Claire Greaves inquest

A still from a BBC TV programme showing four adults (two male, two female) sitting on a semicircular red sofa round a glass-topped table. Claire Greaves is second from left.
Claire Greaves on BBC TV

Yesterday the inquest into the death of Claire Greaves, who took her own life on a Cygnet-run eating disorder in Coventry in February 2018, concluded and recorded an open verdict (i.e. it was not a verdict of suicide) though it ruled that failings in her care contributed to her death, specifically:

  • Long-term segregation and seclusion contributed to a decline in Claire’s mental state
  • Staffing levels “probably caused or contributed” to her death
  • There was a failure to increase observations despite Claire making numerous self-harm attempts in the days prior to her death
  • Had there been “sufficient staff” then Claire’s care plan could have been followed and the risk period of 17:00 to 18:00 “would have been covered”
  • There was a failure in allowing Claire to be alone in her room prior to her death, contrary to her care plan.

(Adam Wagner, who represented the family, has stated on Twitter that this is not the full list of contributory failings identified by the jury.)

I’ve written about Claire Greaves before; I followed her on Twitter when she was a few months into her final period of being detained (sectioned) under the Mental Health Act from late 2015 onwards. At that time she was in a local mental health unit and hoping to be admitted to the Retreat, a specialist eating disorder unit, but was refused, and instead transferred to the Ty Catrin secure unit, operated by the Priory Group, in south Wales. The standard of care there was appalling, as she described in a blog entry after she was transferred to a local general hospital when her anorexia had nearly killed her. This was not the same unit in which she died, but the trauma of being subjected to this regime should have influenced her care at Cygnet in Coventry. The petty indignities she described are still standard practice in many secure mental health units countrywide, and are indiscriminate: the denial of privacy while using the toilet and bathroom, the withholding of sanitary products to menstruating women and girls (or their being expected to ask for them individually), and the denial of the use not only of computers and the Internet but even pens and pencils, ostensibly for the prevention of self-harm, regardless of their individual needs, are common practice. With all the hand-wringing about deaths in these places, the question of whether these regimes are abusive in and of themselves does not seem to have been asked.

A picture of Claire Greaves, a young white woman wearing a loose but short grey patterned dress, doing a jigsaw puzzle based on an "1980s shopping basket" theme.

Cygnet claim they have learned lessons from Claire’s death, that they are very sorry and all that. But it’s not good enough. Hers was not the first death from self-harm of a young woman in such a unit, and no doubt the ‘learning’ will be about how to prevent self-harm (by removing everything that could possibly be used for it, thereby further denuding the environment the patients lives in) rather than reducing the motivation for it by making the experience of being in such a place less miserable. There must be pressure put on the management of mental health units not to indiscriminately subject people to restriction and invasive supervision when it is not appropriate. If someone is in a secure unit for lack of the right kind of inpatient care, for example, they should not be refused use of the Internet for months or years just because there are forensic patients (those sent by the courts on hospital orders after committing crimes such as manslaughter) in the same unit — and if there aren’t, that is even less justifiable. Bathroom and toilet supervision should be imposed strictly on an individual, temporary basis, not imposed on everyone or by default. Maintaining dignity should be of paramount concern. How do you persuade a woman with anorexia nervosa to put on weight when she knows it will cause her periods to restart, when she has previously been locked in a room and left to bleed over herself?

Operators of these units should be facing stiff financial sanctions not only when an inpatient dies and neglect or abuse has been a contributing factor but also when an inspection finds that such practices are ongoing (and they should speak to patients, away from supervision, and their parents or relatives). In the case of deaths, chain operators which are repeat offenders should be liable to lose their licence to run healthcare facilities at all, not just face the closure of single units whose patients then have to be decanted elsewhere, possibly to other units in the same chain; the running should be taken over by the NHS or a better-rated provider. There must be legislation to prevent people being subjected to needless indignity in mental health inpatient settings but also to ensure that enough appropriate inpatient places are available so that people are not transferred to secure units simply because they need long-term care that an acute mental health ward or assessment and treatment unit (ATU) cannot provide, and even more so when the secure unit does not specialise in the care and treatment they do need.

And if the stiff sanctions mean that fewer of these companies are willing to set up new units (when not actually needed; they are often built speculatively), then that is all for the good. Companies profiting from abuse, indignity and death have no place in a modern healthcare system or in a civilised society, for that matter.

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