An urgent call for more mental health funding has been made by Norfolk's senior coroner after a teenager took her own life while waiting for treatment.
Mary Bush, 15, from Edwards Court in Sprowston, was found in her garden by her grandparents, who had looked after her since she was a week old, at 7.30pm on August 6 last year.
During the inquest on October 19, senior coroner for Norfolk Jacqueline Lake concluded the Broadland High Ormiston Academy pupil died from suicide.
At the time, Miss Bush was waiting on psychological treatment for post-traumatic stress disorder (PTSD) through the Norfolk and Suffolk NHS Foundation Trust (NSFT) after an assessment in January 21 last year.
She had also been diagnosed with anxiety and PTSD with suicidal thoughts in March 2019 and her GP had sent an urgent referral to NSFT on November 28 that year which was judged as routine.
Mrs Lake said: "Psychological therapy had not been started at the time of her death. I am not satisfied this has been dealt with that not everyone referred is being seen in the required time period. This is to do with funding."
The coroner said she would include the clinical commissioning group and health minister in the prevention of future deaths report.
Miss Bush's grandmother, Janet Brenkley, said the teenager had told her that she had been self-harming 18 months before her death.
She added that on night of August 5, the pair had watched television together during which time they "cried with laughter".
Mrs Brenkley received two calls from an NSFT assistant practitioner in June and July while the teenager, who reported improving mental health, awaited treatment.
The practitioner did not speak directly to the teenager, who received school counselling.
Mrs Lake was satisfied the NSFT had acted on concerns of communication between other agencies and patients.
Stuart Richardson, chief executive at NSFT said: "Mary's death was a tragedy and I'm deeply sorry for her family's loss. I want to assure her family that significant changes have taken place following our internal review which was carried out after her death.
"We will review the coroner's report to prevent future deaths and will make any further changes that are needed."
If you need help or support, please contact the Samaritans on 116 123 or Norfolk and Suffolk Foundation Trust’s First Response helpline on 0808 196 3494 both 24/7.
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