GOVERNMENT CONTINUES TO DENY FAMILIES FULL STATUTORY PUBLIC INQUIRY INTO ‘CALAMITOUS’ FAILINGS
Feb 18, 2021 —
Posted on: 18th February 2021
Robust review into mental health services that led to more than 30 deaths will become another victim of the COVID-19 pandemic unless the Government acts now
Campaign backed by MP’s, 66 failed-families, charities and community leaders
Despite the Government’s recent attempt to invest in mental health with the appointment of Dr. Alex George, over 66 failed families in Essex have still been left with no answers over the deaths of their family members in the care of Essex’s mental health services.
The families have, once again, written to Nadine Dorries, Minister of State for Mental Health, Suicide Prevention and Patient Safety, to call for an immediate change of heart in the investigation into failings that have accounted for the deaths of more than 30 people, and suffering of many more.
Dr. Alex George, a medical practitioner and former reality television star, was recently appointed as youth mental health champion by the Prime Minister, having lost his brother last year. However, despite this, the Government has only offered an independent inquiry into the failings, which does not have the power to compel witnesses to testify – allowing vital evidence to fall through the cracks. This is despite a petition signed by more than 105,000 people across the UK calling for a full Statutory Public Inquiry.
The families, represented by Hodge Jones & Allen Solicitors, have written to Nadine Dorries, Minister of State for Mental Health, Suicide Prevention and Patient Safety, asking her to do the right thing and give the families what they are asking for – a full public and statutory inquiry. Many of the families have already had ‘independent investigations’ carried out, that have proved to be an utter waste of time and far from independent or geared towards getting to the truth of what is going so badly wrong in Essex.
Many of the families have made it clear that they will not engage with anything less than a public and statutory inquiry and refuse to be fobbed off with anything less.
Melanie Leahy who lost her son Matthew in November 2012, while he was in the care of Essex Mental Health Services. For 8 years, Melanie has campaigned tirelessly for answers around her son’s death. Melanie, who is renewing her push amid a government campaign to promote the importance of youth mental health said: “Our loved ones were extremely vulnerable. Some of them were neuro diverse, with Special Educational Needs (SEND) and identify (or identified) as having Autism, ADHD, or Dyslexia. Some of our loved ones have/had medical conditions such as B12 deficiencies, Dementia, or PTSD and sadly, some of our loved ones battled with their Mental Health. Some of them are still fighting today, and others lost their fight when they could fight no more. Our loved ones were reliant on the care of underfunded, understaffed, under qualified, poorly governed mental health services. Some of them were sectioned, some voluntary, and others not – All were desperately in need of professional help.
“As a collective of families, we have found strength in our unity and together we are pushing for a #StatutoryPublicInquiry to prevent these deaths from being covered up! We want to help to save the lives of other vulnerable children before their families lose them too. Our loved ones lost their lives as a direct result of a catalogue of failings both in mental health hospitals and in the community in Essex, but the same failings and multiple deaths are happening all over the country, everywhere, and could happen to you and your family too. Mental healthcare will never be improved to a sufficient level if existing failings are never addressed. We understand at the moment the health system is under a lot of pressure, but we can’t allow justice for families failed by mental health services to be yet another victim of Covid-19.
“Nobody should ever experience the same brutal lack of care, experienced by our loved ones. The damage is done to our families and there is nothing we can do to reverse this. The pain we feel is real, raw, deep, and excruciating – We are living a nightmare, as our daily routines. The grandiose inquiry announced by the government has no substance – it won’t achieve anything meaningful. We make a direct plea to Nadine Dorries to change course now, and set up the statutory inquiry we need. Lessons need to be learnt about what went wrong. I and other families demand answers. The service needs to learn from their mistakes, we cannot afford to add more lost lives to the list. We will never give up.
“We are determined to secure the first ever, ‘Mental Health Statutory Public Inquiry,’ to bring this out into the open, to defibrillate our system, and to improve every aspect of treatment and care in both mental health hospitals and in the community. The Government is great at ‘talking the talk’, but not so good at ‘walking the walk’.”
The call for a Statutory Public Inquiry is backed by Barbara Keeley MP (Worsley and Eccles South), Dr Rosena Allin-Khan MP (Tooting), Kim Johnson MP (Liverpool Riverside), Mike Hill MP (Hartlepool) and a host of household names, including; the charity Inquest, Young Minds, presenter Carrie Grant MBE, the Citizens Commission on Human Rights, broadcaster Sean Fletcher, and the campaign group Hundred Families.
Priya Singh: Associate Solicitor at social justice law firm Hodge Jones & Allen, one of the team representing Melanie Leahy and the other families, emphasised the importance of the campaign: “The independent inquiry offered by the Government is simply not good enough, it lacks essential legal powers and will therefore be pointless. We will not get to the truth and failings will be missed. A full Statutory Public Inquiry is mandated.”
Supporters of the campaign include:
Barbara Keeley MP (Worsley and Eccles South) said: “At the inquest into Matthew’s death, the coroner asked the NHS trust to consider commissioning an independent inquiry. The ombudsman, in his recommendation, said that the review due to be held by NHS Improvement, ‘should consider whether the broader evidence it sees suggests that a public inquiry is necessary’.
“In an interview on ITV, the ombudsman went further on the failings, including about Matthew’s care plan being altered after he died and his claim of rape not being investigated. He described them as a ‘catalogue of failings which are entirely unacceptable.’ He also said that he would fully support a public inquiry if one was recommended, and that he would like to have investigated further if he had had the powers. Both public officials who have investigated Matthew’s death, the coroner and the ombudsman, have said that they would support a public inquiry. Only a public inquiry will have the transparency and broad participation needed to rebuild trust in the services. The Minister will know that that is the only way that witnesses can be compelled to give evidence without seeking to apportion blame, and evidence must be given on oath.”
Dr Rosena Allie-Khan MP (Tooting) said: “After all this time, Melanie deserves some answers. I support her call for a statutory public inquiry into Essex mental health services and for the appointment of an independent chair. It is crucial that lessons are learned from Matthew’s case.”
Kim Johnson MP (the Labour representative for Liverpool Riverside) said: “It is absolutely right that we commit to uncover the truth about the significant failings in the care and treatment of vulnerable patients, and that the mantra of “learning lessons” is not merely a soundbite accompanied by endless toothless reviews but results in substantive and tangible change. An independent inquiry without the backing of the families affected will not take us further than the countless previous investigations and inquests. None have prevented further deaths or enabled accountability and change. Now nothing less than a full Statutory Public Inquiry will suffice.”
Mike Hill MP (Hartlepool) said: “I pay tribute to Melanie Leahy and family in their fight to get justice for Matthew, and was proud to have led the Parliamentary Petitions debate on calling for a Statutory Public Enquiry into his tragic death and the death of others at the Linden Centre in Essex. Over 100,000 people signed the Petition seeking Government intervention and up to 65 families are still seeking answers about what happened to their loved ones who were in the care of Essex Mental Health Services. Following a damning report by the Parliamentary and Health Services Ombudsman, in which the call for a full Statutory Public Inquiry is fully supported, the Government needs to now either confirm that its pledge to launch an Independent Inquiry will have the power to call vital witnesses or agree to a Full Statutory Public Inquiry.”
Deborah Coles, Director of INQUEST said: “Essex mental health services ignored dangerous practices that led to preventable deaths. If it were not for the dedication and persistence of bereaved families to get to the truth, these failings would never have come to light. It is time that those families are listened to. Only a statutory public inquiry can provide the scrutiny and oversight that is so necessary.”
Mental Health - Time for Action Foundation Rachel Bannister says:-
fully supports the call by Melanie Leahy and the other 65 Essex families (and growing) calling for a Statutory Public Inquiry into Essex Mental Health Services.
Despite continuous attempts over a number of years, Melanie and other families have been unable to access any evidence uncovered by Essex Police during their corporate manslaughter investigation and continue to be refused documents held by the trust itself.
Until services are open and honest about failings, staff are interviewed under oath and are held fully accountable and services adhere to contractual Duty of Candour, we will continue to witness unexplained deaths of the most vulnerable in society.
Tom Madders, Campaigns Director at YoungMinds said: “We stand in solidarity with Melanie and all families in Essex and across the country who have lost loved ones in mental health units. We continue to support a statutory public inquiry into all unexplained deaths in inpatient care, to ensure that failings in the system are fully understood and addressed.
“More generally, we need to see stronger rights for children and young people in inpatient care. That is why the proposed reforms of the Mental Health Act must lead to real change for young people and families, and why the Government must implement Seni’s Law – the Mental Health Units (Use of Force) Act – as soon as possible.”
Also backing the campaign, presenter Carrie Grant MBE and David Grant MBE said: “No parent should ever have to consider they may lose their child to a Healthcare system that is meant to be designed to care for them. No parent should ever have to plead and fight to uncover lies. No parent should ever have to continue to try and piece their lives together in an atmosphere where no one has been held to account. Surely Statutory Public Inquiries exist to unpick situations exactly like this. To uncover the truth, to hold to account those who need to be held to account, to make new laws and re-design a Mental Health Service that is currently not fit for purpose.”
Melanie’s son Matthew, who had been experiencing mental health problems, was admitted to the Linden Centre, Chelmsford on 7 November 2012, for ‘care and treatment’, and to ensure his safety. During his stay, Matthew contacted Essex Police begging for help. Eight years on, Melanie Leahy has acquired a recording of Matthew’s call to the emergency services: Matthew is heard telling the call operator that he has been raped, that he is bleeding, that he needs medical attention, and that doctors are ignoring him. On 15 November 2012, just 7 days after admission, Matthew was found hanging in his room. Matthew was taken to Broomfield hospital where he was pronounced dead. He was just 20 years old. Since the start of her campaign, Melanie has been joined by more than 66 other families whose loved ones were also badly failed by NHS Mental Health Services in Essex.
An inquest revealed that there had been multiple failings in the care given to Matthew at the Linden Centre by the North Essex Partnership University Trust (NEP). However, the inquest did not get to the bottom of what had happened and how it was possible for a young man to have died in this way, while in the care of ‘professionals’.
Professor Alison Leary Phd FRCN FGNI MBE
Chair of Healthcare & Workforce Modelling LSBU
“As a patient safety researcher and modeller I fully support the call that multiple Essex families, both bereaved and failed are making for a statutory public inquiry into Essex Mental Health Services. Having spoken to a number of the families and read the available evidence, a Statutory public inquiry is necessary to ensure that the issues are fully understood with transparency.”
Sean Fletcher, journalist and Good Morning Britain and Countryfile presenter added:“It’s shocking to see a mother fight for eight-plus years to find out how her son died in a mental health hospital, and still not have the answers. What she does know is the ombudsman found 19 instances of serious failures at the Linden Centre after investigating Matthew’s death, including changing his care notes after he had died to make it look like they were providing the right level of care. That is a disgrace and raises more questions than answers. Those members of staff have never been answerable. I am fully supporting calls for a statutory public inquiry because until there is one, Matthew’s story will be repeated in mental health hospitals across the country. One mother’s battle has now led to another 65 failed families coming forward. How many more?”
Julian Hendy – Chief Executive of campaign group Hundred Families said: “Hundred Families supports the campaign for a statutory public inquiry into mental health services in Essex. From Freedom of Information requests, public records, and our own work with bereaved families, we are aware of at least 40 mental health-related homicides by Essex patients since 2002. This is deeply concerning. In far too many of these cases warning signs were missed or even ignored. Many seriously ill people were unable, or unwilling, to access timely and effective care which might well have saved lives. We are concerned that lessons are not being learned effectively or embedded in practice to prevent further avoidable tragedies. In order to be effective, the Inquiry needs to be public – it needs to be robust, transparent, and be chaired by an independently-minded person, with experience in holding state agencies to account, and who enjoys the confidence of all the affected families.”
Iris Benson MBE
(Service User Carer Rep, Expert by Experience)
“We do not put people into care services to die. People who are vulnerable, in distress and mental illness, or learning difficulties, autism ,dementia etc….their voices must be heard and our families need to be able to speak up for them, and be listened to.
In my experience a lot of staff also want to speak up for patients, as they have a duty of care, but many are scared of repercussions. Until they are listened to nothing will change.
I stand side by side with Melanie and all the other families in their call for a #Statutorypublicinquiry into Essex mental health services and fully support it. Families/carers/patients and staff must all stand side by side to make the changes needed to a failing system.”
Dr Umesh Prabhu
Former NHS Medical Director - Bury NHS Trust 1998-2003 and Wigan 2010 -2017. NCAA Advisor and Clinical Director for NHS Professionals.
“Good Quality mental health is important.
These patients are most vulnerable and they need good quality care with great kindness and compassion. To learn so many patients have been harmed is really sad.
Hence I support this call for a Statutory Public Inquiry.”
Marjorie Wallace CBE. Chief Executive of SANE- mental health charity.
SANE supports the call for a statutory public inquiry into mental health services in Essex.
The disturbing series of suicides, unexplained deaths and homicides over the years, many of which we believe could have been prevented had there been earlier intervention, more sustained care and involvement of families, leads us to the view that only through full accountability can we be sure that lessons will be learned for the future.”
Anna Kennedy OBE, UK Autism Ambassador & Founder of UK Autism Charity.
'What happened to Matthew Leahy and other vulnerable people in similar tragic circumstances is intolerable.
It is vital that a light is shone on bad practice in mental health services wherever it exists. It is for this reason I fully support an objective and comprehensive statutory public inquiry into these tragic events.'
The Citizens Commission on Human Rights commented: “Mental health services in Essex are under fire as a result of either detention under the Mental Health Act or community-based treatment. Whether it’s voluntary in the community or involuntary in a psychiatric clinic, ‘treatment’ for mental illness has failed. For some, the results have been fatal or so damaging that their lives have been immeasurably impacted.
“The pursuit of the truth, the whole truth and nothing but the truth can only be achieved when enough pressure is exerted on those responsible for such poor results. Those with information have not come forward of their own volition in all this time. It is therefore vital that they are interviewed under oath and forced to engage. That’s why the Citizens Commission on Human Rights (CCHR) is supporting the call for a Statutory Public Inquiry. It’s the only solution in bringing about accountability of both Trust management and the consultant psychiatrists, the Responsible Clinicians (RC). Anything less than a Statutory Public Inquiry would be insulting to sixty-five families and counting.
“While attention has focused on the safety regulations of facilities governed by EPUT, the same amount of attention must be given to the prescribing habits of RCs and the debilitating effects of psychiatric drugs that are also known to create suicidal thoughts and suicidal behaviour. Blaming a person’s mental difficulties, a common occurrence when things go wrong, cannot be allowed to happen anymore.
“For Matthew Leahy and the other people who needed a helping hand in their time of need, the level of responsibility was evidently lacking and continues to be lacking. A slap on the wrist isn’t enough. People’s lives are at stake. A Statutory Public Inquiry is, therefore, a vital step in the direction of truth, accountability and change that will detect and prevent the same situation happening in the future.”
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