Recurance · prevention of future deaths reports
Pre-inquest brief
Untrained staff conducting mental health assessments
The earlier warning
Aaron Deeley · 19 Jun 2024 · Sonia Hayes, Essex
“The acute care healthcare professionals do not have specialist mental health training to conduct a mental health assessment and the consequential presenting harm.”
judiciary.uk/…/aaron-deeley-prevention-of-future-deaths-report
What was promised
Stated action 1 · response to Aaron Deeley (19 Jun 2024) · stated timescale: none stated
“We have therefore added a new flowchart to our 'Admission & Treatment of Patients with a Mental Health Disorder in an Acute Hospital Setting' Policy. A copy of the flowchart is attached for reference.”
judiciary.uk/…/2024-0331-Response-from-Mid-and-South-Essex-NHS.…
What recurred
- 27 May 2026 · Abbigail Smith (3) · Sonia Hayes · Closely related · confidence 0.92 (high)
The clearest link, quoted from both reports:
Earlier · Aaron Deeley · 19 Jun 2024
“The acute care healthcare professionals do not have specialist mental health training to conduct a mental health assessment and the consequential presenting harm.”
Later · Abbigail Smith (3) · 27 May 2026
“There were not sufficient trained staff to conduct the enhanced observations required to monitor Abbi with her known risk of severe self-harm whilst she was awaiting assessment under the Mental Health Act and actively attempting to take her own life.”
What happened next
No web check of the stated actions has been published for this chain.