Plea for parents to be heard in mental health care
The parents of a woman with mental health problems who died have called for families to have more of a voice.
Evangeline Wilson, 24, was found dead at her Bristol home in 2022 while on a “period of short leave” from a hospital in London where she was being treated.
A coroner conducting the inquest into her death said she died of cardiac failure due to morphine toxicity.
Her mother Sally Watson said: “We were parents to a young vulnerable woman but our voice was never listened to.”
The West London NHS Trust and Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) offered their condolences for what they called a “tragic incident”.
Known as Evie, Ms Wilson had a complex mental health history including bulimia, depression, self-harm, suicide attempts and post-traumatic stress disorder (PTSD), the inquest heard.
Her father Dr Nick Wilson, an experienced GP, described his daughter as “an incredibly energetic, vivacious young woman” who was “incredibly creative” and used her art to express “difficult, dark subjects but also joy”.
Speaking after the inquest, he said: “One big issue is how the different parts of the health system don’t work with each other.
“We struggled for six years trying to support Evie.
“We had to try and unearth information about what was going on. When someone reaches 18 there are difficult issues around consent.”
Ms Wilson had a history of interacting with local mental health services in Bristol, the inquest was told.
She had secured a place to study fine arts at Goldsmiths, University of London, which had been deferred so she could go to the Cassel Hospital, London, which offers residential, therapeutic care, in June 2022.
A few weeks into her stay, she was found intoxicated during a therapy session.
“As this was a breach of her agreement and likely to cause disruption in her treatment, there was a discussion between Ms Wilson and the treatment team and all agreed that she would take a period of short leave,” a spokeswoman said.
At the inquest, coroner Dr Peter Harrowing said she was not considered a risk to herself at this time and that the London hospital had put in place all the “appropriate measures”.
‘No causal link’
Ms Wilson returned to Bristol for a long weekend and AWP was asked to phone her on Saturday and Sunday.
But neither call took place. One because of illness and the other for “reasons not explained”, said the coroner.
The professional asked to make the call did not give evidence.
But Dr Harrowing added: “There is no causal link between [the lack of calls] and [Ms Wilson’s] death.”
Her last contact was with her grandparents on the Saturday at about 21:00 GMT.
They said she sounded calm but wanted more support and that she had planned to return to Cassel the following week “110% committed” to the programme.
Ms Wilson was found dead by police carrying out a welfare check at her flat on 10 July 2022.
Dr Wilson said: “The inquest was the most awful, harrowing and sad experience of my life. Most people don’t have to pick apart the last few days of your loved one’s life.
“It’s extremely hard that we have to learn so many important things after she died. I lie thinking about this, I have just learned all of this too late.
“If I have a message it is about how families and carers [can be] empowered to help.”
Ms Watson added: “We could’ve shared information on the vulnerabilities of our daughter.”
Serious incident review
A spokesperson for AWP said: “We are committed to learning the lessons from Evangeline’s death and addressing the issues raised during the inquest and following our own internal investigations.”
While a spokesperson for West London NHS Trust said: “We strive to give the best possible care to all our patients and have completed a serious incident review jointly with mental health services in the patient’s local area.
“In this review we have identified areas to improve our care and treatment and are implementing these to reduce the risk of tragic incidents like this happening again.”
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