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Chambers & Partners
27/10/2022

Emily Slocombe Acts for Family in Tragic In-Patient Mental Health Ward Death Inquest

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Emily Slocombe Acts for Family in Tragic In-Patient Mental Health Ward Death Inquest

Emily Slocombe represented the family in the inquest touching the death of Michelle Morton at Essex Coroners Court.

Michelle was a 29-year-old lady who tragically died due to self-ligaturing whilst an in-patient on Ardleigh Ward at the Lakes, Colchester Hospital under the care of Essex University Partnership Trust on 8th December 2019.

Michelle had a diagnosis of Emotionally Unstable Personality Disorder, a condition that can cause extreme highs and lows of emotion.

Michelle was admitted under section 3 of the Mental Health Act 1983 earlier in 2019, and in September 2019 was moved to Ardleigh Ward. Michelle was due to be discharged on 13th December 2019, just four days after her death.

Ardleigh ward is a female-only, inpatient ward, which has a garden area for patients to access. In the garden of the ward, there were recognised ligature points which had not been removed, and the identified mitigation of constant observation was not, on the 8th of December 2019, put in place.

Michelle was seen ligaturing in the garden, on the evening of the 8th December 2019, by two friends, and fellow in-patients who notified a member of staff. Staff attended to Michelle, but, sadly, staff and ambulance personnel were unable to resuscitate her.

The inquest was heard over 10 days before a jury. The Jury found in their conclusion that the following failings contributed to Michelle’s death:

  • failing to lock the door to the garden when unsupervised;
  • failing to take “trivial” corrective actions for the ligature point;
  • leaving Michelle on an observation level which was too low;
  • inadequate staffing levels on 8th December 2019; and
  • inadequate training of staff in relation to ligature points.

Following the conclusion, the Coroner indicated an intention to issue a Regulation 28 Prevention of Future Deaths Report encompassing the family’s concerns.

Emily was instructed by Hodge Jones and Allen Solicitors and the inquest was reported in the following press reports.

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