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recurance

Alexander Channing

31 Jan 2025 · Coroner Richard T Middleton · Dorset

The coroner's concerns

  1. 1. students with mental health issues seeking wellbeing support

    “The number of students commencing or resuming studies following the Covid 19 pandemic with mental health issues and requiring support from the wellbeing services at Arts University Bournemouth has significantly increased”
  2. 2. lack of knowledge about direct transfer process

    “[name redacted] was to be transferred from the Community Mental Health Team in his home town to the Community Mental Health Team in his university town. The transferring CMHT were unaware that it was possible to arrange a direct transfer to the receiving CMHT without the need for [name redacted] to be first registered with a GP surgery in his university town”
  3. 3. discharge planning lacked multidisciplinary coordination

    “[name redacted] was admitted to a district hospital on 7/1/22 and seen by the Liaison Psychiatry Team. Following a decision to discharge [name redacted] from hospital it was decided that a referral to the Home Treatment Team was unnecessary. [name redacted] was discharged to a date provided by the CMHT in his university town. There was no involvement of that CMHT in his discharge planning”
  4. 4. absence of proactive consent seeking policy

    “There is no policy in place at Devon Partnership NHS Trust which encourages a repeated proactive approach in seeking consent from a patient to share information at relevant times”

Responses

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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.

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