Coroner raises training concerns following Wickham woman's death
Teaching assistant Samantha Young died in November 2023
Last updated 28th Aug 2025
A coroner has raised serious concerns about Hampshire and Isle of Wight Healthcare NHS Foundation Trust’s failure to provide mental health risk assessment training for staff.
It follows a two day inquest into the death of 49 year old Samantha Young.
In a narrative conclusion Assistant Coroner Henry James said the teaching assistant had done all she could to seek mental health support before taking her own life in November 2023.
Samantha was under the care of her Community Mental Health Team - but the inquest heard her repeated pleas to be sectioned or admitted to hospital were ignored.
Staff failed to carry out a risk assessments, provide additional help and didn't contact her family - despite Samantha giving her consent for them to do so.
Samantha’s family said:
“We believe the trust’s mental health team effectively assisted in the death of our sister. In the last 10 days of her life, unknown to the family, Sammy self-rescued by calling emergency and mental health services three times. She begged them to take her into hospital; to keep her safe and protect her daughter from her own painful experience of losing a parent to suicide. Three times members of the CMHT refused Sammy’s pleas for help and did not remove the means of suicide. This was after years of failing to offer Sammy treatment.
“Sammy’s death is in a long list of cases in which desperately ill mental health patients have been denied their right to treatment by NHS mental health services. This needs an independent investigation. Without the NHS being held to account for their failings more people will die.”
Julia Reynolds said:
“This has been an exceptionally distressing case. Samantha was a much-loved and devoted mum to her daughter who should have received the support she was crying out for. It is quite remarkable the lengths that Samantha had gone to seek help. But that help was simply not provided.
“The inquest into her death found that she was badly let down by mental health services, to whom she repeatedly expressed her need for help. Her situation should have been escalated, and her family should have been informed.
“It is a matter of grave concern that this is not the first time a family has lost a loved one due to mental health struggles where a coroner has had to make a Prevention of Future Deaths report about this Trust.
“I sincerely hope that this tragic case results in improvements in the mental health support provided by Hampshire and Isle of Wight Healthcare NHS Foundation Trust so that another family does not have to endure the heartbreak that Samantha’s family has.”
Susanna Preedy, Clinical Director for Mid and North Division, Hampshire and Isle of Wight Healthcare NHS Foundation Trust said:
“We are deeply saddened by Sammy’s death and our thoughts are with her family and friends.
“Following this incident, we carried out a full investigation and have identified where our care fell short, for which we are profoundly sorry.
“We fully accept the findings of the coroner and are committed to doing everything we can to put in place the necessary changes to prevent anything similar happening again.
“This includes clearer risk assessment processes, stronger follow-up procedures and better involvement of families and carers.”