Insufficient mental health resources for children and young people
Department of Health and Social Care received 4 coroners' reports about this hazard between 16 Apr 2018 and 19 Oct 2022.
They came from 4 different coroners in 4 coroner areas. A similar concern was raised again 3 times after the first warning.
A published response was found for 3 of the 3 earlier reports, stating 2 specific actions.
The story, report by report
Spacing grows with the time between reports.
“(1) The provision of mental health services for children and young people in Cumbria is underfunded.”
Original on judiciary.uk ↗ Department of Health and Social Care responded, stating 1 specific action.Response (PDF) ↗
“the CCGs are working to implement an action plan to address the issues raised in your Report.”
- 1 year 4 months laterClosely relatedConfidence 0.85 · higha different coroner
“(1) | ask please that your Department reviews the availability of resources to those Local Authorities which have a high proportion of young people in care and disproportionately few qualified and experienced staff.”
Original on judiciary.uk ↗ Repeated from the earlier report:youngpeople
Department of Health and Social Care responded.Response (PDF) ↗
- 3 years laterClosely relatedConfidence 0.90 · higha different coroner
“Due to the lack of availability of a Child Psychiatrist there are long waiting times for children to be assessed.”
Original on judiciary.uk ↗ Department of Health and Social Care responded, stating 1 specific action.Response (PDF) ↗
“we are working nationally to support local areas to expand mental health services so that more people can access the care and support they need.”
Stated timescale: 2023/24
- 2 months later
Raised again · 3rd time
Charley Patterson↗
19 Oct 2022 · Andrew Hetherington · North and South Northumberland
Closely relatedConfidence 0.90 · higha different coroner“I ask for there to be an assessment of the services and resources that can be offered to meet the increase in demand in the number of children and young people seeking support with regard to their emotional well-being, psychological distress and mental health difficulties which have impacted on them since the Coronavirus pandemic and to reduce the delay in receiving early support in order to avoid a mental health crisis.”
Original on judiciary.uk ↗ Repeated from the earlier report:serviceschildrenyoungpeoplementalhealth
The most recent report. A response may not be due or published yet.
- All reports to Department of Health and Social Care
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2018 → 2019Daniel Shorrocks1 year 4 months after Karen Edgar · different coronerClosely relatedConfidence 0.85 · high
Closely relatedConfidence 0.85 · highBoth reports highlight insufficient resources for youth mental health services leading to preventable harm. The earlier report focuses on underfunding in Cumbria, while the later calls for a resource review in areas with many young people in care.
Karen Edgar · 16 Apr 2018
“(1) The provision of mental health services for children and young people in Cumbria is underfunded.”
Original on judiciary.uk ↗ Daniel Shorrocks · 1 Aug 2019
“(1) | ask please that your Department reviews the availability of resources to those Local Authorities which have a high proportion of young people in care and disproportionately few qualified and experienced staff.”
Original on judiciary.uk ↗ 2018 → 2022Robyn Skilton4 years 4 months after Karen Edgar · different coronerClosely relatedConfidence 0.90 · high
Closely relatedConfidence 0.90 · highBoth reports identify insufficient resources and provision for child and adolescent mental health services as a core problem. This leads to delays in assessment and treatment, increasing risk of harm.
Karen Edgar · 16 Apr 2018
“(1) The provision of mental health services for children and young people in Cumbria is underfunded.”
Original on judiciary.uk ↗ Robyn Skilton · 7 Aug 2022
“Due to the lack of availability of a Child Psychiatrist there are long waiting times for children to be assessed.”
Original on judiciary.uk ↗ 2018 → 2022Charley Patterson4 years 6 months after Karen Edgar · different coronerClosely relatedConfidence 0.90 · high
Closely relatedConfidence 0.90 · highBoth reports highlight insufficient mental‑health resources for children and young people leading to treatment delays.
Karen Edgar · 16 Apr 2018
“(1) The provision of mental health services for children and young people in Cumbria is underfunded.”
Original on judiciary.uk ↗ Charley Patterson · 19 Oct 2022
“I ask for there to be an assessment of the services and resources that can be offered to meet the increase in demand in the number of children and young people seeking support with regard to their emotional well-being, psychological distress and mental health difficulties which have impacted on them since the Coronavirus pandemic and to reduce the delay in receiving early support in order to avoid a mental health crisis.”
Original on judiciary.uk ↗
Stated action
“the CCGs are working to implement an action plan to address the issues raised in your Report.”
No specific action could be extracted with a verified quote.
Stated action · timescale: 2023/24
“we are working nationally to support local areas to expand mental health services so that more people can access the care and support they need.”
No published response from Department of Health and Social Care was found for this report. It is the most recent report, so a response may not be due or published yet.
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to Department of Health and Social Care at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2018 → 2019 | 0.63 | 0.20 | Closely related · 0.85 | different |
| 2018 → 2022 | 0.74 | 0.40 | Closely related · 0.90 | different |
| 2018 → 2022 | 0.62 | 0.25 | Closely related · 0.90 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.