An NHS trust said it 'couldn't have prevented' the death of a pensioner who took her own life following decades of battling mental health.
The Tees, Esk and Wear Valley NHS Trust believes that 'lessons have been learnt' following the death of 72-year-old Evelyn Boyd, from Northallerton on September 22 last year - but said that no further intervention would have helped save her life.
An inquest into Ms Boyd's death took place at Northallerton Coroners Court on Monday (October 14) and Tuesday (October 15), with assistant coroner of North Yorkshire, Jonathan Leach, recording the 72-year-old's death as suicide.
During the inquest, it was noted that Ms Boyd had battled mental health since her 20s, which had developed into an Emotionally Unstable Personality Disorder (EUPD) - which saw her cared for in West Park, Darlington, and Roseberry Park in Middlesbrough during the last two years of her life.
The inquest heard from mental health professionals and care coordinators from the Tees, Esk and Wear Valley NHS Trust - who said that Ms Boyd had been treated in hospital 13 times between 2012 and 2023, but, at the time of her death, she was undergoing community care at her house, which saw carers visit her twice per week.
The witnesses at the inquest included Dr Jennifer Adams, who is a consultant physiatrist and cared for Ms Boyd while she was in the hospital, including administering medication to help deal with her mental health condition.
Dr Adams told the inquest that Ms Boyd had expressed suicidal thoughts, but was reacting well to treatment, both in the hospital and the community, with it believed that her needs could be cared for better with Ms Boyd living in her own home.
The inquest also heard from Ms Boyd's care coordinator Laura Blythe, who cared for the 72-year-old at her home between June 12 up until her death on September 22.
Ms Blythe's role was noted as visiting Ms Boyd and assessing her needs - which saw her visit twice per week in the weeks leading up to Ms Boyd's death.
This included on the day of the pensioner's death, with Ms Blythe saying that she had 'no further concerns' for the wellbeing of Ms Boyd during that visit.
"I have spent a lot of time since Evelyn's death about if there's anything I could have missed, but there is nothing I can think of," Ms Blythe told the hearing on Monday.
Ms Blythe also highlighted that Ms Boyd has expressed suicidal thoughts during past visits, but this wasn't 'out of the ordinary' and that Ms Boyd was showing progress compared with several days before her death.
Throughout the inquest, Ms Boyd's family had expressed their concern and criticism for the Tees, Esk and Wear Valley NHS Trust, with Evelyn's son, Ashley Ajisafe, questioning his mum's care at various stages.
Mr Ajisafe said that the NHS and the Tees, Esk and Wear Valley NHS Trust had 'failed' his family; believing that his mum might have been safer in a hospital or care setting at the time of her death - which saw her discharged from Roseberry Park 16 days before her death.
He said: "I'm not happy about what I heard at the inquest today - I just want some accountability.
"I'm disappointed that my mum's death has been brushed under the carpet.
"I didn't want to come here and point fingers, but I want answers as to why this was allowed to happen."
The Tees, Esk and Wear Valley NHS Trust admitted during the inquest that "lessons had been learnt" - which includes more thorough checks when it comes to care plans and patient care.
But the trust also said that staff did "all they could" to care for Evelyn and "couldn't have prevented the outcome" with any level of care it would have provided.
The inquest heard from Nicola Everatt, who investigated Evelyn's case within the NHS, who said that communication between the families of patients and the NHS had been improved following Evelyn's death, while also offering an apology to the family of Ms Boyd for their loss.
But Mr Ajisafe said after the inquest that he wanted "accountability" from someone about the death of his mum.
He believes that "multiple failings" contributed to his mum's death.
Alongside the criticism, though, Mr Ajisafe paid tribute to his mum, who had been a healthcare assistant at the Friarage Hospital in Northallerton during her working days.
Describing her as 'the life and soul of the party', Mr Ajisafe recalled his mum's love of dancing and her dedication to her family.
He said: "My mum had a big heart and dedication to her family.
"She was a keen dancer and would always describe herself as a tough cookie.
"She was the most selfless person you could ever meet. She had her struggles but was the true life and soul of the party."
Anyone can contact Samaritans FREE any time from any phone on 116 123, even a mobile without credit. This number won’t show up on your phone bill. Or you can jo@samaritans.org or visit www.samaritans.org
Whatever you are going through, you don’t have to face it alone. Call Samaritans for free on 116 123, email jo@samaritans.org or visit www.samaritans.org for more information
When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org for more information.
Comments: Our rules
We want our comments to be a lively and valuable part of our community - a place where readers can debate and engage with the most important local issues. The ability to comment on our stories is a privilege, not a right, however, and that privilege may be withdrawn if it is abused or misused.
Please report any comments that break our rules.
Read the rules here