'Gifted’ Somerset teenager died on mental health unit after 'lapses in monitoring'

Cariss’s mother, Gina Schiraldi, told the inquest her daughter was 'bright, caring and compassionate'. Credit: Irwin Mitchell/family photo

There were lapses in the monitoring of a 19-year-old woman from Street who died while detained under the Mental Health Act, an inquest has heard.

Cariss Stone died at Musgrove Park Hospital in August 2019, two days after being found unresponsive with a ligature round her neck on Holford Ward at Wellsprings Hospital.

She was being held at the NHS psychiatric intensive care unit in Taunton under a section.

An inquest into her death, held before a jury of seven women and three men, began at Wells Town Hall on Tuesday 2 April.

The jury heard how the teenager had a long history of anorexia, self-harm and suicide attempts - sometimes being admitted to emergency departments several times weekly.

At the time of her death, Cariss was judged a high enough risk to require welfare checks every five minutes Credit: Irwin Mitchell/family photo

She had been detained under the Mental Health Act six times previously.

At the time of her death, Cariss was judged a high enough risk to herself to require welfare checks every five minutes.

Nicholas Rheinberg, assistant coroner for Somerset, told the jury that there were lapses in this monitoring regime.

The jury also heard that Samantha Sands, the Holford staff member responsible for Cariss’s observations at the time she was found with the ligature, was medically unfit to appear at the inquest.

The coroner said options to facilitate Ms Sands' evidence were still being examined.

Cariss’s mother, Gina Schiraldi, told the inquest her daughter was "bright, caring and compassionate".

Luke Stone told the inquest that his ‘gentle-hearted’ sister had been through more mental health services and wards than he could remember Credit: Irwin Mitchell/family photo

She had been part of the Gifted and Talented Programme at Crispin School in Street, before going on to study Health and Social Care at Strode College, where she made good friends and served as a volunteer police cadet.

She said Cariss was first hospitalised for anorexia when she was 14 and her mental health struggles began to escalate. At times, she needed a feeding tube and used a wheelchair.

Andreas Papadopoulos, Cariss’s psychiatrist until shortly before her death, told the inquest it was likely that the teenager had Emotionally Unstable Personality Disorder.

The condition may have been caused by the trauma of witnessing domestic abuse as a child and could explain her behaviour.

In March 2019, Cariss was admitted under section to St Andrew’s Ward, an acute psychiatric unit in Wells, due to more serious acts of self-harm, and was transferred to Holford Ward after her condition deteriorated.

That summer, she was found using a ligature on 55 occasions. However, just before her death, staff had reported an improvement in her mental health.

In a statement, Cariss’s younger brother, Luke Stone, told the inquest that his "gentle-hearted" sister had been through more mental health services and wards than he could remember, but "none seemed to give her the right support".

The inquest is scheduled to last ten days and will hear from 30 witnesses.

How to get help if you have been affected by the issues mentioned in this article:

  • CALM (Campaign Against Living Miserably) - Helpline:  0800 58 58 58

  • MIND provides advice and support to empower anyone experiencing a mental health problem. Information line: 0300 123 3393

  • Samaritans is an organisation offering confidential support for people experiencing feelings of distress or despair. Phone 116 123 (a free 24 hour helpline).

  • Shout is a 24/7 text service, free on all major mobile networks, for anyone struggling to cope and in need of immediate help. Text SHOUT to 85258.