Media Media releases Statutory inquiry into 2,000 deaths in Essex mental health services to open 3 September 2024 Chair Baroness Kate Lampard CBE Chelmsford Civic Center, Duke Street, CM1 1JEOpens Monday 9 September Scheduled until 25 September On 9 September, a statutory public inquiry will open into the deaths of mental health inpatients in Essex. The inquiry will be investigating the deaths of 2000 people who died while they were a patient on a mental health ward in Essex. The inquiry will be looking at deaths between 2000 and 2023. In November 2020, an independent inquiry was announced into deaths of mental health inpatients in Essex. following powerful campaigning by bereaved families, led by Melanie Leahy. Her son Matthew, aged 20, was one of six people to die at the Linden Centre in Essex over a short period. Due to concerns about the lack of candour and disclosure of information from those working at the Trust the inquiry could not proceed with its work. Following further campaigning by bereaved families, the inquiry was relaunched in October 2023 with statutory legal powers as the Lampard Inquiry. Statutory inquiries are often judge led and have more powers, including to compel witnesses to give evidence. This is the first public inquiry into mental health services that has ever been held in England and established by a Minister. The inquiry will be establishing the circumstances and arising issues in the deaths of mental health inpatients in Essex. As a result of its expertise on deaths in mental health services and their investigation in Essex and nationally, the charity INQUEST has now for the first time been given core participant status in a public inquiry. Deborah Coles at INQUEST, said: “We can all agree that when people die in the care of mental health services, their deaths must be investigated, and action must be taken to prevent further deaths. Instead, families bereaved by deaths in Essex mental health services have been denied the truth, kept in the dark and their calls for change left unanswered. Too often NHS Trusts and other providers respond to deaths with defensiveness and denial rather than candour, transparency and a genuine commitment to improving policy and practice. INQUEST’s work shows a systemic failure to tackle repeated and critical failings of mental health services. Without the courage, persistence and determination of bereaved families and survivors campaigning for the truth for so many years this statutory inquiry would not be happening. It must now finally shine a spotlight behind the closed doors of Essex mental health services and tackle the unacceptable death toll of people under their care. The value of this inquiry can only be judged by its impact in creating change. That change is long overdue.” ENDS NOTES TO EDITORS For further information, to note your interest and to arrange interviews, please contact Selen Cavcav at [email protected]. INQUEST and families are represented by INQUEST Lawyers Group members Charlotte Haworth Hird and Amy Ooi of Bhatt Murphy and Anna Morris KC and Lily Lewis from Garden Court North Chambers. Other families are represented by Adefolaju Sanda, Agata Usewicz, Nina Ali, Priya Singh, Grace Folley and Christina Jose of Hodge Jones and Allen and Steven Snowden KC and Dr Achas Burin from 12 King's Bench Walk. A number of families are also represented by Rachel Harger of Bindmans, Brenda Campbell KC of Lincoln House Chambers and Tom Stoate from Doughty Street Chambers. Other core participants include Essex Partnership University NHS Foundation Trust (EPUT), North East London NHS Foundation Trust, Suffolk and Northeast Essex ICB, Care Quality Commission(CQC) and Department of Health and Social Care (DHSC) Find out more about the Lampard Inquiry here. The full Terms of Reference for the inquiry can be found here. INQUEST’s opening submissions to the inquiry will be available here on Monday 9 September. Recent deaths in Essex mental healthcare: Sophie Alderman, died on 19 August 2022, aged 27, after having applied a ligature in her bedroom while a detained inpatient at Willow Ward, Rochford Hospital, Essex. An inquest found she died by ‘misadventure’. Media release. Morgan-Rose Hart, 18, died on 12 July 2022 after being found unresponsive on 6 July 2022 on Chelmer Ward at the Derwent Centre, an adult acute mental health ward in Essex. An inquest found that neglect contributed to her death. Media release. Marion Michel, 56, died of self-inflicted injuries on 4 March 2022 whilst an inpatient at Brockfield House, a secure mental health unit in Essex. An inquest found that the absence of a specific risk assessment may have contributed to her death. Media release. Chris Nota, 19, had been under the care of Essex mental health services when he died on 8 July 2020 after falling from a height in Southend. An inquest found that multiple failures in care contributed to his death. Media release. Edwige Nsilu, 20, died on 5 February 2020 after being found unresponsive at St Andrews Healthcare Essex. An inquest concluded that neglect contributed to her death. Media release. Bethany Lilley was 28 when she died whilst an informal patient on Thorpe Ward at Basildon Mental Health Unit on the evening of Wednesday 16 January 2019. The inquest in March 2022 concluded that her death was contributed to by neglect due to a plethora of failings by Essex University Partnership Trust. Media release. Neil Challinor-Mooney, 51, died on 18 November 2018 after he was found unconscious in his room at Goodmayes mental health hospital in Ilford two days prior. An inquest concluded that gross failures in the mental health care provided to him by the North East London NHS Foundation Trust (NELFT), amounting to neglect, contributed to his death. Media release. Other relevant cases: Deaths of people in the care of Essex mental health services, November 2020 In 2021, EPUT was prosecuted in relation to health and safety failings concerning ligature points. The Trust was fined £1,500,000. Sentencing remarks. Journalists should refer to the Samaritans Media Guidelines for reporting suicide and self-harm and guidance for reporting on inquests.