The mental health of a girl who died after she was struck by a train was badly affected by the Covid-19 lockdowns, an inquest has heard. Seventeen-year-old Holly Egan, from Fleetwood in Lancashire, was found on the tracks of a railway station in Blackpool in January this year after colliding with a train.
LancsLive reported how the inquest at Blackpool Town Hall heard how the driver, who had carried out a brake check, said they felt the train travelling at around 40mph hit a female. The hearing heard that the driver had not done anything inappropriate, but saw a female facing away from the oncoming train. The incident was reported straight away, the train stopped, and emergency services rushed to the scene but paramedics were unable to save Holly's life.
Alji-Mohamed Samir, consultant psychiatrist with Children and Adult Mental Health Services In Patient services at Lancashire and South Cumbria NHS Foundation Trust, told the inquest that Holly was first referred there in March 2020 and came to hospital with low mood and suicidal thoughts in May that year. She stayed in hospital on May 8 and was discharged several days later, with support and follow-ups in place, after being assessed by the specialist team.
But at an appointment on May 13, Holly was still displaying depressive symptoms and low mood, so was admitted to a specialist centre called the Cove as an inpatient. The doctor explained that while she engaged with activities on the ward such as baking, and maintaining a good diet at first, she did have a history of self-harm. He said that while she did not have a "plan or intention" at the time, "she had thought of making cuts to herself and wanted to end her life".
Further meetings and holistic treatment followed in the two weeks after admission, and she was diagnosed with depressive disorder, for which she received substantial holistic treatment and support. At the doctor’s third meeting with her, he said she seemed to be engaging in activities and had not self harmed since admission, although she had previously said she had thought of self harming daily.
Holly returned for a home visit, from June 3 to 8, with considerable risk assessments, support and advice on how to keep herself safe, but said she did not want to return home when she came back to the Cove on June 9, as the doctor said she told him she did not want to burden her mum. The consultant told the hearing, quietly: “My first impression of Holly was that she came across as very polite and compassionate. She did not want to talk about her difficulties.”
He continued: “She wasn’t able to open up… she would speak in short snatches and she would not want to elaborate on things.” No antidepressants were prescribed and treatment, meetings, documenting, monitoring via multi agency teams and risk assessments took place. The doctor told the hearing: “She had difficulty opening up… she would be honest. If she felt safe, she would say it, if she felt unsafe, she would say it. Although there was reluctance, she did engage reasonably well.”
Asked if the lockdown had impacted on provision of services that she received, the doctor said: “I would not say lockdown had a major effect on her health care.”
However, when pressed on whether the lockdown itself had had any impact by Assistant Coroner Andrew Cousins, the doctor said: “She started feeling guilty because her friend had mental health issues - she felt responsible. The effect of the lockdown, when that happened, was that she could not have contacted those friends; she could not check on them.”
A former student at Cardinal Allen Catholic High School in Blackpool, Holly was thought by services to have been someone whose mental health benefited from school, he added, as it ‘kept her busy, gave her activities to do through the day and was felt to be a good thing that she was full time'.
Coroner Andrew Cousins surmised: “It seems to me, lockdown had a significant impact on Holly’s mental health, and really it seems to be that suicidation and high risk seemed to increase to a higher level of intent.” Yet during her time at the Cove until June 17, when she was discharged, she was responding positively to treatment, and engaging with staff, said the doctor. However, she said she was affected by the environment on the ward, since she was seeing other patients who were regularly talking about self harming and were in the vicinity bearing visible scars of this, which was one of the reasons that she did not want to remain on the ward, he added.
The hearing heard how Holly was discharged with a care package on June 17. The doctor said that she was reviewed regularly, had six care plans and risk assessments completed during her admission period.
Similarly, Catherine Warwick, Dialectical Behaviour Therapy coordinator at CAMHS, said Holly had first been referred to the community service in March 2020 and placed on a pre-treatment programme as well as being offered group sessions that summer. However, it was decided to switch her to a different type of invention, due to her finding it difficult to open up.
Ms Warwick told the hearing: “We could see Holly wanted support. She never cancelled at the last minute, never missed any appointments... but she found it very difficult to engage and answer questions.” When it emerged that the team member who had been meeting with Holly would be leaving, Holly was asked if she wanted to continue with the intervention or be discharged. Ms Warwick explained that there was a risk that the intervention, if perceived by the young person to not be working, could be harmful in the long run.
Family therapy would have been one other solution in early 2020, the hearing heard,, but a member of staff was not available to do it, although that was no longer the case at the service. Ms Warwick added:“We made the professional assessment that she was not in crisis, that she was not presenting in distress.”
A mutual decision was made, with Holly, for her to be discharged from the service in January 2021, with her GP subsequently being contacted and a four week check to follow, Ms Warwick explained. Holly was discharged from the service in January 2021, with a discharge care plan and advice as to what to do if in crisis.
Since Holly’s death, although risk assessments had been standard practice, there were now enhanced risk assessments, discharge check lists and multi agency meetings for discharge plans at the service, the hearing heard. Doctor Suboda Weerasinghe, consultant at Blackpool Teaching Hospitals NHS Trust, said bleeding and fractures were found, and he believed Holly had died from multiple injuries.
For more stories from where you live, visit InYourArea.
