Teen improved after move from 'hell-hole' hospital
Family handoutThis article contains details of suicide and self-harm
A teenager's condition improved after she left a "hell-hole" mental health hospital but she feared returning to the troubled trust's care, her inquest has heard.
Emily Moore, from Shildon, fatally injured herself in February 2020 while being detained by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) after almost a year in hospitals.
She left one TEWV hospital, where her concerned family said she was being "slowly killed", for one run by another trust, but had to return to TEWV after turning 18, a jury heard.
Emily said she had been traumatised by TEWV, while her father David Moore previously said the contrast between her treatment at the two trusts was like "chalk and cheese".
The inquest in Crook has heard Emily began experiencing mental health problems in 2017 when she was 15, resulting in her being sectioned in March 2019 and diagnosed with emerging emotionally unstable personality disorder (EUPD).
She spent three months at TEWV's West Lane Hospital in Middlesbrough, which she complained about and her father described as a "hell-hole", before being moved to Ferndene in Prudhoe, run by Cumbria, Northumberland Tyne and Wear NHS Foundation Trust (CNTW), in July 2019, jurors heard.
Dr Cathlene Seller, consultant psychiatrist at Ferndene, said the teenager's condition improved after her admission, with her self-harm incidents largely reducing in frequency and severity.
She said Emily was "very, very depressed" when she arrived, but following treatment she became "happy" and "normal" with "no features of a depressive disorder".
Ferndene patients were given a timetable for the week ahead so they knew what to expect and could see "what normal life will look like", she said, adding it was "very clear [Emily] benefited from the structure".
Emily's family had previously complained of a lack of structure at West Lane with her father saying he would see patients being left to sit watching TV in their pyjamas rather than be encouraged to attend educational sessions.
Seller said education was "really positive" for Emily.
She said Emily became subject to certain restrictions at Ferndene to stop her self-harming which "frustrated" the teenager but also "gave her a sense of consistency".
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Ultimately, Emily "felt people around her cared enough to be able to instil those restrictions to ensure her safety", Seller said.
The inquest previously heard inconsistency in West Lane staff's approach to Emily, sometimes intervening in self-harm attempts and other times not, was harmful to her recovery.
Emily's EUPD remained however, with Seller saying it was a "chronic condition" that "waxes and wanes" and "doesn't go away", but Emily's engagement with treatment had improved.
She said Emily's presentation was "similar" to other young patients but her risk to self was "quite extreme" at times.
Family HandoutSeller said planning for Emily's future when she turned 18 and became an adult began in November 2019, three months before her birthday, with three options investigated.
Discharging her home was not realistic as previous home visits had been "unsuccessful" and Emily acknowledged it would not be safe for her, while a specialist residential placement also said she posed too high a risk to herself for them to take her in, Seller said.
That left moving her to an adult inpatient ward, the inquest heard.
Jurors heard Emily's family's preference was to keep her under CNTW care but no adult beds were available, partly because she was an "out of area" patient, meaning she would have to return to TEWV.
The Tunstall ward at TEWV's Lanchester Road Hospital was deemed the "least worst option" with Emily's visit to see it on 30 January going "relatively well", the jury heard.
GoogleSeller said Emily's preference would have been not to leave CWNT and Ferndene clinicians advised she remain on "eyesight" or "one-to-one observation" at Tunstall ward to mitigate the risk she posed to herself.
Emily's family's barrister Anna Morris KC asked Seller if part of Emily's concern was about returning to TEWV's care.
"I think that is fair to say", Seller replied, adding that was partly why the team recommended she remain under increased observation following the move.
Family handoutThe day before she left Ferndene, Emily gave one of her nurses a thank you card, the inquest heard.
She wrote she had been a "quiet nervous" girl when she arrived at Prudhoe due to the "trauma [she] suffered" at West Lane, the jury heard.
She said because of West Lane she "thought nurses were meant to tell me off", but the Ferndene nurse "showed me that people do care" and saved her life on many occasions.
The teenager also said moving hospitals and leaving the nurses would "sadden" her.
Emily moved to Lanchester Road on 6 February 2020, two days after turning 18.
The inquest has heard she was found unconscious after injuring herself on 13 February, hours after her father alerted staff to a worrying Facebook post she had made and they assured him not to worry as they would "keep an eye on her".
The inquest continues.
