An inquest jury has found that ‘multiple failures’ contributed to the death of a prisoner who had sought help with mental health issues.
The jury at the inquest said yesterday they felt a lack of face-to-face mental healthcare over five months had contributed to the death of Callum Brown, 25, who was found hanging in his cell at Highpoint Prison near Stradishall on Monday, April 8, 2013.
Mr Brown, originally from Romford, was serving three years and had been moved to the prison from HMP Wormwood Scrubs in 2012.
The father of two had a history of mental health problems and the inquest in Bury St Edmunds heard he was placed under a suicide and self harm management programme after he told a prison psychologist of an attempt to take his own life while at Highpoint in October 2012. Three days later he was deemed no longer at risk of suicide.
He was then referred for a mental health assessment, was seen by a mental health nurse and prescribed anti-depressants in November 2012 but had no further contact with mental health professionals. A statement from his mother, Helen Carey, read to the inquest on the first day on January 11, said that on March 18, 2013, Mr Brown had written to request a meeting with someone from the prison’s mental health team but this didn’t happen.
The inquest heard that the operational support worker claimed his last check of the cells had been at 6.45am on the day Mr Brown was found dead at about 8.30am.
But when crime scene investigators reviewed the CCTV footage, it revealed no checks had been made since 8.40pm on the evening before.
The jury yesterday said it found Callum received no notification of any mental health appointments after contact with his mental health nurse ceased in November 2012 and that this contributed to his death.
The jury also recorded: “Whether through possible failings in the appointment notification process, decisions that Callum may have taken not to attend an appointment or for any other reason that might have resulted in the lack of face-to-face mental healthcare contact, we find it more likely than not that the lack of face-to-face mental healthcare contact after 22 November 2012 contributed more than minimally, negligibly or trivially to the death”
Helen Carey said: “Since I learnt of his death, I knew that there was something wrong and have always felt strongly that his death was avoidable.
“The jury’s findings that failings in mental health services contributed to his death reflects what I believe went wrong.“
Deborah Coles, co-director of Inquest, which provides specialist advice to families on deaths in custody, said:
“Callum did not slip through the net. He was asking for help and was not given it. He was clearly vulnerable and desperate to speak to someone face-to-face about the problems he was facing.
“How many other people are sitting in their cells desperately crying out for help in prisons which are not equipped to deal with vulnerable people?”
A spokeswoman for the Ministry of Justice said; “Our sympathies are with Callum Brown’s family and friends.
“We will look closely at the findings of the inquest to see what lessons can be learned.
“We have accepted and acted upon the independent Prison and Probation Ombudsman’ recommendations.”
Any mental or physical healthcare for prisoners is provided by local NHS trusts.