WARNING: DISTRESSING CONTENT: Emily Miller, 27, was under the care of a home-based treatment team from Greater Manchester Mental Health at the time of her death
An “incredible, kind and beautiful” young woman who was “excited for the future” tragically took her own life by accident, an inquest has determined.
Emily Miller, 27, was discovered at her residence on Clyde Road in Didsbury on October 23, 2023. Known affectionately as Ems or Emmie to her loved ones, the court was informed that she had been diagnosed with Emotionally Unstable Personality Disorder (EUPD), which often led to mood swings and self-harm.
As a mental health practitioner herself, she was under the care of a home-based treatment team from Greater Manchester Mental Health (GMMH), represented at the inquest by Nicola Flood. However, concerns were raised by her family about potential shortcomings in her care under the Greater Manchester Mental Health Trust.
Despite these concerns, area coroner Zak Golombeck concluded on Wednesday, May 21 that her care had been “appropriate and reasonable”, with “no clinical reason to escalate her care” in the days leading up to her passing.
Testifying on Tuesday, May 20, consultant psychiatrist Dr Faisal Farid acknowledged that Emily had been self-harming most days. However, he added that she viewed it as a means of “control” and “managing her stress”, rather than an attempt to end her life.
Dr Farid informed the court that she had previously been admitted to hospital twice for brief inpatient stays, but these were deemed “detrimental” to her progress. He elaborated that she had been given the option of a voluntary inpatient stay on October 16 – just seven days before her death – but she declined, opting to continue with visits from the home-based treatment team (HBTT) until her death.
The court was advised that she had been categorised as “red zone,” signifying her case was under daily review and she often engaged with healthcare professionals. On the tragic day she died, Dr Farid conveyed to the court that Emily expressed a desire to be ‘stepped down’ from the HBTT as she believed she was “taking up other people’s time”.
“It wasn’t because she felt the treatment wasn’t working or wasn’t helping her,” he clarified. “It was about being stepped down, not discharged. We were monitoring her risk and her engagement with services.” He noted that Emily had been actively “making an effort” and “engaging” with the team leading up to her death.
He interpreted the “ambivalence” she occasionally exhibited towards her own life and her fluctuating attitudes towards therapy as “typical” for someone dealing with EUPD’s emotional instability.
Subsequently, Lucy Swanson, a specialist in mental health and a social worker, provided evidence to the court. She detailed performing the final formal risk assessment for Emily on October 10, after learning Emily had acquired means to potentially harm herself.
Ms Swanson recounted to the court her “good therapeutic relationship” with Emily and shared how she was “surprised” and “upset” upon hearing of Emily’s passing. Nicola Conoma, another mental health practitioner who worked closely with Emily, also told the inquest of her “shock” and “devastation” at the news of Emily’s death. She recalled her last visit to Emily’s home on October 14, where Emily had indicated she hadn’t self-harmed in ‘a couple of days’.
Ms Conoma reflected on Emily’s discussions about future events. “Her sister’s birthday, her brother’s wedding, their plans to go and see Taylor Swift in concert – lots of things. There were times when she was hopeful for the future. She had a place at uni for the following year. I think it was her wish to be alive.”
Michelle Brown, representing the Miller family, suggested that Emily’s purchase of items for self-harm signalled an “escalation” of risk, noting that by October 19, Emily had been self-harming ‘daily’. Ms Conoma responded: “We did offer hospital admission, but she was quite clear she did not want to go into hospital. I did not feel use of the Mental Health Act would be appropriate.”
At Manchester Coroner’s Court, Emily’s sister Jessica painted a picture of her as “magnificent”, “vibrant” and possessing a “calming aura” that made her “great at her job”, reports the Manchester Evening News.
She said: “I don’t know how to find the words to get across the true essence of Ems or how much I absolutely adore her. I want her to be more than a name, more than a statistic, because although her ending was so tragic, she was not. When someone dies by mental health, they’re defined by their death. But she was and is so much more than that. I love my baby sis with every fibre of my being and I will never forgive myself for not doing my job as her big sister and protecting her.
“Em touched so many hearts, I miss laughing with her, I miss sitting in her presence, I crave it all the time. I miss our 4 hour long phone calls, our walks, our long voice notes, our little adventures – everything about her. As beautiful as the thought is that she’s always with me, it doesn’t bring me comfort yet because she should be here.”
Adding to her emotional address, she said: “Please look at her and know that she was the most incredible, kind, beautiful [person]. Her body may not be here anymore but her soul is in every person she ever loved. I’ll never find the words to describe how heart wrenching this loss is, how part of me died that day too. She’s taken part of my soul with her but that’s okay, she can keep it until I get there.”
The coroner confirmed that the cause of death was determined to be hanging. He provided a summary of Emily’s treatment journey, noting her consistent refusal of multiple offers for hospitalisation. He verified that a meeting took place on October 19 regarding Emily’s care plan. She was to remain in the red zone with a planned transition from home-based treatment to the Community Mental Health Team “in a safe manner”.
Mr Golombeck remarke: “Emily continued to self-harm on a daily basis. There was no meaningful escalation in her risk. She was not detainable. On the 23rd, another offer of voluntary admission was extended, but this did not imply that involuntary admission was the subsequent step. I find that the care provided was appropriate and reasonable. There was no clinical justification to escalate her care.”
The coroner concluded with a verdict of misadventure – an accidental death resulting from a voluntarily taken risk – rather than suicide. “I am not satisfied on the balance of probability that she intended to take her own life. There was no clear expression of intent, no note or communication to her family; and there was some evidence of her future planning.
“I conclude that she did not intend to cause her own death. Her death resulted from a deliberate human act, with some awareness of the risks involved, which unexpectedly went awry.”
The Mirror has reached out to GMMH for their response.
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