Reece Nelson

Navigo

I am Marianne JOHNSON, Assistant Coroner for the coroner area of North Lincolnshire and Grimsby

On 07 March 2022 I commenced an investigation into the death of Reece William NELSON aged 23. The investigation concluded at the end of the inquest on 05 December 2023. The conclusion of the inquest was that: Reece Nelson was found hanging [REDACTED] on the 28th February 2022 at his home address of Richmond Road, Grimsby. Paramedics attended and pronounced death.

Reece Nelson was found hanging [REDACTED] on the 28th February 2022 at his home address of Richmond Road, Grimsby. Paramedics attended and pronounced death.

During the course of the investigation my inquiries revealed matters giving rise to concern. In my opinion there is a risk that future deaths could occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows: (brief summary of matters of concern) On the morning of Reece Nelson’s death his family attempted to contact his Care Coordinator due to concerns regarding his mental state. The Care Coordinator was on sick leave, however this information was not reported to the family and therefore no return call was made to them. Had the family been made aware that the Care Coordinator was on sick leave they would have tried alternative routes to contact the mental health services to seek assistance. There should be a system in place whereby alternative contact details are provided in the event of a staff member being absent

In my opinion action should be taken to prevent future deaths and I believe you (and/or your organisation) have the power to take such action.