Care agencies have been criticised by a coroner for missing ‘a number of opportunities’ to intervene before a Sheffield teenager killed himself.
Peter Stanley, aged 17, was found hanged in woodland off Middlewood Road, Sheffield.
He was homeless and had been placed in bed and breakfast accommodation by Sheffield Council.
But despite a past suicide attempt and expressing suicidal thoughts to a member of the local youth justice team, neither the community health services, his parents or GP were informed he was an immediate risk and he died two days later.
Recording a narrative verdict following an inquest, coroner Chris Dorries said: “There was no recognition of how troubled Peter was and there seems to have been a reliance on normal practice and what steps would be followed in due course rather than on what immediate actions were necessary.”
The hearing was told Peter saw a Youth Justice Team substance misuse worker and confessed his suicidal intentions saying he was ‘so distressed he wanted to run into oncoming traffic or slice his own leg off’.
Daily telephone calls were arranged and a mental health assessment was made for a week later, by which time Peter was dead.
Mr Dorries added: “I find it difficult to believe, in a city the size of Sheffield, that no more immediate mental health assessment could be arranged by either social services or others for a 17-year-old youth who spoke so vividly of his suicidal ideation with a serious attempt at suicide earlier in the year.”