Amy Jayne Morby didn’t want to be sent home from the Royal Cornwall Hospital. She was suffering and had told staff she wanted to die. So when the psychiatric team approved her discharge, Amy stole a scalpel and locked herself in a disabled toilet, sending a photograph of her self-inflicted injuries to her friend Jamie Sampson.
Doctors found Amy, bleeding, after Sampson called the hospital requesting they find her. They treated the 23-year-old’s wounds and deemed her safe to be discharged to the homeless shelter where she’d been living for a year since a breakdown in relations with her family.
Amy was discharged after visiting A&E 10 times in the nine months leading up to September 2018. On the thirteenth of that month, she died by suicide.
Lucy Dynes, Amy’s best friend, spoke to HuffPost UK over the phone two days after she attended Amy’s Disney-themed funeral, where attendees wore colourful outfits, in the churchyard of Ponsanooth, a tiny village 10 miles away from the hospital she died in.
The 24-year-old explained that she and Jamie, another of Amy’s friends, decided to speak out because they believe the system failed Amy and that she killed herself because she felt people were not listening. “This wasn’t a case of someone who wasn’t asking for help. Amy begged for help. Her only way to escape her demons, her pain and suffering, was to end her life,” Lucy said.
Vulnerable patients with mental health conditions like Amy are regularly being let down by the NHS, according to a March 2018 report from the parliamentary and health service ombudsman, which highlighted the issue of the NHS discharging patients from hospital without appropriate aftercare plans in place. In a previous 2016 report, they described aftercare as “shambolic and ill-prepared”.
The issue is one that affects patients across England, but some areas can be better than others; much depends on local funding, explained Brian Dow, deputy CEO at Rethink Mental Illness. “Local authorities (are) being squeezed and having to make very difficult decisions about what to fund.”
Amy did not fare well in the geographical lottery: the EU considers Cornwall to be the second poorest region in northern Europe, while the Cornwall Partnership NHS Foundation Trust saw income slashed for three years running (2013-2016).
The trust was put in the spotlight in 2015 when patient David Knight died by suicide. The coroner’s report deemed one of the biggest contributing factors to his death was that he’d been sent to ‘out of area’ psychiatric care – five hours away from home – because the trust had no beds available. This was happening to around 30 to 40 patients a day. At the inquest the trust gave evidence showing this was not just a problem for them but a national issue.
Although neither the coroner nor the trust explicitly attributed the lack of beds to funding, in 2017 the trust’s medical director Ellen Wilkinson said: “Historic underfunding has set many services up for failure. In one instance, money was given to commissioners for children and young people’s mental health services, but then subsumed into paying off overall debt.”
The people often most affected by the gaps in an under-funded system at breaking point are those, like Amy, without immediate family to pick up the pieces. People who fall off the radar.
The Royal Cornwall Hospitals NHS Trust, formerly and still commonly known as Treliske Hospital, is currently conducting a review of the care Amy received.
Paula Sherriff MP, Labour’s Shadow Minister for Mental Health, told HuffPost UK: “This truly heartbreaking case shows the disastrous consequences of the Tory government’s continued underfunding of crucial mental health services. Historic underfunding has led to a workforce crisis that has seen more than 20,000 people leave mental health roles in the NHS and waiting lists grow – as in this case, with tragic results.”
In November 2015, Amy’s grandma died. Amy had been her primary carer, and she was badly affected by her death. “She never really came to terms with her loss and wished to be with her all the time,” said Lucy. Soon after, Amy was first diagnosed with depression and anxiety by her GP.
She volunteered at a British Heart Foundation shop in Falmouth for a year until 2017, but Amy’s mental health was becoming progressively worse; she moved into a homeless shelter following the family breakdown, where she began deliberately overdosing. Lucy, who first met Amy in 2017 through a mutual friend, said that she and Jamie called paramedics multiple times after finding their friend lying unconscious on the floor of her small bedroom.
“I lost count of the number of times I was in the ambulance with her,” said Lucy.
Amy normally stayed in hospital for between 24 and 48 hours, depending on her physical condition. She would then be passed from the care of emergency doctors to the on-site psychiatric team at the Royal Cornwall, the people responsible for evaluating a patient’s mental state before discharging them.
Lucy was present at a number of the pre-discharge evaluations – she said the ones she witnessed only lasted around five minutes – and said sometimes Amy could have been perceived as uncooperative or hostile because of her illness.
When this happened, Lucy claimed she expressed her own concerns to doctors about what was happening. “[Amy] would tell them ‘I want to die, I’m going to self-harm’,” she said. “They still discharged her anyway.”
Friends were distressed by Amy being discharged, but also by an apparent lack of meaningful aftercare. Amy was supported by a community psychiatric nurse and was given a leaflet for a therapy service, Outlook South West which is partnered with the trust. It receives around 14,000 NHS referrals each year.
“The waiting list there [at Outlook] was six weeks long, and even then they only offered six CBT sessions [Cognitive Behavioural Therapy],” said Lucy. “That is just not appropriate for someone who needs emergency crisis care.”
A spokesperson from Outlook SW told HuffPost UK that they agreed with Lucy’s categorisation of their services: “We do CBT sessions for patients once a week, perhaps once every two weeks, this is for people with mild to moderate anxiety or depression. We are not a crisis resource.”
“This wasn’t a case of someone who wasn’t asking for help...””
Geoff Heyes, head of health policy at Mind, said: “Too often, we hear of people taking their own life soon after coming out of hospital or A&E. If you’re in crisis, or in hospital for your mental health, you are at your most vulnerable. At the very least, you expect to be kept safe and treated with dignity while under their care.
“No one in touch with services, asking for help, should reach the point of taking their own lives. Trusts need to do all they can to ensure they minimise the ways patients can come to harm – both during and after their stay.”
If the government is committed to reducing suicide rates, it must put more money into A&E psychiatric liaison teams, argued Heyes.
On the day of Amy’s death, Jamie and Lucy received a phone call from her sister. She explained that Amy was in a coma. The pair managed to join their friend’s family around her bedside before she passed away.
“The nurses and doctors in the critical care unit worked so hard to save Amy’s life, I can’t fault them at all,” said Lucy. “What I will say though, is that she should have never ended up in that position.”
At Amy’s funeral Lucy read a eulogy in tribute to her “hilariously funny and ridiculously clumsy” friend, who she described as being incredibly caring and concerned with the happiness of others. Reflecting upon the events of the past year, she added: “I did have some hope she was going to get help and people were going to listen. But part of me always knew it was going to happen.”
A spokesperson for the Cornwall Partnership trust told HuffPost UK: “We would like to express our sincere condolences to Amy’s family and friends for their very sad loss. We will conduct a full review of Amy’s care. As part of this process, we will offer to meet with her next of kin, to discuss our findings. The coroner will also examine all aspects of this case through an inquest; as a result we are unable to comment further at this time.”
Useful websites and helplines:
- Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
- Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
- The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk