‘Mental health care black hole failed my daughter’
AGRIEVING mother feels her transgender daughter was let down by mental health services in the Bristol area.
Alexandra Greenway, 23, died on May 11 last year after becoming unresponsive following excessive vomiting that night, and the inquest into her death at Avon Coroner’s Court last week recorded a conclusion of suicide.
At the time of her death, Alexandra was experiencing mental health problems and was under the care of Avon and Wiltshire Mental Health Partnership NHS Trust and her local GP.
However, she was not receiving any sort of mental health treatment apart from antidepressants.
Avon and Wiltshire Mental Health Partnership NHS Trust said Alexandra’s death was a tragedy and offered their condolences to the family, encouraging people struggling with their mental health to speak with someone.
Alexandra’s mother Jacqueline Greenway claimed her daughter, who was living in Bristol, selfreferred to Bristol Wellbeing Therapies in 2018 after a discussion with her GP about her depression, but was later told she was not suitable for that service.
Mrs Greenway added Alexandra had been sectioned by police a month prior to her death after a suicide attempt and was taken to a Wiltshire mental health facility, but was released later that same day because she was deemed too low risk to be kept in.
She said her daughter was stuck in a limbo and never received the cognitive behavioural therapy (CBT) she wanted.
Mrs Greenway said the way she was treated made it worse for her daughter, adding: “There is no provision in the middle, it is just this huge black hole.
“[A few days prior to her death], she phoned me in tears because she was getting nowhere with getting help.
“She said to me once ‘Unless you are cutting your wrists in front of them, they won’t help you’. From my point of view, she had been completely let down by services for many, many years.”
Mrs Greenway criticised the provision in the area for taking a one-size-fits-all approach.
Mrs Greenway said Alexandra started to show signs of gender dysphoria at the age of 15, but didn’t get diagnosed until a couple of years later.
Unable to get hormones via the NHS, she ended up buying them over the internet and, in 2017, she went through gender reassignment surgery.
After graduating in clinical psychology, she moved down to Bristol in 2018 to live with her boyfriend in the city centre, working in care at first before starting a job as a recruitment consultant.
Mrs Greenway said Alexandra had been to her to GP because of her depression and that, over the years, she was given a number of antidepressants which had serious side effects.
“Alexandra was gifted and very intelligent,” the 55-year-old said. “She loved literature and had an informed opinion on many things – she wanted to change the world.”
In the weeks before her death she reported increasing distress relating to a desire for genderaffirming hair removal.
After Alexandra was sectioned on April 10, 2019, and subsequently released, Alexandra started receiving “cursory” phone calls from the Bristol
crisis team to check on her, Mrs Greenway said.
She said professionals assessing her suicide risk prior to her death failed to take account of her long-standing dissatisfaction and distrust of medical professionals, which was developed through her experiences of GPs, the gender identity clinic and mental health services generally.
“She felt constantly marginalised and fobbed off,” she said. “We believe there were systemic failings in Alexandra’s care.”
Mrs Greenway said Avon and Wiltshire Mental Health Partnership NHS Trust carried out a serious incident review after her daughter’s death and identified seven failings including a lack of clarity for the required care and follow up plan, no formal care plan recorded and her risk’s formulation not being fully completed in line with guidance.
Selen Cavcav, senior caseworker at INQUEST, a charity which provides expertise on state related deaths and their investigation, said: “She was a young woman trying to access suitable therapy and support but passed from pillar to post.
“With oversubscribed, disconnected and under supported mental health services, she simply did not get the help she needed.
“Urgent national action is required to ensure the needs of transgender people are met at every level of our NHS.”
Dr Sarah Constantine, medical director for Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust, said: “Alexandra’s death was a tragic event and we offer our sincere condolences to her family and friends at this difficult time.”
She phoned me in tears because she was getting nowhere with getting help ... from my point of view, she had been completely let down by services for many, many years Jacqueline Greenway