Poor mental health unit layout and ‘unsatisfactory’ communication led to Chelmsford’s man’s death on trainline, jury concludes

The jury reached its conclusion on the care received by a young man from Essex prior to his escape from a mental health unit. Jayden Borough’s death contributed to a number of problems at the Linden Center’s mental health unit, including “inadequate” layouts for the center and a lack of communication which resulted in Jayden’s escape not being reported quickly enough.

Jayden, 23, who had mental health difficulties including delusional thoughts and periods of psychosis, died on 23 October 2020 after being hit by a train in the Chelmsford area. He had previously been housed under the mental health act at the Linden Center in Broomfield but escaped on 23 October by following staff out of the building.

The investigation was examining the care Jayden received by the University of Essex Partnership’s NHS Foundation Trust, which runs the Linden centre, along with research carried out by Essex Police after he left the centre. EPUT has since apologized for the failures in Jayden’s care and confirmed that immediate action was taken to improve security.

Read more: The latest breaking news from Chelmsford

The Essex Coroner’s Court in Chelmsford had previously heard that Jayden had a promising career in the arts and theatre, but suffered a decline in his mental health as he suffered from delusional ideas and paranoia. He had previously been partitioned under the Mental Health Act, released and then partitioned again in Bristol when he was transferred back to Essex to the Linden Centre.

But on October 23, 2020, Jayden escaped from the secure unit and was reported missing by his mother and the Linden Center. Essex Police launch a search but tragically later that night Jayden is hit by a train traveling between Chelmsford and Shenfield and is tragically pronounced dead at the scene.

Jaden Borough has been split twice in a matter of weeks when he exited the Linden Center in Chelmsford

Returning to their conclusions today (November 25), the jury said Jayden had a history of alcohol and drug abuse that contributed to his psychosis that led to intrusive thoughts, and he had a family history of mental health conditions that “were not considered aggressively enough.” The jury said there were “inconsistencies with patient care record keeping and communication”.

The jury also said that if Jayden’s history of drug and alcohol abuse had been addressed earlier, it would have been beneficial to his welfare. The jury also said that the design of the Linden Center – in particular the area around the main doors – was “inappropriate” for safe use by patients. The jury said: “The Linden Center’s registration and reporting policy for escapes was insufficient and led to a lack of awareness and delays in reporting.”

The jury also said that the communication was “unsatisfactory” and led to “mistakes” made in the documents relating to Jayden and “failed to retain important information,” and that there were “lessons to be learned from the escapes.” However, the jury said that Network Rail’s responses Ferris and emergency services were “appropriate” in searching for Jayden.

You don’t have to suffer in silence if you are struggling with your mental health. Here are some groups you can contact when you need help:
Silver Line – a free, confidential helpline offering information, friendship and advice for seniors: 0800 4 80 4 90
Samaritans: Phone 116123, 24 hours a day, or email [email protected], confidential
Childline: Phone 0800 1111. Calls are free and will not appear on your bill
PAPYRUS: A voluntary organization that supports suicidal teens and youth. Tel. 0800 068 4141
Students Against Depression: A website for students who are depressed, depressed, or suicidal. Click here to visit
Bullying UK: A website for both children and adults affected by bullying. click here
Campaign Against Miserable Lives (CALM): for young people who feel miserable. He has a website here and a helpline: 0800 58 58 58

The investigation has previously heard evidence from mental health nurses and police officers, including Rachel Siege, a Division Six Community Psychiatric Nurse (CPN) on the Trust’s First Episode Psychosis (FEP) team who previously performed evaluations on Jayden before it split. Mrs. Siggee broke down when she recalled a phone call from Jayden’s mother Michelle when Jayden was threatening to run away, saying that she “thought he was safe there”.

Inspector Jonathan Thurston, who was responsible for the police response to Jayden’s loss, told the court how it was considered a medium risk level rather than a high one. Inspector Thurston said that on the night of 23 October he had six police cars covering the areas of Chelmsford and Maldon but while there was concern for Jayden’s safety he said his life was “in no danger” in the near term.

Jayden’s mother, Michelle Borough, said in a statement during the inquest that she believes her concerns to the police and the Linden Center on the night of her son’s death fell on deaf ears and that they failed in their duty to him. .

Paul Scott, chief executive of the University of Essex Partnership’s NHS Foundation Trust (EPUT), said: “Our sympathies remain with Jayden’s family, friends and loved ones following their loss. I am sorry for the failures in the care provided to Jayden.”

“Immediate action was taken to improve security at the Linden Center and the Trust has made a significant investment in safety and technology improvements across all mental health inpatient wards.”

“We are committed to continuous improvement to provide the best possible care for those who need us most when they need us most.”

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