Caroline Adeyelu
5 Mar 2026 · Coroner Nadia Persaud · East London
The coroner's concerns
1. inadequate risk assessment and management of mentally ill son
“The assessment of the subject's risk to others and the management of that risk by NELFT and ELFT following the discharge in October 2020 was inadequate”
2. insufficient safeguarding measures for adult child to parent domestic abuse
“lack of information gathering from wider family members; there was a lack of carer support; a”
3. ineffective communication between mental health services and police
“lack of effective communication systems in place between the mental health services and the Metropolitan Police Service, in circumstances where there are dual forensic and mental health concerns”