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Mental Health failings led to death.

“Persistent failings” by an NHS health trust led to a high-risk mental health unit patient taking his own life, Liverpool and Wirral Coroner's Court has ruled.

Steven Edwards, 49, from Liverpool, died in 2016 after making a ligature from a belt at the city’s Clock View Hospital.

Liverpool and Wirral assistant coroner, Joseph Hart, criticised communications between nursing and medical teams at NHS Mersey Care Foundation Trust.

Solicitors representing Mr Edwards said he became unwell and experienced paranoid delusions in 2012.

Mr Hart said Mr Edwards had been sectioned as a "high risk" patient under the Mental Health Act. He died on 27 August 2016 after sustaining an ‘unsurvivable’ brain injury.

In his conclusions, Mr Hart said that there had been a series of failures at the hospital. These were: a failure to consider all relevant documentation, including historical risk factors and information not carried through to risk assessments; an inappropriate appreciation of risks to Steven Edwards, individually and environmentally, and persistent communication failures between nursing and medical teams.

Mr Edwards' family said they felt badly let down by Mersey Care. They said that immediately before Steven Edward’s death, they had warned of their concerns but nothing was done to support him or prevent him taking the action he did.

They said: "To hear information which might have saved his life was not read, not understood or simply ignored, was heartbreaking. We desperately hope the concerns raised in Steven's case are taken seriously this time, so no other families have to go through what we have suffered."

Mersey Care NHS Foundation Trust apologised to Mr Edwards' family and loved ones for the "tragic event".

A statement said: "Mersey Care accepts the judgment of the coroner and has already been working with staff to implement changes to our procedure."

 

 

                  

 

 

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