A Broken Man

In August last year, 21-year-old Joe Black (top) went to his GP for help, as he was having thoughts about taking his own life.

Following an acrimonious break-up, Joe was struggling. He had been prescribed antidepressants. He had subsequently taken an overdose and, on a separate occasion, attempted to drown himself.

The GP sent Joe to the A&E department at Macclesfield Hospital (right) and flagged him as an urgent case – a suicide risk. However, at A&E he was referred back to his doctor with some advice to “work on self-care”.

Three days later, on August 12th, Joe’s work colleagues became worried as he had not turned up for his shift. They went round to his flat in Macclesfield where they found him hanged.

At his inquest at Cheshire Coroner’s Court this week, Joe’s mother Clare (left) revealed that his mental health started to deteriorate when he was at Sheffield University, which he had left at the end of his first year. She said: “I was aware he was on and off antidepressants that would cause his mood to go up and down; triggers for his moods included abandonment and isolation.”

Clare added: “After Christmas, he seemed to be okay. But looking back, that was just Joe putting on a brave front…He did what he could to try and motivate himself and be positive, but sadly wasn’t able to do so.”

Holly Nettle, a registered psychiatric nurse at Macclesfield District General Hospital, told the court that Joe was referred to A&E by his GP. She told the inquest: “Joe had seen his GP and was coming to A&E as he was being flagged as someone with suicidal thoughts.

Joe told me that he had suicidal thoughts in the past and they had reoccurred in recent weeks, but he had no current thoughts or intent to act and was actually talking about the future. He was quite thoughtful and intelligent and seemed to understand himself quite well. I didn’t feel he required an inpatient admission to manage that risk. He felt able to keep himself safe at that time.

The plan was he would go back to his GP and work on self care and engage with the psychiatric services through the health care provision. He seemed like he wanted help and he was actively seeking it. He did feel able to engage in it.”

Clare’s emotional response was: “He’s a young man seeking help from his GP. He is referred to A&E, but then told to go back to his GP. There’s a breakdown here. He was a broken man asking for help. He came to you and you turned him away.”

Clare attempted to persuade coroner Peter Sigee (right) to file a ‘Regulation 28’ report, in which recommendations to bodies can be made in light of inquest findings. However, this was not to be. Returning a verdict of suicide, the coroner stated: “Whilst I hear very acutely the families concerns I regret I do not consider this is a case which requires a report. Those practitioners that where involved will have already reflected upon Joe’s death and continue to do so.”

Clare told the Manchester Evening News that she intends to challenge the coroner’s decision. “I don’t understand what more someone needs to do,” she said. “The alarm bells were ringing. Aside from saying ‘I’m going to kill myself’, what more could he have done?”

Both the GP and the psychiatric nurse should be well aware that antidepressants can induce akathisia, leading to impulsive suicide attempts. Moreover, they should be familiar with what is in the British National Formulary  (BNF), the official prescriber’s handbook. This contains the paragraph: “The use of antidepressants has been linked with suicidal thoughts and behaviour. Where necessary patients should be monitored for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment or if the dose is changed.” The fact that Joe was “on and off antidepressants” would have exacerbated the risk of his self-harming. Yet this does not to have registered with the GP, the nurse or the coroner.

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