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recurance

Parminder Sanghera

12 Aug 2024 · Coroner Zafar Siddique · Black Country

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. lack of full mental health act assessment before release

    “During the course of the inquest, I heard evidence Mr [name redacted] was deemed to be suffering from behavioural issues rather than a mental health crisis and no full Mental Health Act assessment took place either at New Cross Hospital or whilst in custody at Oldbury Police station.”

Linked reports

Repeats an earlier warningRichard Carlon22 Jul 2019 · 5 years 1 month earlier
Closely relatedConfidence 0.90 · high

Earlier report

“No approved Mental Health practitioner was available to make the Mental Health Act assessment of Mr [name redacted] on 14/11/18. I was told this was an ongoing problem and was delaying assessments.”
Original on judiciary.uk ↗

This report

“During the course of the inquest, I heard evidence Mr [name redacted] was deemed to be suffering from behavioural issues rather than a mental health crisis and no full Mental Health Act assessment took place either at New Cross Hospital or whilst in custody at Oldbury Police station.”
Full chain: Lack of mental health act assessment before release

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.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error