Source · Prevention of Future Deaths
Leighton Dickens
Ref: 2023-0367
Date: 29 Sep 2023
Coroner: David Regan
Area: South Wales Central
Responses identified: 0 / 1
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Police officers have limited access to qualified mental health advice and clinical records when responding to mental health crises, as urgent support teams are not readily available and a promised service is unimplemented.
Date
29 Sep 2023
56-day deadline
13 Dec 2023 est.
Responses identified
0 of 1
Coroner's concerns
Police officers have limited access to qualified mental health advice and clinical records when responding to mental health crises, as urgent support teams are not readily available and a promised service is unimplemented.
View full coroner's concerns
(1) Following the withdrawal of the mental health triage support provided to the police by mental health nurses, the medically qualified sources of urgent support available to police officers to assist them to safeguard the public are limited to the mental health crisis teams.
(2) The crisis teams may not be readily available and deal with their own case load.
(3) The alternative support available from a mental health tactical adviser, is not provided by a clinically qualified member of staff and does not have access to the PARIS mental health records system.
(4) The intended replacement of the mental health triage support was to have been by the “111 press 2” service. This has not been put in to place and there is no current timescale for it to be put into place.
(5) This leaves officers with limited sources of qualified mental health advice, with access to relevant clinical records, when responding to the risks posed by those suffering from mental health crisis within the community
(2) The crisis teams may not be readily available and deal with their own case load.
(3) The alternative support available from a mental health tactical adviser, is not provided by a clinically qualified member of staff and does not have access to the PARIS mental health records system.
(4) The intended replacement of the mental health triage support was to have been by the “111 press 2” service. This has not been put in to place and there is no current timescale for it to be put into place.
(5) This leaves officers with limited sources of qualified mental health advice, with access to relevant clinical records, when responding to the risks posed by those suffering from mental health crisis within the community
Report sections
Investigation and inquest
A Coronial investigation was commenced on 27th October 2020 into the death of Leighton Alan Dickens. The Investigation concluded at the end of the inquest which I conducted with a jury on 18th – 28th September 2023. The conclusion was a narrative conclusion and the medical cause of death was 1 (a) pressure on the neck (incomplete or atypical hanging)
Circumstances of the death
These were recorded as: - Leighton Dickens died by incomplete atypical hanging alone in his home address on 14th October 2020. The narrative conclusion which the Jury returned was: Leighton Dickens died by hanging himself in circumstances where his intention could not be ascertained. It is the juries understanding, that it was a missed opportunity on the part of the police not to detain Leighton Dickens at hospital until he had been assessed by a Mental Health Professional.
The Inquest focused upon: -
a. Mr Dickens’ mental health condition and behaviour on the night of his death.
b. The fact that police officers came upon him by the side of the road in an undressed state in the presence of his partner who was trying to convey him to hospital.
c. His presentation and behaviour towards the officers before during and after arrival at hospital d. The decision by officers not to invoke their powers under s. 136 Mental Health Act and to leave Mr Dickens at hospital in circumstances in which they knew that he had not been subject to medical assessment and intended to leave.
e. The limited sources of support available to assist or guide the officers.
The Inquest focused upon: -
a. Mr Dickens’ mental health condition and behaviour on the night of his death.
b. The fact that police officers came upon him by the side of the road in an undressed state in the presence of his partner who was trying to convey him to hospital.
c. His presentation and behaviour towards the officers before during and after arrival at hospital d. The decision by officers not to invoke their powers under s. 136 Mental Health Act and to leave Mr Dickens at hospital in circumstances in which they knew that he had not been subject to medical assessment and intended to leave.
e. The limited sources of support available to assist or guide the officers.
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Report details
- Reference
- 2023-0367
- Date of report
- 29 September 2023
- Coroner
- David Regan
- Coroner area
- South Wales Central
Responses identified
Responses identified
0 of 1
1 response not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 13 Dec 2023 (estimated).
Sent to
- South Wales Police
Part of a series
2024-0522
All responses identified