Review urged after woman takes own life

Oldham Coroner Simon Nelson has demanded a “robust audit” of the procedures for granting mentally-ill patients home leave.

His call came after a woman dived in front of a lorry only eight days after leaving the Royal Oldham Hospital.

Julie Gormley - who had been sectioned under the Mental Health Act weeks before - had been allowed by Pennine Care NHS Foundation Trust to leave the hospital even though support hadn’t been organised.

Ms Gormley’s family thought procedures were in place for visits after she left hospital on March 28 last year. Eight days later the mother-of-one (46) was killed on Greengate, Chadderton.

Consultant psychiatrist Dr Alistair Stewart told Friday’s inquest he thought a referral had been made when he made the decision to grant home leave on March 25.

He said: “No written record had ever been made, there should have been a written record or some documentation — there was no verbal record.

When asked by the coroner if the tragic events could have been averted had there been contact with the service, Dr Stewart said potentially it could.

Mr Nelson said there was neglect following her discharge, but said her care prior to her release was appropriate - as was the decision to allow home leave.

Ms Gormley, of York Road East, Middleton, who worked as a hospital domestic across Manchester, suffered from depression and encountered financial difficulties, the inquest heard. In March she was detained to a secure unit at Royal Oldham Hospital under the Mental Health Act.

Dr Stewart said that as Ms Gormley has shown no sign of self harm and had family and friends around her - plus a referral in place - home leave would be granted.

Her sister, Jacqueline Gormley, said Ms Gormley was “scared” of an appointment on the day of her death, in case she was detained again. A scribbled note to her sister was discovered in her home.

David Reid, who drove the wagon that struck Ms Gormley, told the inquest: “I couldn’t do anything, she just dived.”

Mr Nelson recorded a narrative verdict into her death, outlining she took her own life, but he had to consider neglect.

He said he had “no difficulties” with the care she received up to the decision to allow her home.

“The difficulty that I have is a complete absence of care from the time of her discharge, when she commenced her home leave.

“It’s not as if there was an element of care that could be considered as part of the decision-making process. There simply was no care.”

The trust said it was taking the matter “very seriously”.


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