The suicide of a Chalfont St Peter man, who had mental health issues and was considered vulnerable could have been avoided if a detailed written care plan was provided following his discharge, an inquest was told.
Roy Morris of Grove Hill was found dead, by act of hanging, in Birchwood off the A40 between Gerrards Cross and Beaconsfield.
His body was found on June 30 2019, five weeks after he went missing.
Nine days before going missing, Roy was discharged by Whiteleaf Centre, a mental health hospital in Aylesbury, where he was admitted for attempting to take his own life.
The inquest at Beaconsfield Coroner’s Court reached the conclusion that “the absence of a detailed written care plan for Roy at the time of discharge, the allocation of Roy’s care coordinator only shortly before his discharge and the difficulties the family experienced in being given appropriate opportunities engage effectively, particularly through the inpatient period, all contributed more than minimally to the manner in which Roy was discharged and thereby to his deterioration and death.”