Abigail Jelley
13 Oct 2025 · Coroner Nicholas Walker · Hampshire, Portsmouth and Southampton
The coroner's concerns
1. lack of mandatory training on perinatal red flags
“Community Mental Health Teams do not receive mandatory training on the perinatal red flags that are used when assessing patients with postnatal mental health issues”
2. lack of professional curiosity
“lack of professional curiosity shown by professionals both in [the deceased]'s case and generally”
3. structural cultural issues in trust services
“cultural issues within the trust services. A”