Prevention of Future Deaths reports · 2021

Joanna Leven

Regulation 28 report to prevent future deaths, reference 2021-0126, written 30 Apr 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report30 Apr 2021
Reference2021-0126
DeceasedJoanna Leven
CoronerChris Morris
Coroner areaGreater Manchester South
CategoryMental Health related deaths · Suicide (from 2015) · Community health care and emergency services related deaths · Hospital Death (Clinical Procedures and medical management) related deaths
Organisation namedPennine Care NHS Foundation Trust · North West Ambulance Service NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

Rt.Hon. Matt Hancock MP, Secretary of State for Health and Social Care.

1 | CORONER

|
| |am Chris Morris, Area Coroner for the coroner area of Greater Manchester
(South).

2 | CORONER'S LEGAL POWERS

5, and The Coroners (Investigations) Regulations 2013, regulations 28 and 29.

3 | INVESTIGATION and INQUEST

On 9th April 2020, | opened an inquest into the death of Joanna Leven who was
found dead at her home on 26th March 2020, aged 34 years.

A post mortem examination undertaken by Dr aoranet consultant
pathologist, determined that Ms. Leven died as a result of asphyxia.

The coronial investigation into her death concluded with the inquest, which was
heard before me on 26th — 27th April 2021, resulting in a conclusion that Ms.
Leven had died as a consequence of suicide.

| make this report under Coroners and Justice Act 2009, paragraph 7, Schedule °

CIRCUMSTANCES OF THE DEATH

Ms. Leven was found dead at her home on 26th March 2020 as a consequence
of asphyxia which was self- induced with the intention of bringing about her
death. Ms. Leven was under the care of community mental health services
having previously been diagnosed with Emotionally Unstable Personality
Disorder arising from traumatic experiences in childhood.

As a result of her Personality Disorder, Ms. Leven had frequently self- harmed
and/or attempted suicide, often telling others what she had done. A major
protective factor in maintaining Ms. Leven's safety was her dog.

In February 2020, Ms. Leven's dog became seriously unwell. This led to a
profound deterioration in her mental health. After Ms. Leven'’s dog was

euthanized in March 2020, she cut her groin and took a mixed overdose,
resulting in her being taken to hospital. Whilst she received treatment there for
her physical health, Ms Leven left hospital before the mental health liaison team
could assess her.

Despite the clear deterioration in Ms. Leven's health, the removal of the major
protective factor in maintaining her safety and her e-mailing her care coordinator
to inform him she intended to complete suicide after leaving hospital, no
comprehensive mental health assessment took place.

It is possible the absence of a comprehensive mental health assessment at this
point in Ms. Levens life might have contributed to her death.

5 | 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 court heard evidence that there is no national therapeutic pathway for

| treatment of Personality Disorders. Whilst the court heard steps are in place to
introduce a loca! pathway for residents of Greater Manchester, it is understood
eligibility for and availability of various therapies which may be beneficial to
patients diagnosed with a Personality Disorder varies from place to place;

2) Evidence was heard in court to the effect that there are gaps in provision by

| statutory agencies of counselling and other mental health services specifically

tailored for victims of trauma, violence and domestic abuse. In Stockport,

specialist services of this nature fall to be provided by a registered charity with

| only short-term funding in place, a position which is understood to be replicated
elsewhere in the country; |

3)The court heard evidence that, where a patient attends a Hospital Emergency
Department with both physical and mental health needs, it is usually the case
that Hospital and Mental Health Liaison staff are working with different
computer-based records systems. This creates an obvious risk of information
being lost or incompletely conveyed as between different professional groups.

ACTION SHOULD BE TAKEN |
In my opinion, action should be taken to prevent future deaths and | believe that

you and/or 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 25th June 2021. 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 following:

- HHJ Thomas Teague QC, the Chief Coroner of England and Wales;

FY on behalf of Ms Leven’s family;

hi: Stockport Metropolitan Borough Council;
; Hempsons LLP, Solicitors to Pennine Care NHS

Foundation Trust;

; of Weightmans LLP, Solicitors to North West Ambulance
Service NHS Trust;

: oc To Greater Manchester Police;
. fs OG Stockport Without Abuse; and
a. Independent Chair, Safeguarding Adult Review.

| am 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.

30" April 2021

Christopher Morris, HM Area Coroner, Manchestef South.

Responses

1 response 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 Dept. of Health Social Care (PDF)
From Nadine Dorries MP 
Minister of State for Patient Safety, 
Suicide Prevention and Mental Health 

39 Victoria Street 
London 
SW1H 0EU 

Mr Christopher Morris 
HM Coroner's Court 
1 Mount Tabor Street 
Stockport SK1 3AG 

Dear Mr Morris 

15 July 2021 

Thank you for your letter of 30 April 2021 about the death of Joanna Leven.  I am replying 
as Minister with responsibility for mental health services and suicide prevention.    

I would like to begin by saying how deeply sorry I was to read the circumstances of Ms 
Leven’s death and I offer my deepest sympathies to Ms Leven’s family and loved ones.  

In preparing this response, Departmental officials have made enquiries with NHS England 
and NHS Improvement (NHSEI) and the Care Quality Commission (CQC).  I am also 
aware that the Stockport Clinical Commissioning Group (CCG) has written to advise you of 
the local action that is being taken to improve services for patients with serious mental 
illness, including personality disorders.    

I would like to assure you and those who knew and cared for Ms Leven that we are 
committed to ensuring that people have access to the right mental health support, in the 
right place, and at the right time and that improving mental health services for people with 
severe mental illness, including personality disorders, is a key priority for the Government.  

Under the NHS Long Term Plan, we are investing almost £1billion extra in community 
mental health care for adults by 2023/24.  New and integrated models of primary and 
community mental health care will give 370,000 adults with serious mental illnesses, 
including personality disorders, greater choice and control over their care and support 
them to live well in their communities by 2023/24.  

This care and support will include access to psychological therapies; improved physical 
health care; employment support; personalised and trauma-informed care; medicines 
management; and, support for self-harm and coexisting substance use.  

Local areas will be supported to redesign and reorganise core community mental health 
teams to move towards a new place-based, multidisciplinary service across health and 
social care aligned with primary care networks.  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Furthermore, as part of the Spending Review 2020, we have announced that the NHS will 
receive around an additional £500million in 2021/22, to address waiting times for mental 
health services, give more people the mental health support they need, and invest in the 
NHS workforce.  How the funding will be used is set out in our COVID-19 mental health 
and wellbeing recovery action plan. The recovery action plan also includes details of the 
funding we have provided to support mental health throughout the pandemic. 

£58million will be used to accelerate the roll-out of the community mental health framework 
to treat adults and older adults with serious mental illness, specifically:  

•  Bringing forward the expansion of integrated primary and secondary care for adults 

and older adults with serious mental illness; 

•  Embedding mental health practitioner roles in primary care networks across the 
country from 2021 to 2022 to better meet the needs of people living with severe 
mental illnesses in primary care; 

•  Expanding peer support and non-clinical workforce to boost the capacity of 

community mental health services; and, 

•  Accelerating transformation across eating disorder pathways, with a focus on early 

intervention models and close working with voluntary and community sector 
partners. 

In relation to commissioning mental health services for victims of trauma, violence and 
domestic abuse, local clinical commissioning groups are responsible for decisions about 
commissioning services to meet the needs of their local populations. Services may be 
provided by a range of organisations, including NHS and private providers, and providers 
in the voluntary, community and social enterprises. 

We continue to take steps nationally to ensure that victims of abuse and domestic abuse 
have timely access to care and support.  As laid out in the recovery action plan, the 
Government is providing £40million in 2021/22 to boost specialist support services for 
victims of rape and domestic abuse.  This includes: over £20million for local community-
based sexual violence and domestic abuse services, to help reduce the amount of time 
survivors wait for support;  £16million to recruit more independent sexual violence and 
domestic abuse advisers; and £2million for smaller, specialist organisations that help 
ethnic minority, LGBT or disabled victims. 

Turning to your concerns about improving information sharing between services and 
professional groups, effective information sharing is vital to support improved patient 
outcomes.  The NHS Long Term Plan Implementation Framework makes several 
commitments to improve information sharing.  By 2024, all secondary care providers 
should be fully digitised and integrated with other parts of the health and care system, for 
example, through a local health and care record platform.  Shared care records ensure 
that information and care plans are available across health and social care to support 
planning, better risk management and ensure care is more joined up and delivered around 
an individual’s needs.  

 
 
 
 
 
 
 
 
 
 
 
 NHSX, responsible for digital transformation strategy, expects all areas to have a basic 
minimum viable shared care record in place by September 2021.  This work builds on the 
Local Health and Care Record programme and will provide access to patient records 
across organizational boundaries, including between mental health services and acute 
hospitals. 

Finally, we are taking action more broadly with the aim of reducing suicide rates and 
ensuring that fewer people take their own life each year.  We are investing an additional 
£57million in suicide prevention by 2023/24 through the NHS Long Term Plan.  This will 
see investment in all areas of the country to support local suicide prevention plans and the 
development of suicide bereavement services.  In addition, we are also providing an extra 
£5million in 2021/22, to be made available specifically to support suicide prevention 
voluntary and community sector organisations, with part of this set as a grant fund to help 
ensure that the financial gaps incurred as a result of additional pressures during COVID-
19, are covered. 

I hope this response assures you, and Ms Leven’s family, that we are taking action 
nationally to ensure that people can get access to vital mental health support sooner and 
in the community wherever possible.  Thank you for bringing these concerns to my 
attention. 

NADINE DORRIES 

MINISTER OF STATE FOR PATIENT SAFETY, SUICIDE PREVENTION  
AND MENATL HEALTH

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