Mental health clinicians 'dismissed' a patient making threats to take his own life moments before he 'rolled' into the road and was hit by a taxi, an inquest has heard.
Daniel Kirton, 35, tragically died after being hit by a car on Upper Brook Street less than two hours after being discharged from Manchester Royal Infirmary by the mental health team - part of Greater Manchester Mental Health NHS Foundation Trust - on December 3, 2020. An inquest into his death on Monday (August 22) heard that Daniel had been deemed fit to be released, despite attempting to take his own life on the hospital grounds minutes later.
The inquest, at Manchester Coroner's Court, heard how Daniel, who was homeless at the time, had attended the emergency department earlier that evening, at around 4.40pm. He was not assessed until around 10.15pm.
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He was then assessed again a short while later before being 'escorted' out of the hospital at around 11.15pm, when security officers based at MRI got a radio call from colleagues telling them there was an 'aggressive male' refusing to leave the department.
Upon arrival, David Postlethwaite, one of the security officers with Sodexo, the agency that hires security personnel at the hospital, said they found Daniel trying to take his own life on hospital grounds. Mr Postlethwaite told the court that they rescued him but that they had 'no training in dealing with people with mental health'.
However, the court heard that the security officers carried out training where they were awarded certificates in behaviour management and ways to restrain patients safely and did refresher courses every year after that.
“As soon as I approached him (Daniel), I knew he wasn’t well. I have been around mental health for a period of time as I am in a programme personal to me, so I can see those signs more than my colleagues,” Mr Postlethwaite told the court.
“We went over to him to get him down and I radioed for the mental health team to come out and speak to him. He was scared and didn’t know what was going on, he was convinced that he did want to end his life at that point."
'I am not 100 per cent sure they were taking it seriously'
Mr Postlethwaite said he radioed the control room to ask for additional support from the mental health team, who said Daniel was able to go back inside the hospital if he wanted to. A short while later, at around 11.22pm, two mental health practitioners came outside to try and assist but were 'dismissive' and told Daniel he would get a 'home visit' the following day, according to Mr Postlethwaite.
“I am not 100 per cent sure if they were taking it seriously,” said Mr Postlethwaite. “They kept repeating he had already had an assessment and that the home treatment team would visit him. It felt they were dismissing it because they had already made their decision.
“Once they (the clinicians) said he would be seen by the home treatment team tomorrow, he said he wasn’t going to make it to tomorrow and that he was going to die that night.”
Asked if he felt he was being ‘supported’ by the mental health clinicians by Sam Harmel, representing Daniel’s family, Mr Postlethwaite responded “No.” The court heard the clinicians stayed outside for around five minutes before going back inside because they felt their presence was making Daniel 'agitated'.
Daniel left the hospital grounds and was hit by a taxi nearby, on Upper Brook Street, at around 11.37pm - 22 minutes after first being escorted out of the emergency department. A pre-inquest review earlier this year heard that the 35-year-old 'rolled' out into the road before the fatal collision. He was pronounced dead the following day, December 4.
'He was a good brother, a good father and a good son'
Daniel's brother David, who was present at Manchester Coroner’s Court on Monday (August 22), said Daniel had ‘struggled with mental health for a long period of his life’ but was 'kind and compassionate'.
He told the court he hadn't seen his brother for around seven months prior to his death, and said: “He was someone who struggled with mental health for a long period of his life. He was kind, compassionate and would help out anyone.
“He was a good brother, a good father and a good son. He wasn’t perfect as a character but was a good person in his heart who was easily led astray. His mental health challenged him for a lot of his life and he didn’t get the help he needed when he needed it most.”
The inquest also heard from a police inspector based with GMP, Stephen Wiggins, who told the court that security staff based at the hospital initially told him they had ‘no training’ in dealing with people with mental health issues and that they witnessed Daniel ‘throw away £100’ and ‘make comments saying he was going to end his life’ shortly after being discharged.
Deceased suffered 'serious assault' days before death
Chief Inspector Wiggins had been called to the scene the following morning (December 4 2020) as he was the duty inspector on at the time. He said a joint investigation with the criminal investigations department and serious collisions unit (SCIU) was carried out due to Daniel’s contact with mental health practitioners the previous day and also due to the fact he had been hit by a vehicle.
“Three security officers were spoken to who provided witness statements, who stated they had no training in dealing with people with mental health, that mental health staff came outside advised him (Daniel) to return to A and E, and that they witnessed him throw away £100 and make comments that he was going to end his life," he said.
Following a special procedure investigation, Chief Inspector Wiggins deemed there was no third party involvement involved in Daniel's death. He also told the court of a ‘serious assault’ that Daniel suffered a few days prior to his death on December 1. He said Daniel had been staying with a friend in Trafford when an argument ensued indoors.
“It led on to the street and there were members of the public present,” he said. "At which time he was then assaulted and had to receive medical treatment. The suspect was arrested and that is still being processed today.”
The medical cause of Daniel's death was noted as 1A chest injuries. Over the course of the full inquest, set to last for five days, Area Coroner Zak Golombek will hear from legal representatives on behalf the Greater Manchester Mental Health NHS Foundation Trust and Manchester University NHS Foundation Trust, along with the Security Industry Authority, mental health practitioners and the security officers.
Proceeding .
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