The mother of a severely anorexic 15-year-old girl who died after stepping in front of a train has said that failings in her daughter’s care “from beginning to end” resulted in her death.
Pippa “Pip” McManus was granted home leave from the Priory hospital in Altrincham, Greater Manchester, ahead of completion of the formal discharge process, in December 2015.
Five days later, after a family row, she walked to Gatley station in Stockport and was hit by a train. She was pronounced dead at the scene.
A jury at South Manchester coroner’s court concluded on Wednesday that Pip had taken her own life, but said that the lack of support provided to her family and the delay in implementing a care plan when she arrived home could have been contributory factors in her death.
The court was told that Pip’s parents had reservations about their daughter’s release, as they believed she remained in danger of self harming, but felt they had no option but to go along with the decision.
Reading a statement outside the court after the verdict, Pip’s mother, Marie McManus, said her daughter’s death had caused a “tear in the thread of our family [which] will never be mended”.
“Anorexia has the highest mortality rate attributed to any psychiatric illness, with as many as 40% of deaths [of those with anorexia] due to suicide,” she said. “Too many of our children are dying from this terrible illness. Effective treatment is needed more quickly and if this had been available to our beautiful daughter, maybe she would still be alive. Maybe we would not have needed this inquest.”
Jim McManus, Pip’s father, said that throughout the three years of his daughter’s illness there were many more failings than that of not creating an adequate plan for her discharge from the clinic. “From start to finish there were many hurdles, which we felt we were failed on,” he said.
The court was told that Pip talked to her mother about suicidal thoughts on many occasions and that once, the family had found goodbye letters written to her family, dog and doctor. One note read: “I do want to grow up and have a life; at the moment I don’t have one. I can’t fight anorexia any more. I have tried so very hard, but it has won me.”
A medical report made a week before the teenager died judged that absconding, suicide and deliberate self-harm were not “current risks” in Pip’s case. Janet Walsh, a consultant adolescent psychiatrist who was in charge of her care at the Priory, told the inquest that 40% of people with the teenager’s condition relapsed.
“She would still have risks with eating habits and exercise, it’s whether they could be managed,” she said. “There are going to be ongoing issues. You don’t get a young person at discharge without significant problems.
“It is about whether you can get a young person to a stage where it is reasonable to do a trial at home. I was concerned she might end up back in hospital, but it is an important learning process. My fears were about long-term hospitalisation. She had been in a long, long time and she was getting frustrated.”
The jury in Stockport decided that the decision to send Pip home had been appropriate, “as this was deemed to be the lowest risk option”. The jury foreman said: “The planning for discharge was not carried out in a timely manner. This resulted in not all necessary support packages being in place at the time of discharge.”
The jury also concluded that Pip’s parents had not been adequately warned of “the statistically increased risk of suicide in the first week following discharge”.
Pip was formally diagnosed with anorexia at 13, before a deterioration in her mental and physical health led her to be detained by the private hospital in Altrincham in September 2014 under section 3 of the Mental Health Act. When she arrived at the facility she weighed 27kg, which Dr Walsh said was “probably the most severe case” she had seen.
Responding to the inquest verdict, Paula Stanford, director of the Priory hospital in Altrincham, said: “Our heartfelt sympathies are with Pip’s family and we will now carefully consider the findings of the jury.”
Deborah Coles, director of the charity Inquest, said Pip’s death had exposed serious failings in the mental health system in relation to the discharge of a highly vulnerable child. “Her terrified family knew there was huge risk,” she said.
- In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here