Prevention of Future Deaths reports · 2022

Ami Mitchell

Regulation 28 report to prevent future deaths, reference 2022-0356, written 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report2022
Reference2022-0356
DeceasedAmi Mitchell
CoronerSimon Fox
Coroner areaAvon
CategorySuicide (from 2015)
Organisation namedAvon and Wiltshire Mental Health Partnership NHS Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

M. E.  Voisin 
His Majesty's Senior Coroner 
Area of Avon 

3rd November 2022 

REF:  27343 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BE ING SENT TO: 

Avon & Wiltshire Mental Health NHS Trust 

1 

CORONER 

I am  Dr Simon Fox Assistant Coroner for Area of Avon 

2 

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. 
httQ:LLwww.legislat ion.gov.ukLukQgaL2009L25Lschedu1eL5LQaragraQhL7 
httQ:LLwww.legislation.gov.ukLuks iL2013L1629LQartL7Lmade 

3 

INVESTIGATION and INQUEST

On  22/06/2022 an  investigation was commenced into the death of Ami Louise Mitchell. The investigation 
concluded at the end of the inquest on 3rd  November 2022. The conclusion of the inquest was Suicide. 

4 

CIRCUMSTANCES OF THE DEATH 

See below 

5 

CORONER'S CONCERNS 

During the course of the inquest the evidence revea led 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.  -

Ms. Mitchell was under the care of AWP Trust with suicidal ideation from March to May 2022 until she 
hung herself on 31

May 2022. 

st 

Throughout this period she presented regularly and  persistently with 
a) delusions; 
b)  auditory hallucinations (including command); 
c) visual  hallucinations; 
d) intrusive thoughts of killing her partner and children; 
e) her and her family requesting admission 

The Coroner's Cou rt, Old Weston Road, Flax Bourton, BS48 lUL 

 
 
 
 Despite this 
a) No formal diagnosis was made; 
b)  No escalation in management or admission took place. 

The Coroner's Court, Old  Weston Road, Flax Bourton, 8S48 lUL 

 
 
 
 6 

ACTION SHOULD BE TAl<EN 

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

7 

YOUR RESPONSE 

You  are under a duty to respond to this report within 56 days of the date of this report, namely by 29
December 2022. the coroner, may extend the period. 

111

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. 

8 

COPIES  and PUBLICATION 

I have sent a copy of my report to the chief coroner and to the following interested persons: 

• 

the family of Ami Mitchell 

I 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. 

9 

03/11/2022 

Signature 
Dr Simon Fox Assistant Coroner Area of Avon 

The Coroner's Court, Old Weston Road,  Flax Bourton, BS48 lUL

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 Avon and Wiltshire Mental Health Partnership (PDF)
Dr Simon Fox 
HM Assistant Coroner (Avon)  
The Coroner's Court 
Old Weston Road 
Flax Bourton  
BS48 1UL 

Avon and Wiltshire  
Mental Health Partnership NHS Trust 
Bath NHS House 
 Combe Park  
Bath  
BA1 3QE 

            20 December 2022 

Inquest into the death of Ami Louise Mitchell 

Regulation 28 Report to Prevent Future Deaths 

Dear Dr Fox 

Thank you for the Regulation 28 letter you sent us dated 3 November 2022 regarding the 
tragic death of Ami Mitchell who died on the 31 May 2022. We are very sorry that Ms. 
Mitchell lost her life and we have accepted the findings of the internal report commissioned 
following her death. 

In the conclusion of the Inquest held 3 November 2022 you shared your concerns in regards 
to lack of formal diagnosis and lack of escalation in management or in admission that took 
place in Ms. Mitchells care and treatment. 

The Trust has completed a review of the diagnostic processes for service users in South 
Gloucestershire, which has in turn informed an action plan to address the improvements.   

Lack of formal diagnosis 

Our improvement in this area includes the assurance that that all service users receive a 
diagnosis and formulation from which care and treatment is informed by the NICE guidance 
appropriate for the diagnosis.  In order to achieve this the trust must ensure the diagnosis or 
working diagnosis is clearly recorded in the clinical record, that the diagnosis or working 
diagnosis is discussed with the Service user and their family where appropriate and that 
there should be a protocol to adhere to where there is a difference of opinion. 

We have ensured that there is now a Consultant medical lead for diagnosis in the area of 
South Gloucestershire and that this lead with senior support will work with the local team to 
put in place a diagnosis, which has been discussed informed by best practice guidelines and 

                                                                                             
 
 
 
 
 
                    
 
 
 
 
 
 
 
 
 
 discussed with service user and their carer.  We expect this progress on these actions to be 
audited in 3 and 6 months of the implementation for internal assurance. 

Lack of escalation in management or in admission  

The trust will achieve improvement in this area in part by the previous improvement around 
diagnosis, which will clearly support the escalation of a pathway. The Clinical lead for South 
Gloucestershire will also ensure that all care and treatment plans (Crisis Plans) have a clear 
expectation of management escalation including possible admission if relevant.  This might 
include clarity on escalation to admission if deemed appropriate.  

I also believe that our ambitious Trustwide Strategy, currently out to consultation will direct 
a wider improvement in pathway clarity. 

The Clinical Strategy element of the Trustwide Strategy is underpinned by five principles 
which have been created in consultation with patients and service users, staff and the wider 
community.  We have developed five priority pathways, Complex Emotional needs, 
Dementia, dual diagnosis, neuro-development, and psychosis.  The future of psychosis 
services is an integrated pathway that is co-produced with service users and their carers, 
delivering timely interventions with appropriate length treatments, to enable recovery. We 
want to provide the best care, at the right time, through consistent services that are 
accessible by all communities.  

We aspire to be a prevention-focused, trauma informed service with renowned expertise in 
early intervention for psychosis. 

We attach the updated action plan for your information and will be happy to send you an 
updated version six months from today, after completion and quality control. 

Yours sincerely 

Chief Executive

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