Thiago Araujo

1. 1. lack of supervision of discharged psychiatric patient

   “On 24 January 2020 Mr [name redacted] had discharged himself from psychiatric inpatient care he was to be supervised by the Camden and Islington NHS trust crisis team. Mr [name redacted] failed to engage with the crisis team and following a meeting on 30 January 2020 the crisis team closed Mr [name redacted] referral. In the course of this closure no arrangements were made to address the risks presented by Mr [name redacted].”

2. 2. lack of support for families of emotionally unstable personality disorder patients

   “Family and carers of patients diagnosed with emotionally unstable personality disorder do not receive support or education upon management of this diagnosis from Camden and Islington NHS Trust, unless the patient has been received for treatment by the personality disorder service.”

3. 3. failure to act on acute suicide risk

   “By 4 February 2020 the Camden and Islington community recovery team identified an acute risk of suicide in Mr [name redacted], faced with his non-compliance with community treatment they considered an admission into inpatient care. No actions were taken to affect this plan.”

4. 4. excessive delay in mental health act assessment

   “In evidence the community recovery team indicated that a factor in their inaction was the knowledge that arranging a section 135 mental health act 1983 warrant and assessment would take two weeks. Such an assessment requires actions by an approved mental health practitioner from the local authority, two section 12 mental health act approved doctors, the assistance of the Metropolitan police and the local magistrates court to secure a warrant. A delay of 14 days in securing a mental health act assessment”

5. 5. inability to prevent delivery of harmful online purchase

   “In the days leading to Mr [name redacted] death his family became aware that he had made an online purchase of which was to be delivered to his father's home. Despite raising these issues with Camden and Islington NHS trust, the Metropolitan police and employees of the post office there appeared to be no process available to the family to escalate their concerns to prevent delivery of this package.”

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