At the request of the young man’s father, the names of the young man and those who treated him have been removed in order to protect the identity of the young man in question.
In February last year, an academically successful sixth-form student lost his life when he was struck by a train at a station in Cambridgeshire. A few weeks earlier, the young man (YM) had celebrated his 18th birthday. He had achieved 12 Grade A* passes at GCSE level, the highest ever achieved at his school. He was on course for excellent A-level results, and had been offered a place at Cambridge University the following year. He was also a gifted pianist.
At YM’s inquest this week, the family’s GP confirmed that he had seen YM 18 days before his death, when YM told him he was depressed and having suicidal thoughts.
The GP told the inquest he recommended an immediate transfer for more appropriate psychiatric care. YM then had a 15-minute phone interview with a registered mental health nurse, who decided that YM would not be eligible for the rapid 24-hour referral. He recommended the use of the antidepressant Citalopram, which the GP prescribed.
As I have mentioned before on this site, Citalopram has been linked to more self-inflicted deaths in the UK than any other SSRI antidepressant. Because of the heightened risk of suicidal ideation, NICE Guideline CG28 does not countenance its use under any circumstances for anybody under the age of 18, or just a few weeks younger than YM.
Moreover, because of the suicide risk, Citalopram and other SSRIs are recommended for adults only after a diagnosis of moderate to severe depression has been confirmed. For any “subthreshold” condition, NICE Guideline CG90 states that “the risk-benefit ratio is poor”. YM’s “depression” may well have been a temporary reaction to the stress of the pressure of performing well, in which case the prescription of Citalopram would not have been appropriate. It would be astonishing if neither of the two professionals involved in its prescription did not appear to consider the risk that the drug may well do more harm than good.
It was reported that: “At subsequent appointments with [his GP], [YM] reported no improvements, despite the course of Citalopram.”
YM was then seen by a liaison psychiatric practitioner who concluded that, while YM was definitely depressed, he was not at risk of harming himself. The psychiatrist said that YM’s behaviour and demeanour did not strike him as that of a person in need of being passed directly on to the crisis team.
YM was given the number of a self-referral help line, as well as the addresses of several websites he could visit to find more information about depression, something he had already been researching on his own initiative. YM told his parents that the consultation had been helpful and a further appointment was arranged.
But, four days before the appointment and after 18 days on Citalopram, YM went to a station at a nearby village, where he was hit by an express train and killed instantly.
At the conclusion of the inquest, coroner Belinda Cheney (left) recorded that YM had died from multiple traumatic injuries as a result of having been struck by a train and delivered a verdict of suicide.
She highlighted the underfunding of mental health services nationally, and failings in the way YM’s case was dealt with: nobody told him about the side-effects of the antidepressants he took, and he didn’t have one stable contact, which didn’t help his feelings of low self worth.
Following the inquest, YM’s father commented on my site that the coroner would be issuing a Regulation 28 Prevention of Future Deaths notice to the Chief Coroner and to the Secretary of State, directly related to the appalling process of prescribing antidepressants to his son in complete contravention of all accepted guidelines. He wrote that he would never know for certain whether Citalopram contributed to his son’s death, but that he strongly suspected that it might have done. He added that there was no doubt that the method of prescription was fundamentally flawed and totally unacceptable. He concluded by stating that our entire strategy with regard to antidepressants for young people requires complete and radical overhaul.
In her PFD Report, published in September 2016, the coroner reported the following matters of concern:
- The GP [redacted] understood that he had been instructed by a member of the Assessment and Referral Team to prescribe Citalopram. The member of staff with whom he spoke was a nurse with no prescriber status. The GP felt bound to follow the advice given seemingly without appreciating that prescribing was his responsibility and with it the obligation to advise the patient about the medication.
- The trust acknowledges that it would be inappropriate for non psychiatrist members of staff to be advising GPs on medication and that this must be communicated to all staff.
- YM received no advice about the contraindications of the medication and critically that he may well feel worse before he felt better and may feel more suicidal. In either event he should have been told who to call to get further assistance.
- The fact that YM did not receive this information could be due to there being no clear sense of who would be responsible for his care pending further mental health team appointments.
- [Redacted] did not appear to appreciate that he could ask to speak with a consultant psychiatrist if he had any concerns and wanted to discuss any aspect of care or treatment.
- Apparently all GPs should have been made aware by the CCG that there is a duty psychiatrist with whom they can speak but according to the trust many GPs remain unaware of this.