Sasha Forster: a 'lovely, clever' woman let down by a litany of failures

https://www.theguardian.com/society/2019/may/23/sasha-forster-let-down-litany-of-failures

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Sasha Forster was one of the most complex patients many of the mental health professionals who treated her had encountered. Her most obvious condition was an obsessive compulsive disorder (OCD) that compelled her to undertake complicated and time-consuming rituals that she believed kept her and her loved ones safe.

But in addition, she was diagnosed with post-traumatic stress disorder and her family believed she had autism. The 20-year-old managed her anxiety by repeatedly self-harming and running away from those charged with caring for her.

Despite her difficulties, Sasha’s family insist that she was a clever, lovely young woman who wanted to get better and was ultimately let down by a raft of problems in the way she was treated.

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They are angry that she was able to obtain potentially dangerous medication from a private GP practice that did not know her history and have struggled to understand why, on the day she took a fatal overdose, she had been turned away from hospital amid confusion over her care plan.

The family is also concerned that when Sasha ran away on the day she died, staff shortages meant there was nobody available from the mental health hospital where she was being treated to fetch her back after police managed to find her.

Sasha’s parents, Steven and Angela, from Fleet, Hampshire, claim there was no joined-up approach to their daughter’s care.

OCD began to affect Sasha from an early age. By the time she was 13, she came to believe she had “evil” inside her and that if she did not complete her complicated rituals, harm would come to her and her nearest and dearest.

In a family statement read out at her inquest in Winchester, Sasha’s family said her rituals dominated up to 80% of her time and thoughts. “It took her three or four hours to complete her rituals just to be able to get out of bed,” they said. “She then had to continue performing rituals for a further hour or two before she could leave the house.”

These rituals included touching and tapping and repeating of words and number sequences and as she grew more unwell, she could not bear close contact with her family. By the time she died her family hadn’t been able to touch or hug Sasha for five years.

At the end of 2016, Sasha travelled to London and twice visited a private GP service called the London Doctors Clinic. She persuaded two doctors to prescribe her a total of six weeks’ worth of a medication that she knew was highly toxic if taken in large doses. The inquest was told the doctors had no access to Sasha’s notes or any detailed knowledge of her psychiatric history.

On 10 January 2017, Sasha almost died from an overdose. It took 35 minutes to resuscitate her. She was detained under the Mental Health Act.

“We agreed with the decision to section Sasha,” said her father, though the family did have concerns about the ability of hospital staff to keep her safe. She became a patient at Farnham Road hospital in Guildford, Surrey, a specialist mental health facility run by Surrey and Borders Partnership NHS foundation trust.

Because of her rituals, staff struggled to persuade her to eat or drink. They say they were faced with the choice as restraining and force-feeding her or allowing her to leave the hospital temporarily under section 17 of the Mental Health Act.

Sasha began to divide her time between home and hospital. A plan was in place for her involving other local hospitals and agencies. She was often picked up by police after running away when anxiety took hold.

When she was at home, it was terribly difficult for her family to cope. Sasha would suffer night terrors and they would have difficulty comforting her. But they did not feel she was better off being permanently in hospital, fearing she did not get the therapy she needed. Steven told the inquest they were “between a rock and hard place”.

Angela added: “In hindsight, I wished I’d made greater objection, I think I was swayed, because I’m a mum, because Sasha preferred being at home and felt safer in her bedroom and she hated being on the ward at night, but it was at night that she struggled the most.”

To make matters worse, Sasha’s short-term memory was “shot to pieces” following the overdose, according to her family. She remembered her OCD obsessions and her fears about what would happen if she didn’t complete her rituals – but couldn’t remember the rituals themselves.

On 31 March, Angela said Sasha was at home and woke up distressed. Her mother took her to Frimley Park hospital at 10.50am and asked to speak to a member of the psychiatric liaison team run by the Surrey and Borders trust based there.

The inquest heard that to their surprise and concern, the pair were told they could not be seen. They were told that under the plan in place for Sasha, the options were for her to go to Farnham Road or contact a home treatment team. “Sasha was deflated,” Angela said. Sasha slipped a note to staff expressing suicidal intent without her mother seeing, and vanished.

The police found her at 1.15pm. Sasha told them she had been turned away by psychiatric liaison and said she had the potentially toxic medication with her.

But the officers had no power to detain her or seize the medication. The inquest heard it was not their job to take her back to Farnham Road – and the hospital did not have spare staff to go out and get her.

Sasha returned home later and her mother was taking her to Farnham Road hospital when she became worried that her daughter may have already taken an overdose and they diverted to another hospital, the Royal Surrey County hospital in Guildford.

She was seen outside A&E by a nurse who tried to persuade her into the hospital. Angela said: “I told Sasha she had to go inside if she wanted help. She shrugged and walked off.”

The police were called again and after analysing mobile phone data, they found her by a pond that evening. She had taken a massive dose of the medication and could not be saved.

An independent consultant forensic psychiatrist, Jenny Shaw, told the inquest that Sasha’s was a very difficult case. She concluded it was not clear what diagnosis those caring for her worked to, and argued that a more robust care plan might have helped. Shaw and the coroner, David Reid, also raised concerns about the way Sasha obtained medication from the private GPs in London.

During the inquest, the Surrey and Borders trust accepted there was a shortage of mental health staff at the time of Sasha’s death – which made it difficult for someone to go and bring her back when she ran off – but it claimed the situation had improved.

For Sasha’s family, the changes come too late. In a family statement not read to the inquest jury, they said: “By the time of her death, Sasha felt she was struggling on alone, without sufficient support from the organisations that were supposed to support, treat and protect her.”