- guardian.co.uk, Sunday 6 July 2003 14.51 BST
The story of one woman's precarious journey through the mental health system, and her family's futile attempts to get her the treatment she needed, ended last week at the inquest into her death.
Hers was one of more than 1,000 suicides committed last year by people in contact with psychiatric services, and it is being seized upon as evidence of the chaos and uncertainty facing patients and relatives. Despite setting out a suicide prevention programme, mental health charities are worried that many patients are being written off as 'the worried well', as health professionals concentrate resources on a much smaller number of patients who are considered to be a risk to the public.
In Melanie's case, a verdict of misadventure was recorded, with the coroner saying her suicide attempt had been a cry for help which went drastically wrong - and that there was no evidence the system had neglected her.
Her sister Roslyn and her mother Aileen disagree, and still do not know how she could have been allowed to slip through the net of care despite all their efforts.
Her mother had pleaded, time and again, to see a psychiatrist who might be able to throw some light on to the nature of Melanie's illness, and to offer hope that it was treatable. Many of her letters to doctors went unacknowledged. She finally got her appointment with the psychiatrist in charge - two days after Melanie's death.
'Melanie had been ill for quite some time, but she had such a struggle to get any treatment,' her mother, a former social worker said. 'I don't want any other family to go through the pain we have suffered, because if just one person had taken her more seriously, she might still be with us. She was battling so hard with feelings that she could no longer trust anybody or anything.'
Mental health charities are worried that many patients find it difficult to get proper care, amid budget pressures on the NHS and a shortage of qualified staff. There is also concern that families are not being properly included in care plans for patients.
Melanie's family say she was a highly intelligent child, who won a scholarship to King Edward's School in Edgbaston, an achiever who never felt wholly sure of her abilities. Her father died suddenly when she was 19: this further shook her confidence.
In her thirties, she held a job as a museum curator and enjoyed her life in York. But in 2001, she gave up the job, and moved back home with her mother, unable to cope with depression and anxiety. Her GP records show doctors had found her difficult - one note read that 'she was to be kept at arm's length'.
In October of that year, she was found by a river in York in a distressed state. Friends took her home, but nine days later, she walked into a fast-flowing river in the Yorkshire Dales. She managed to get out but her family became seriously concerned.
Her sister, Roslyn, said: 'We finally managed to get her to a psychiatrist in Solihull, but he didn't appear to understand the severity of her condition. She was given another tablet, and told at one point to "think less and get on with her life". But that was the problem; Mel found coping with day-to-day problems very difficult. She knew she was ill but couldn't explain exactly how she felt.'
Only her mother's own GP in Solihull, Dr Julia Markham, was able to help by seeing her but two further suicide attempts followed.
She was finally admitted in December, but the care seemed inconsistent, and her condition deteriorated. On most days, her mother would receive a call from Melanie, who would be wandering around the shopping centre, having been released from close observation. Staff told the family they could not restrict Melanie's movements as she was not under section.
She hanged herself in a toilet of Solihull Hospital, while she was supposed to be under close observation on the nearby psychiatric ward.
Recording the verdict of misadventure, Birmingham coroner Aiden Cotter said: 'I do not see that this death was caused by anything that the hospital did or did not do.'
Michael Howlett of the Zito Trust, a charity which highlights mental health issues, said: 'This kind of story is repeated so many times, with patients not being given the time and consideration they need. Very often, families are saying "Please help" but very often they are ignored.' Howlett said there needed to be a fresh look at how relatives could be more involved in patient care.
Marjorie Wallace, head of the mental health charity Sane, which takes calls every week from families desperate for help, said: 'What I find so sad is that with all the attempts we have made to have families included in the information and care of patients, they are still being left out in the cold.
'Someone might be very seriously depressed but if they don't present a public safety threat, they are treated as though their illness is almost something they have wished upon themselves.'
