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The waiting game

Patient died by suicide after A&E referred him back to his GP

A 21-year-old man having suicidal thoughts took his own life after a hospital sent him back to his GP, despite having initially been referred by the GP as an urgent case.

Joe Black was referred by his GP to Macclesfield District General Hospital after he presented with suicidal ideation over the summer, according to local reports.

The GP concluded that Mr Black was at risk of suicide and referred him to the hospital's A&E department.

However, the psychiatric staff said hospital admission was not necessary and sent him back to his GP, advising him to work on self-care.

Mr Black died by suicide at his home on 12 August 2019, three days after he had been turned away from hospital.

The Manchester Evening News reported that the inquest, held last month at Cheshire's coroner's court, heard that Mr Black had previously made two suicide attempts - in 2017, when he took an overdose, and the following year, when he tried to drown himself. 

Holly Nettle, a registered psychiatric nurse at Macclesfield District General Hospital, told the court Mr Black said he was able to keep himself safe at the time and hospital staff advised him to go back to his GP.

She said: 'Joe told me that he had suicidal thoughts in the past and they had reoccurred in recent weeks. But he had no current thoughts or intent to act and was actually talking about the future.

'He was quite thoughtful and intelligent and seemed to understand himself quite well. I didn’t feel he required an inpatient admission to manage that risk. He felt able to keep himself safe at that time.'

She added: 'The plan was he would go back to his GP and work on self-care and engage with the psychiatric services through the health care provision. He seemed like he wanted help and he was actively seeking it. He did feel able to engage in it.'

Cheshire and Wirral Partnership NHS Foundation Trust director of nursing Gary Flockhart said: 'Our deepest condolences are with the family at this very difficult time.'

A recent Pulse investigation found that only a third of NHS mental health trusts in England accept patients with 'severe' or 'significant' conditions for specialist child and adolescent mental health services (CAMHS).

In October, a teenager died by suicide after his local CAMHS rejected his GP referral as it did not meet the threshold of 'moderate to severe' mental health issues

Readers' comments (16)

  • How sad for all involved in this poor man's care, and for his family and friends. I have learned that one can never know what is going on in someone else's mind, and that an impulsive suicide attempt can not always be predicted or prevented. We cannot (GPs or MH nurses) be solely reponsible for the later actions and decisions of every person that we see.

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  • David Banner

    Copernicus is right, we shouldn’t be playing the blame game here. Using the trusty old retrospectoscope it would be easy to criticise the Mental Health team, but if they performed a proper risk assessment then allowed the patient to return home, then we should accept that sadly tragedies like these can happen.
    There but for Grace of God and all that.

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  • Took Early Retirement

    I agree, no one person needs to be blamed here.

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  • Vinci Ho

    (1) The million dollar question of determining whether somebody expressing suicidal ideation would go on to complete the task of killing oneself , is perhaps beyond any scientific prediction. For those who have been long enough in the mental health business will probably understand the irony of, ‘ things are never what they seem ‘ for these lives being taken away prematurely and unnecessarily. The truth is , as human beings , we are , in fact, so fragile .
    (2) It would be so simplistic to play sensationalism by blaming those who made a decision to close the book at one particular stage in dealing with these vulnerable subjects . But equally, there is a question about whether the system has provided enough safety net to confer further protection of these patients , other than merely referring back to the gatekeepers of the system who are not really equipped enough to fulfil this duty of care these days . I do not know the subtle answer for this but that , does not necessarily mean there isn’t one existing somewhere, somehow .
    (3) That goes back to the authorities which are supposed to be humbled by these tragedies, seek and search a way by all costs to help the frontline professionals to establish this ‘subtle’ solution . Instead , so far , we have seen frontline colleagues took the fall for the ‘system’ when apology to the public was clearly inevitable. The parody lies where repeatedly ,regulatory bodies seemed to be more ready identifying the ‘scapegoats’ than diligently tracking down the truly malicious, malevolent offenders. Presumed guilty takes less effort than good detective work , I suppose ?
    All in all , it has led to this discouraging, demoralising and denigrating environment which frontline medical professionals have found themselves stuck into .

    Mr prime minister and health secretary, you can say whatever you want to say about keep the NHS afloat but without an introspective , insightful understanding of the values and virtues which had gone missing , you can only see more and more frontline colleagues walking away from their positions they were once proud of ........
    ‘’A minister of state is excusable for the harm he does when the helm of government has forced his hand in a storm; but in the calm he is guilty of all the good he does not do.’’

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  • Tragic for all concerned. With the best will in the World we are all fallible.

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  • The one metric which has been impossible to tease out for all the research done in mental health is the likelihood of suicide. I suspect many GPs at the older end of the profession with years of experience have got a "surprise" suicide or two in their minds. It's an impossible dichotomy; over caution and incarceration for those at minimal risk vs allowing personal freedom and with that the risk of an unwise decision. The act of suicide may be made impulsively after, for example, an argument with an ex, or a drunken night and loss of innate inhibition. The actual drivers for suicide are hidden and unpredictable, and as the commentators above have stated, to castigate the poor sod who "got it wrong" is to give credence to the idea that suicide is always preventabel and predictable. Agree this piece would be more suited to the Daily Mail than Pulse. Shame on you.

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  • |Last Man Standing | GP Partner/Principal|03 Feb 2020 7:53pm

    - And what responsibility is there to be taken? Does Joe Black have none to take at all?

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  • The blame game again. Nobody has a crystal ball.
    Next step, coroner inquest then someone gets blamed and struck off plus charged with Gross Negligence Manslaughter like Dr Bawa Garba.
    Toxic UK.

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