Enfield man who took own life 'completely failed' by two hospitals

Christopher Karieren spent more than 28 hours waiting for treatment at North Mid and Barnet hospitals but was not admitted to a mental health ward

A local NHS trust has issued an apology to the family of an Enfield man who took his life after being “completely failed” by two hospitals.

Despite father-of-one Christopher Karieren reporting continuing suicidal thoughts and deteriorating mental health, he was not admitted to a mental health ward, nor observed on a one-to-one basis as he should have been for his own protection.

A recent inquest into his death at North London Coroner’s Court heard that he attended North Middlesex University Hospital in Edmonton on 12^th November last year, with his sister, and they told staff he’d had thoughts of wanting to end his life.

Christopher remained at the hospital in the emergency department overnight, and throughout the next day, and was eventually discharged on 14th November into the care of the community crisis home treatment team.

This was despite repeated requests from his sister that Christopher was at risk and needed to be admitted to hospital instead.

Later that day, he went to Barnet Hospital’s emergency department by himself and, after being reviewed by the psychiatric liaison team, agreed to voluntarily be admitted to a mental health ward within North London NHS Foundation Trust, when a bed became available.

The inquest heard that the psychiatric liaison service requested he be placed under continuous one-to-one observation by a mental health nurse in the emergency department, until a bed became available, due to concerns about his safety and risk of absconding.

However, due to staffing issues, this didn’t happen and Christopher left the emergency department unseen sometime after 7.40pm. It was not discovered that he was missing until around 9.20pm.

Despite the Metropolitan Police and London Ambulance Service being alerted, Christopher was not found alive.

Coroner Peter Murphy recorded that Christopher died as a consequence of suicide on 16^th November. He said the non-availability of a bed at North London NHS Foundation Trust and the lack of one-to-one observation by staff at Barnet Hospital “probably made more than a minimal contribution” to Christopher’s death.

A spokesperson for Royal Free London NHS Foundation Trust, which runs both North Mid and Barnet hospitals, said: “We would like to share our deepest condolences with Christopher’s family at this incredibly difficult time.

“We apologise wholeheartedly for failing to take full care of him in our emergency department whilst he was waiting for transfer to the specialist mental health service.

“There are lessons to be learnt for all of the organisations involved in his care and we are working with mental health colleagues on a number of measures to prevent something like this happening again.”

Christopher’s parents, Sharon and Mike Gunard, say his death must lead to changes in how people suffering with their mental health are treated in hospital settings.

“My son was completely failed by two hospitals,” said Sharon. “Just because somebody isn’t physically injured or bleeding out, it doesn’t mean that they are not in pain or in danger.

“Christopher could feel he was a risk to himself. His sister was with him at North Middlesex Hospital and was pleading for him to be helped, but they were ignored.

“Because he wasn’t violent or aggressive, they classed him as less vulnerable than others. He was dismissed completely, left feeling that nobody cared for him, and that nobody was helping him.

“He was looking for help. He knew he needed help. We as a family knew he needed help, but they didn’t listen. Health professionals need to listen to families.

“I don’t want other young men like Christopher to be let down like this. I’ve lost my son and Christoper’s young son has lost his dad.”

Christopher’s step-father, Mike, said: “We want change and accountability. Mental health has to be treated in hospitals in the same was as heart attacks and cancers. It is life-threatening, but it is too often dismissed as not being as important.

“We want Christopher’s death to leave some form of legacy, and the only legacy can be accountability and real change.”

In a tribute to Christopher read to the Inquest, his parents described him as a “beautiful soul” who had a “quiet, gentle and calm nature” and a “heart of gold”.

A former librarian assistant, he had more recently worked as a crematorium technician, supporting other families through difficult times.

“He’ll be remembered for his kindness and empathy for people. We miss him, his sister misses her brother dearly and our hearts are breaking that he is no longer with us,” they said.

“He is and will continue to be missed by so many people, he left his mark on this world which will remain forever, as he touched the hearts of countless people that he encountered during his short life on this earth.”

Solicitor Caroline Murgatroyd, of Hudgell Solicitors, added: “This is deeply distressing for Christopher’s family. Christopher had sought help. He knew his mental health had been declining and he reached out to health professionals to provide him with the care, treatment and support he needed to keep him safe.

“He spent more than 28 hours in each of the hospitals and was not admitted to a mental health ward.”

The Samaritans are available to help if you need someone to talk to. They are available to talk to for free on 116 123.

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