Simon Reynolds

On 2nd December 2014 commenced an investigation into the death of Simon Peter REYNOLDS, aged 47_ The investigation concluded at the end of the inquest on 15"h July 2015. The medical cause of death reached following Jury inquest was as follows: 1a) Acute pneumonia 1b) Cachexia and chronic obstructive pulmonary disease The conclusion of the Jury inquest was "The conclusion of this jury is that as a consequence of choking on paper which led to cardiac arrest; Simon subsequently died due to acute pneumonia, cachexia and chronic obstructive pulmonary disease

On 10th November 2014 Simon was admitted to Mason Unit at Southmead Hospital after he was detained under s136 of the Mental Health Act by the police. He was admitted to the unit at around 21.00 hours and by 21.20 hours he was found by the staff in the bathroom with his hand over his mouth and he appeared to be choking: He was taken to Intensive Care Unit at Southmead Hospital but died on 21 November, Evidence was given that Simon was experiencing a psychotic episode with comments such as "he had bought the devils stone and lost" and that he thought 'he was on a route to hell"_ There were times when Simon appeared to be fighting hallucinations. One of the police officers who escorted him to the unit and was present with him said that Simon honestly believed what he was saying he was completely distressed. During his admission he attempted to stab himself in the neck with a pen, which the staff then removed. He also had his shoes and laces removed when he told the staff he wanted to die and they had concerns about self-harmlsuicide. Whilst left alone in his room Simon forced a fist sized ball of paper into his throat which caused him to choke: During his short admission he was on 10 minute observations_ the

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