A MENTAL health unit did not have enough staff to adequately look after its patients, an inquest has heard.
On February 3, 2020, 20-year-old Edwige Nsilu was found unresponsive with "bits of ligature material" on her neck in St Andrew’s Healthcare mental health unit, North Benfleet.
She died after being taken off life support machines in Basildon Hospital on February 5, 2020.
An inquest has been taking place place at the coroner’s office in Seax House, Chelmsford, throughout this week.
Yesterday, John-Barry Waldron, a former nurse at St Andrew’s, spoke as a witness.
He said: “During January and February 2020 we were heavily understaffed and Edwige probably required more than the one to one observations she was issued.
“She had tied more ligatures on January 27 and was placed in a sterile bedroom with minimal furniture and placed in rip proof strong clothing.”
Edwige was diagnosed with emotionally unstable personality disorder and schizophrenia and was treated for her illnesses at St Andrew’s.
She also had a history of self-harm and acts of violence.
During January and February 2020 she was under 15 minute observations from staff but still managed to tie ligatures and pass them around to other patients.
As she became more high risks there meetings were undertaken with suggestions to increase the frequency of her observations to every ten minutes, but this was not agreed.
A January 28 report from St Andrew’s Healthcare noted Edwige managed to tear up a mattress to produce a string for more ligatures as she was ‘feeling suicidal’.
The period between August and December 2019 saw Edwige’s behaviour improve from being under four to one care observations to eventually being granted unsupervised visits to see her family.
However, her mood crashed at the start of 2020 as she became upset each time she returned to the ward, eventually leading to the tying of ligatures.
St Andrew’s Healthcare was rated as inadequate by the CQC in February 2020.
The report stated: “The service did not have enough registered nursing and support staff to keep patients safe.
“Managers had not filled a third of registered nurse shifts and 15 per cent of support staff shifts.
“Both staff and patients told us they didn’t feel safe.”
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