Calls for accountability: mental health trust failures contributed to death of Linda Banks

22 December 2023

In April 2022, Linda Banks died due to an overdose following weeks of contact with the Tees, Esk and Wear Valleys NHS Trust (TEWV) Crisis Team.

Linda Banks was the ‘kindest of people’ who ‘worked hard’ raising money for various mental health charities.

During the inquest, it was revealed that Linda had a history of mental health difficulties, as well as learning difficulties which may have increased her vulnerability. Linda herself, her family and her friends, made multiple contacts with mental health services between February 2022 and her death, as her mental health deteriorated and concerns were expressed as to her safety.

County Durham Assistant Coroner, Janine Richards, said a recurring theme emerged in Linda’s care whereby clinicians consistently overlooked her distress and paranoia, viewing them as not ‘genuine’. This oversight resulted in an ‘underestimation’ of the risk she posed to herself. Other issues related to the quality of assessments and triage, quality of safety planning, poor record keeping, and a lack of a trauma informed approach.

As a result, Linda ‘did not receive the right care at the right time and her needs were not fully met’.

The coroner found that these difficulties culminated in advice being given that Linda’s family and friends should consider ‘tough love’ and to effectively step back from their intensive support of Linda, thus removing an essential safety net in the absence of any ongoing mental health treatment or support.

Ms Richards found that the identified failings cumulatively contributed to Linda’s death.

She also found that many similar issues in in the Trust’s provision of mental health services had been identified previously by an internal review in November 2021, and it is clear that many of these problems were continuing at the time of Linda’s death in April of 2022 and had not been addressed effectively by the Trust.

Ms Richards issued a Report to Prevent Future Deaths in relation to actions taken by the Trust to address thematic issues with the functioning of services, and delays in internal post-death investigations. Following submissions made on behalf of the family, she also upheld her ruling that Article 2 ECHR was engaged in the inquest on both the systemic and operational bases.

Lily Lewis, of GCN’s Inquests & Inquiries team, represents the family of Linda Banks. She is instructed by Alistair Smith of Watson Woodhouse Solicitors.

Lily also recently represented the family of David Stevens at the inquest into his death. David died nine weeks after Linda Banks, following contact with the same TEWV Crisis Team.

The families of Linda Banks and David Stevens, along with other bereaved families, are campaigning for a public inquiry into TEWV. See recent coverage of the campaign here.

Media coverage of the inquest can be found below:

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