Mother of anorexic girl killed by train criticises care failings after inquest

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 [that] 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 (4st 3lbs), 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

Mother of anorexic girl killed by train criticises care failings after inquest

Mark Austin admits he told anorexic daughter "starve yourself to death"

The broadcaster Mark Austin has revealed how he struggled to understand his daughter’s anorexia and “failed utterly to grasp that she was seriously mentally ill”.

In a candid account, he admits he thought her “crass, insensitive, selfish and pathetic” and became so frustrated he once told her: “If you really want to starve yourself to death, just get on with it.”

But now the TV presenter hopes to break the taboo around potentially deadly eating disorders and is calling for improved mental health provision to deal with the crisis of more than 850,000 young sufferers, predominantly girls, in the UK.

Austin’s daughter Maddy, now 22, became ill in 2012, losing four stone and changing from a healthy and promising athlete to an “emaciated, ghostlike figure”.

He recalled: “I didn’t understand it at first. Cancer I understand … but this was my daughter wilfully destroying herself by not eating.”

Writing in the Sunday Times magazine, he described how Maddy would lie about how much she had eaten and “explode with rage” when challenged.

“She showered me with contempt. As a father you have to make a decision and I made the wrong one. I decided to go on the attack.”

He said: “I even remember saying, ‘If you really want to starve yourself to death, just get on with it’. And at least once, exasperated and at a loss, I think I actually meant it.”

The newsreader acknowledged that as a father he felt “excluded and hated” and found it hard to talk about issues of body image and weight control.

“I floundered and, in the process, ended up poisoning her against me further,” he said.

Austin described how things hit rock bottom for Maddy after a failed spell at a private inpatient unit on a regime of forced feeding. She resisted the treatment and threatened to kill herself. Maddy’s mother became so worried that when her daughter returned home she took time off work and slept on her bedroom floor so as to monitor her around the clock.

Maddy was eventually “saved” by a local NHS day-patient unit.

She recalled: “Eventually it was a local NHS nurse who really understood me and saw the Maddy without the demons. I was lucky, but mental health treatment should not be a lottery.”

Now her father is urging people to take the illness more seriously and is calling for “walk-in centres on the high street of every town and city in this country, manned by trained counsellors”.

He added: “As a country our response is bordering on the pathetic. It is a mental illness, but, almost uniquely, it is one that kills.”

One in 100 women aged between 15 and 30 are affected by anorexia and it is reckoned that one in five chronic anorexics will die as a result of the condition or because they take their own life.

The Beat youthline can help young people experiencing an eating disorder: 0345 634 7650. 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

Mark Austin admits he told anorexic daughter "starve yourself to death"

NHS England sending anorexic patients to Scotland for treatment

The NHS in England is sending patients who are seriously ill with eating disorders to Scotland for treatment because chronic bed shortages mean they cannot be cared for in England.

Vulnerable patients, mainly teenagers and young adults, are being taken hundreds of miles from their homes in order to receive residential care in Glasgow and near Edinburgh.

Mental health experts voiced deep concern about the trend and said it could damage patients’ chances of recovery, increase their sense of isolation through the separation from their families and even increase their risk of dying.

Doctors, eating disorders charities and patients have told the Guardian that the quality of care received by patients, some of whom are at risk of dying, is being compromised by the NHS in England having far too few beds to cope with the growing number of cases of anorexia, bulimia and other forms of psychiatric illness linked to eating habits.

“I’ve seen a rise in calls from people saying their children have been sent far away, miles away, to be looked after because there are either no services nearby or they are full”, said Jane Smith, chief executive of Anorexia and Bulimia Care. “This is a life-threatening situation for young people. People are in inpatient care because they are at risk of dying. They are in a very fragile, risky state.”

Rebecca Doidge, 20, from St Albans in Hertfordshire, spent six months in the Priory private hospital in Glasgow earlier this year because she was desperate for treatment and could not find anywhere else. The distance had negative side-effects, she said.

Despite being well looked after there, “being sent so far away does compromise care”, she said. “The outcomes are going to be better if you can stay near home. It’s really hard to integrate back home or go to another environment when discharged if you are in a different country. It makes communication between those treating you in hospital and those at home difficult.”

During her stay in the Priory, which has 25-30 beds, “about seven of the people there were from Hertfordshire,” she said. “The number of English people there massively outnumbered Scots.”

Anup Vyas’s stepdaughter has been receiving treatment for a rare eating disorder in Huntercombe private hospital in Livingston, near Edinburgh, since February. After previous stints in units in Watford, London and Colchester in Essex, the 17-year-old’s condition is so serious that “now she is basically being kept alive in Scotland”, said Vyas.

“NHS England acknowledge that her being so far away is not ideal. Her brothers haven’t visited her since June and no friends have gone up. Most people in the unit are from England, especially the north of England – places like York and Manchester.” The family’s home is in Hemel Hempstead, 350 miles from Livingston.

The health secretary, Jeremy Hunt, criticised the practice as “completely unacceptable”. He recently said NHS children and adolescent mental health services were the NHS’s worst area of care.

“It is clearly unacceptable for people to be sent hundreds of miles away for care at a time when they need the support of friends and family the most”, he said. “That’s why in April we committed to a national ambition to eliminate inappropriate out-of-area placements by 2020-21.” Ministers had also earmarked £150m for enhanced services in community settings to help ensure that mental health problems in young people were tackled before their health worsens, he said.

NHS England, despite its professed commitment to openness, refused to say how many patients from England were receiving treatment for eating disorders in Scotland. Expanding the supply of specialist beds to treat people with those conditions would take time, it said.

“It’s extremely distressing for parents to have a child who is so unwell that they require inpatient care, and it’s even worse when they can’t easily visit their child because of long travel distances”, said Sarah Brennan, chief executive of Young Minds. “For many young people the distance from family and friends is one of their biggest fears when they are hospitalised. Being separated from loved ones doesn’t help with recovery and makes the stress of hospitalisation worse.”

Dr Jon Goldin, a consultant psychiatrist in London specialising in children and adolescents, said he had heard of patients being moved long distances. “But it shouldn’t be happening,” he said. “It’s a concern. Patients should be treated nearby and should be in contact with family. They need support and it’s much harder to get that when families have to travel long distances.

“Part of their recovery may involve therapy with their family, especially for children aged 14 and under.”, said Goldin, who is also a spokesman for the Royal College of Psychiatrists.

More young people were developing eating disorders, he said. Genetic factors, personality factors and socio-cultural factors, such as images in the media of models “which glamorise thinness” are among the many reasons for the trend, Goldin said.

A spokeswoman for the Priory hospital in Glasgow said it took patients from all over the UK. “The Priory hospital in Glasgow has a reputation for providing some of the highest standards of mental healthcare in the country, and has been given a ‘very good’ rating by our regulator, Healthcare Improvement Scotland, for staffing, management, information to patients, and the environment it offers those we care for. As such, we support patients from across the UK and overseas.”

A spokeswoman for NHS England said: “The NHS recently laid out very clear plans to expand staff and services for specialist eating disorders and other mental health problems, in order to tackle and eliminate distant out-of-area placements. Transformation won’t happen overnight but work is under way to improve services for everyone and to make sure care is available at home or as close to home as possible when a patient needs more intensive therapy.

“To help achieve this, the government has allocated a cumulative £1.4bn to children and young people’s mental health services over the next five years, and the new waiting time for eating disorder patients will ensure patients get better care more quickly.”

NHS England sending anorexic patients to Scotland for treatment

Anorexic female "could die" following therapy refused, say family members

Beverley Duffy, her mother, said a consultant at Roseberry Park, a facility exactly where Emma is at the moment currently being cared for, referred her to The Retreat since she believed it was the only area that could supply her Emma the help she required to overcome her illness.

“Emma truly had to think about regardless of whether she truly did want the help or not, but sooner or later determined this was the only way to conserve her life,” Mrs Duffy explained.

“Then The Retreat turned round and advised Emma that she was not the sort of person they could deal with and she was refused on of the NHS beds.”

Mrs Duffy explained that whilst The Retreat is a personal facility, the NHS does very own a quantity of beds and can refer individuals there.

“I just can’t understand how one particular portion of the NHS can say anything will truly assist – then another arm of the very same institution refuses, it’s not correct,” she said.

Emma’s troubles started when she was just eight, soon after she overheard a dance teacher saying a single of the other women would never make it as a dancer since she was also obese.

Her household claim the throwaway comment marked as the begin of a lifelong battle towards anorexia.

Mrs Duffy stated: “We have hope, and believe that she will get greater. But even now we do not know the complete story.

“It’s like a million piece jigsaw, and we have only filled the very first line in. It really is a psychological sickness. It really is not just about eating.”

Mrs Duffy, who did not know anything at all of her daughter’s disorder until finally she was 18, additional that Emma suffers from borderline character disorder.

She explained: “She is a various Emma sometimes. It truly is in her eyes. She is violent, she will assault us. She as soon as accused me of attempting to murder her and rang the police.”

Mrs Duffy and Emma’s sister, Amy, have set up a campaign, Saving Emma, to increase the money needed to send her to the unit, with costs up to £1 million for 3 years of treatment.

“We want everyone to know what is going on” Mrs Duffy stated.

“This will not be the initial time it has took place and it wont be the last. Absolutely everyone keeps passing her on.

“She’s acquiring weaker and weaker and she wants help. I hope we can raise the funds ourselves before it is also late for her.”

A spokesman for Tees, Esk and Dress in Valleys NHS Basis Believe in explained: “We are sorry the family has concerns about their daughter’s care and would encourage them to get in touch with us by way of our patient guidance and liaison services to go over these.

“It would not be appropriate for us to comment on the personalized information of an individual’s care. The obligation for funding care placements rests with the commissioners of NHS services.”

Anorexic female "could die" following therapy refused, say family members