Today, Tuesday 10 July 2018, HSIB has published a mental health investigation report about a vulnerable young man who committed suicide while transitioning from child and adolescent to adult mental health services.
The report says that poor co-ordination between services, discharge issues and lack of communication with patients and their families are systemic problems, which were key findings in our Maintaining Momentum report published in March 2018.
Commenting on the report, Parliamentary and Health Service Ombudsman Rob Behrens said:
‘This report reinforces what we’re seeing in our casework - poor co-ordination of mental health services as well as problems in communication with patients and their families.
'We must maintain momentum in improving mental health services to ensure patients receive the safe, effective care they need and prevent the same mistakes happening to others.’