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recurance

Christopher Lloyd

26 Aug 2022 · Coroner Chris Morris · Manchester South

This report repeats 1 earlier warning, and was raised again 1 time later. See the linked reports.

The coroner's concerns

  1. 1. lack of local dual-diagnosis service

    “it is a matter of concern that he did not have ready access to a dual-diagnosis service locally”

Linked reports

Repeats an earlier warningNicholas Spooner28 Jun 2021 · 1 year 2 months earlier
Identical hazardConfidence 0.90 · high

Earlier report

“Specialist dual diagnosis service needed with outreach facilities including drop-in and day centres to provide support for those in mental health crisis which is inextricably entwined with their substance abuse and who are often denied that mental health support.”
Original on judiciary.uk ↗

This report

“it is a matter of concern that he did not have ready access to a dual-diagnosis service locally.”
Full chain: Lack of local dual-diagnosis services
Raised again laterAlexi Susiluoto4 Apr 2025 · 2 years 7 months later
Identical hazardConfidence 0.90 · high

This report

“it is a matter of concern that he did not have ready access to a dual-diagnosis service locally”

Later report

“That substance misuse and mental health treatment is routinely provided by different organisations, despite close interplay between these conditions and that this can result in significant complexities for agencies caring for the same patient”
Original on judiciary.uk ↗
Full chain: Lack of local dual-diagnosis services

Responses

2022-0266-Response-from-Department-of-Health-and-Social-Care.pdf ↗· Department of Health and Social Care

Stated action · 1 August 2022

“the development of a Co- Occurring Conditions team who will deliver system-wide training in recognition of the complexities and contexts of those with co-occurring conditions”
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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error