A MENTAL health unit did not meet its own standards during their care of a mother-of-three who took her own life, an inquest found.

Lauren Rose Braithwaite, who had a long history of mental health problems including self-harm and a previous suicide attempt, was found dead at the age of 27.

An inquest heard she also had issues with alcohol consumption which led her to self-refer to Unity in September 2019.

The court also was told Miss Braithwaite, who lived at Queen Street in Dalton, had been charged with possession of cannabis in the month prior to her death.

Area coroner Ms Kirsty Gomersal questioned Rachel Horrobin, service manager for Lancashire and South Cumbria NHS Foundation Trust, regarding Miss Braithwaite’s treatment at the Dova Unit based at Furness General Hospital in Barrow.

Consultant psychologist Dr Nigel Eastwood and senior community mental health practitioner Amanda Middleton, who treated Miss Braithwaite, said she had been diagnosed with emotionally unstable personality disorder.

Ms Gomersal said she was satisfied measures are being put in place that demonstrate lessons had been learnt.

However, she said the trust was 'extremely close' to having a report to prevent future death implemented and that she would be 'extremely disappointed' to see a similar situation at any future inquests.

Ms Horrobin admitted they did not meet standards regarding the care coordinator following up appointments in the time expected and in regard to whether her care plan and risk assessment were updated in a timely fashion.

Ms Horrobin made assurances the trust was putting in a new protocol to ensure action plans and risk assessments would be updated quicker following a suggestion from the coroner that the trust was not learning lessons from previous deaths.

Another issue raised by the coroner was that the action plan taken from the report following Miss Braithwaite’s death was not put in place until 11 months after she died.

Solicitor Catherine Egan, representing the trust, said the report would not be seen until it is finalised and that immediate risks were accounted for within an initial review.

The inquest heard a statement from PC Rashid Said.

He was the officer who attended her address on the evening of March 18, 2020, for a welfare check.

“Her mother had said she had not heard from her daughter since the previous day,” he said in a statement.

“There was no answer to the knock on the door.”

PC Said went around the back of the property and forced entry following a conversation with Miss Braithwaite’s mother.

He made his way through to the stairs of the property where he found her body with a note saying: “I love you all and I am sorry”.

A toxicology report found alcohol in her system at a level that may impair cognitive function and a pathologist gave the cause of death as hanging.

Mother Melanie Braithwaite said in a statement to the court: “She had been living in Dalton all her life and had three children.

"She had been unemployed for quite some time.

“I was told she may have post-traumatic stress disorder because of a previously abusive relationship.”

Ms Gomersal added: “Lauren was a very lucky lady to have the support she received from her mother throughout her life.

“It was Mrs Braithwaite who raised the alarm to the police about her daughter.

“I find there was no third-party involvement in her death.

“On the balance of probability, I find that Lauren did intend, tragically, to take her own life.”