John Richardson

“The Jury in their Narrative Conclusion confirmed that they agreed with the findings in the Serious Incident Report compiled by and the 9 key failings by the Trust. However I am satisfied that since [the deceased]'s death measures appear to have been put in place to address all these issues.”

“However the death of Mr [name redacted] appears to have occurred when there was some confusion amongst staff with regards to Mr [name redacted] leave status. This was identified by the Jury in their conclusion. Whilst some guidance is provided to staff, with regards to voluntary patients taking leave, there is no specific Leave Policy for Voluntary Patients in the same way as there is one for those patients sectioned under the Mental Health Act.”

“[the deceased] [name redacted] (known as [name redacted]) was admitted as a voluntary patient to Meadowfields Hospital. At the time of his admission he had been having suicidal thoughts. At about 10.20am on the 3rd February 2018 [name redacted] had gone out for a walk in the grounds but he did not return. Staff at Meadowfields contacted Police at 1.06pm to report [name redacted] as a missing person. The Police attempted to locate him but without success. On 4th February 2018 a member of public was walking their dog in some woodlands in”

“On 4th February 2018 a member of public was walking their dog in some woodlands in Patching when they came across the body of Mr [name redacted]. Police 1 and ambulance were called and death was confirmed by paramedics at 11:09am at the scene. Mr [name redacted] was found lying on his right side with a ligature around his neck, above him was the other part of the ligature tied around the branch of a tree which appears to have snapped at some point. Police confirmed”