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recurance

Trinder Birdi

25 Nov 2020 · Coroner Nadia Persaud · East London

The coroner's concerns

  1. 1. downgrading of suicide risk by unfamiliar staff

    “The general practitioner who had known Ms [name redacted] over a number of years and had seen her for multiple mental health consultations had raised concerns with the A & E psychiatric team that Ms [name redacted] was at a high risk of suicide. The GP considered that Ms [name redacted] required an urgent psychiatric assessment and that Ms [name redacted] was at a high risk of taking a further overdose with a higher number of tablets. Following assessment, the same day, by a psychiatric liaison nurse who had never met the deceased before”

Responses

2020-0252-Response-from-North-East-London-Foundation-Trust-Redacted.pdf ↗· North East London Foundation Trust

Stated action

“A requirement will be introduced for a referral to the on-call psychiatrist to be completed where the presenting risk is significantly different to that of another clinician (including GP) who has reviewed the patient on the same day.”
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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