Dear Ms jones
RE: Dean Rowland (Deceased)

Thank you for your letter dated 28 June 2017 regarding this patient. The specific area of
concern with regards to the practice*to improve access for patients to have an appointment
or telephone call with a Doctor sooner than a routine appointment if they so required.

We have instituted a duty doctor and telephone triage system in the practice. If the patient
attends or phones the practice requesting an appointment they are told when the next
routine appointment is available for the doctor of their choice and for any doctor. If they
feel they need to be seen that day or that their condition will not wait until the next
available routine appointment they are offered a “callback”. They will be called as soon as
possible by one of the duty team who will either deal with the problem over the telephone
or make them an appointment that day to see a doctor or a nurse practitioner - whichever
is the most appropriate for the problem. This means that everyone who needs to be seen
will be seen on the same day.

| hope this provides information you require and satisfies your concerns

Yours sincerely
Response from South Staffordshire and Shropshire Healthcare (PDF)
INHS)

South Staffordshire and
Shropshire Healthcare

NHS Foundation Trust

Neil Carr

Chief Executive
Trust Headquarters
St George’s Hospital
Corporation Street
Stafford

ST16 3SR

Tel: 01785 257888

Margaret J Jones

onan Coroner
oroner’s Office

Ne 1 Staffordshire Place

tafford

ST16 2LP

15" August 2017

Dear Ms Jones

e: Dean Rowland (deceased

eport to Prevent Future Deaths
Thank you for your letter dated 28". June 2017, reporting concerns to us, in accordance
with Regulations 28 and 29 of the Coroner's (Investigations) Regulations 2013.

Following discussions within the Mental Health Division, | am now in a position to respond
to your specific concern, which were as follows:

In respect of point 2. He was referred to a community mental health team having made
two serious previous suicide attempts. He was discharged after only one consultation
with no follow up plan other than for him to refer back to primary care. The family
perceive he would have benefitted from a further appointment. He was very willing to
engage with services.

Prior to his referral to South Staffordshire and Shropshire Foundation Trust (SSSFT) in
me 2016 Mr Rowland was not known to mental health services, although as you report
ad taken two overdoses in the preceding four months due to difficulty in coming to terms
With the end of his marriage. It was immediately following the second overdose that he
as referred to mental health services, beginning with an assessment from the Crisis
esolution and Home Treatment Team (CRHTT) who felt a more detailed assessment
rom the Community Mental Health Team (CMHT) would be of benefit; this assessment
‘ook place on 19" August 2016, 18 days after the referral, with one episode of telephone
tontact in between in order to arrange the appointment. This is in keeping with expected

referral timeframes for a CMHT assessment. Notably, the appointment letter also invited
Mr Rowland to bring a friend or relative with him to the appointment, thereby considering
the needs of carers, although Mr Rowland opted to attend alone.

When seen on 19" August 2016, Mr Rowland had moved to Birmingham in order to reside
with his mother, and described improvements in his mental health due to this change of
environment and a now amicable relationship with his ex-wife and access to his children.
Mr Rowland described his wellbeing "feel like | have my life back and am like my old self"

and reported various self-help methods such as exercise and making time for himself.
Importantly he expressed no further ideas of suicide. A Patient Health Questionnaire 9
(PHQ-9) was completed as part of the assessment; this is a 9-item questionnaire to
explore current symptoms of depression, yielding a score of between 0 and 27. Mr

Rowland scored 8, which is indicative of mild depression that would not usually require

treatment; scores of 15 and above are usually seen in individuals requiring the input of a

CMHT. Mr Rowland’s recent suicidal ideation and behaviour was noted, but given his

current wellbeing he was deemed at low risk for further self-harm or suicide. Information

was discussed on 25" August 2016 at a CMHT multidisciplinary team meeting and owing

CMHT.

to the information gathered in the assessment; Mr Rowland was discharged from the

Mr Rowland engaged fully in his assessment and coproduced the plan which was later

communicated to him by letter. He felt that the difficulties in his mental health had

improved and that he did not require input from the CMHT, but was aware that he could be

rereferred at any time should this situation change. The letter validated his efforts to be
well and detailed online self-help resources to support these efforts, and also

recommended that he register with a GP in Birmingham if he wished to continue to reside

there, so that he could be referred quickly to his local mental health services in future

he CMHT, this would have been transferred to the service in Birmingham local to Mr

ho Cl the need arise. If the assessment had highlighted the need for ongoing input from
owland’s new residence, but as described it was not required.

alk Satisfied that the CMHT conducted a sufficiently detailed assessment of Mr
owland’s needs, and with him arrived at the right decision at that time, namely to
discharge him from the service. Following discharge | am satisfied that all communication

with Mr Rowland detailed resources that he could access to support his recovery, and

etailed points of contact with the CMHT should he move back to the area, and invited his

deta appropriate advice to register with a GP local to his new address. The letter
P to rerefer him at any time should the need have arisen. The option to involve his

family in the assessment was offered but declined by Mr Rowland.

I|hope this response helps to address your concerns. However if you require any further

information please do not hesitate to contact me

Yours sincerely

@8ey
Positively
Differen

*, s
re

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