Cardiff health board's apology after man's suicide
A health board has apologised to a family of a former mental health patient who killed himself 10 days after he was refused hospital admission.
Cardiff and Vale University Health Board acted after a watchdog's report into the death of the man, whose GP said he was a suicide risk, in October 2008.
The report found the former Cardiff and Vale NHS Trust lacked clear guidance on helping mental health patients.
The board said it apologised unreservedly.
The man's mother, known only as "Mrs F", contacted the Public Services Ombudsman for Wales, Peter Tyndall, complaining more should have been done to help her son, referred to as "Mr X".
Mr X had been a patient of the mental health service at Cardiff and Vale NHS Trust, the predecessor of the university health board.
Mrs F complained that the trust's crisis home treatment team had discharged her son into her care too soon.
During his care period, he had expressed a suicidal intent and taken an overdose, and while in her care he had further self-harmed, she said.
On 13 October 2008, after having made two attempts to take his own life, Mr X went to Whitchurch hospital to seek admission but was sent home to see his GP the next day.
Ten days later he was found dead on a railway line near his home.
The trust, Mrs F complained, had turned him away throughout because of a shortage of beds.
This claim was not upheld by the ombudsman.
However, Mr Tyndall did uphold the family's concerns over Mr X's care, saying the trust set the bar too high on admission to a hospital bed, and lacked clear guidance on helping mental health patients.
His report also made a number of recommendations, including the need for the health board to review its policy for hospital admission.
Jan Williams, chief executive of Cardiff and Vale University Health Board, said they were deeply sorry and that action had already been taken to implement the ombudsman's recommendations.
She said: "Our sincerest condolences go to the family and we apologise unreservedly for what happened in this tragic incident."
Ms Williams said the health board accepted and agreed with the ombudsman's findings, and had written to the family to apologise.
"We are already acting on his recommendations and will continue to review and improve our mental health services," she said.
"This was a tragic incident and we are doing all we can to make sure we implement the learning following the outcome of the ombudsman's investigation."