Two NHS Trusts based in Kent have accepted that they failed to provide sufficient care in the case of a severely depressed patient who committed suicide in a hospital lavatory.
Simon Willson, who was 34, hanged himself in a disabled toilet cubicle with his belt at the Kent and Canterbury Hospital on January 23rd 2010, shortly after being discharged from the hospital's A&E department without having seen a mental health consultant.
East Kent Hospitals University NHS Foundation Trust, which runs the hospital, had discharged the patient after a four-hour wait in order to meet targets and allowed him to go to the toilet without any supervision.
On the day of his death, Mr Willson, a father of two, had been admitted to the hospital after taking a drug overdose, the latest in a series of such attempts on his own life.
He also had a severe alcohol problem and these issues had contributed to the loss of his job and his marriage, plus a number of previous suicide attempts.
The NHS Litigation Authority (NLA) described the patient as "severely depressed and at high risk of suicide".
Mr Willson first reported to Canterbury Police Station to be sectioned that morning and was taken to St Martin's Hospital, but was discharged and then took the overdose, leading to his admission to the Kent and Canterbury Hospital.
The authority found that Medway Social Care Partnership Trust, to whom Mr Willson had first been referred in 2008, had also failed him, with his problems subjected to "under-evaluation of risk from the outset".
Medway had left Mr Willson to make his own arrangements to deal with his drug and alcohol problems and he had spent nearly two months in hospital after a suicide attempt in November 2013.
Mr Willson's widow Melanie joined the attack on the two trusts. She commented, "He so desperately wanted to get better and was looking for help but simply did not get it."
The Kent and Medway Social Care Partnership Trust said it could not comment publicly on the case, but the Kent and Canterbury Hospital said it had changed procedures for treating mental patients. This included training emergency staff to deal with mental patients and improved liaison with the mental health trust.
By Francesca Witney