The mother of a woman who killed herself while suffering from postnatal depression has said her daughter deserved better from mental health services, during an inquest into her death.
Despite having made multiple attempts to kill herself, Polly Ross, 32, was allowed to leave the Westlands mental health unit in Hull, where she was a voluntary patient, at about 8.30am on 10 July 2015. Ross told nurses that she was going to buy cigarettes. She was hit by a train at 11.10am and died instantly.
Speaking at Hull coroner’s court on Wednesday, Jo Hogg said Ross was “an extraordinary person who leaves behind an extraordinary number of legacies”, not least her two young daughters.
Hogg, who was previously employed by Humber NHS foundation trust as an occupational therapist, said Ross had met with “a lack of focused care when she needed it most”. She said she wanted to see changes in the way care was provided to women like her daughter and not hear about missed opportunities by the trust.
Ross, who ran a translation business in Paris before moving back to east Yorkshire in August 2012, suffered from hyperemesis gravidarum, an extreme form of morning sickness, during both her pregnancies in 2012 and 2014.
The inquest heard that her condition, which left her hospitalised and on a drip, compounded her mental health issues and that she suffered from postnatal depression after both births. Ross asked to be admitted to a specialist mother and baby unit in Leeds, but was turned down.
Giving evidence to the inquest, Ross’s GP, Dr Daniella Maleknasr, said there had been warning signs as to the danger Ross posed to herself, but added that mental ill-health could be unpredictable.
In February 2015 Ross was sectioned after a breakdown and was admitted to the Avondale psychiatric intensive care and assessment unit in west Hull, and her children were taken out of her care. She was in hospital again for five days from 2 April after expressing suicidal thoughts. A week later she attended A&E after self-harming, and later that month, on 28 April, she was taken to hospital after an attempted overdose.
The following month, on 14 May, Ross was again admitted to a mental health unit after having suicidal thoughts, and on 16 June she returned again to A&E after another overdose.
A statement read to the court by Ross’s aunt Emma May, who acted as her carer after she was first sectioned, said her niece had been desperate. “She told me she wanted to feel better and not feel the way she felt … I honestly don’t think there were many days from February 2015 when Polly didn’t feel suicidal,” the statement said.
“I feel that Polly was desperately ill and was unable to make decisions for her own safety and wellbeing. I am certain that the few times my niece left her home since February were times she attempted to take her own life. I cannot understand how she was allowed to leave the unit to buy her own cigarettes the morning she died.”
Speaking through tears, Hogg told the inquest that her daughter’s intelligence was “staggering at times”. She described Ross as a “thinker, a reflector, a reader, a writer, a dancer, a laugher. She loved her children unconditionally and knew heartbreakingly that when she was ill she couldn’t look after them.”
Hogg described how, in the months before her death, Polly attempted to describe her mental state to her mother, saying she could only see in black and white, but that she thought her medication was helping and that “some colour was coming back into her life”.
“I did not realise the levels of strength she needed to get through her depression,” she added.
The inquest heard that Lorna Jennison, a care coordinator at Bridlington and Driffield mental health team, had been worried about Ross given the “large number of serious life events” that occurred at the same time – she faced eviction by her landlord, her children had been taken away and her relationship with her husband had ended.
Jennison was asked whether she thought Ross’s condition had deteriorated in the weeks leading up to her death. She responded that her condition seemed to have “peaks and troughs”, though she agreed that each attempt at self-harm seemed to be more serious than the last. “There would seem to be a period of stability, and then that would deteriorate,” she said.
When Jennison met Ross a few weeks before her death, she seemed stable, she said. “She took control of the room. She was very articulate and certain about what she wanted from her future.”
In October 2015, Prof Paul Marks – the coroner in Ross’s inquest – ruled that Humber NHS foundation trust was guilty of neglect in the case of Sally Mays, 22, who killed herself after being turned away for inpatient mental health care. The trust issued a statement saying it had “ultimately failed to offer Sally the dignity and care she needed and deserved that afternoon”.
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