Months after being discharged from in-patient unit, St Annes teen took his own life

A teenager who had had been a reluctant inpatient at a mental health unit finally got his wish to go home - but within four months he had taken his own life.

Thursday, 18th November 2021, 10:51 am

An inquest was told Marshall Metcalfe, 17, of Heeley Road, St Annes, who had been diagnosed with schizophrenia, had been unhappy during his two spells at The Cove, a unit in Heyham for children and adolescents with complex mental health needs.

Despite his wishes to be returned to the care of his mother, Jane Ireland, and concerns from the family about his health while he was in the unit, concerns had also been raised by Marshall’s sister Holly about their mother’s ability to look after him.

Ms Ireland’s mental health had also been seriously deteriorating at this time but she had made efforts to conceal the extent of her illness from health workers.

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Marshall Metcalfe next to his mum, Jane Ireland, and his two sisters

A month after Marshall died on May 7 last year, after falling from the top of Blackpool’s Sainsbury store in Talbot Road, Ms Ireland was found dead at the home she had shared with Marshall, having taken a dose of methadone which contributed to her death. the inquest into both their deaths, held at the town hall just down the road from Sainsbury’s, their family were keen to find out if vitals opportunities to help them were missed

The third day of the inquiry heard from Rebecca Catterall, who had been the assistant case manager for Marshall as part of the Child and Adolescent Mental Health Services (CAHMS) run by the Lancashire and South Cumbria NHS Foundation Trust.

Ms Catterall, who became involved after Marshall was discharged from The Cove on January 6, was asked if she was aware of the list of ‘relapse indicators’ – warning signs that Marshall’s mental health might be declining – and if she had detected any on her visits.

After stating she was aware of them, she said: “On observation, there were not any relapse indicators but his mum said his self-hygiene had declined.

“I had a chat with him about it but he didn’t admit it. He said he would wash in the afternoon. The next time I saw him, his mum said he had washed but he was wearing the same T-shirt.”

On another occasion, his mum had mentioned Marshall having a facial tick.

Ms Catterall, who was assistant to case manager Adam Stoney, said these incidents by themselves were not considered indicators so were not brought up the regular multidisciplinary team meetings about Marshall.

Asked by Mira Hammad, a legal representative for the family, if she thought Marshall’s condition was improving in the months after his discharge, she said there were small signs of improvement.

But asked if she was relying too much on reports from his mum, she said she had witnessed these small improvements herself, such as walking with her to get his regular injection of Clozapine and going to the shops.

Ms Catterall said that while his verbal engagement with her remained poor, he was never rude and "accepted her presence".

Asked if there was a lack of consistency in his mum’s reports on Marshall’s progress, or if his mother's comments were over-optimistic, she said they weren’t.

Michael Robson, an adult psychiatrist with the Early Intervention Service, confirmed that Marshall was added to his caseload after the teen was discharged from The Cove.

Ciara Bartlam, another legal representative for the family, asked him if he was aware of any concerns about the appropriateness of Jane Ireland's care for Marshall.

He said: "I recognised her name as a previous service user with symptoms of psychosis, but no more than that."

The inquest is being overseen by coroner Andrew Wilson.