Failures in teen's care before death, says report

An autistic 14-year-old boy was at "significant risk" with a history of self-harm when he was found dead in his bedroom at home, a report said.

Scotty Henniker from Essex made several suicide attempts before he died on 24 September 2023.

In a new report, a coroner said his previous attempts were not "appropriately recorded" or shared among professionals.

Essex County Council and the NHS, which both had responsibility for his care, say they are making improvements since Scotty's death.

"The bulk of the responsibility for Scotty's complex needs was falling [to] one parent alone when it was known and understood that no single person could meet these needs," said Sonia Hayes, the area coroner for Essex.

Scotty, who also had ADHD, relied on an educational outreach team for extra support.

However, the support was not provided during the summer holidays - despite it being available - because his social care team failed to make a funding application, the report said.

In the final months of his life, the teenager also did not have any transport to take him to education support in term time, it added.

An inquest concluded on 4 March and a prevention of future deaths report, written by Hayes, was published recently.

She said not being able to attend "a place that he felt safe" caused him a great level of distress.

She said Scotty was "the most complex child" the educational outreach team had worked with.

Hayes also noted that in May 2023, educational outreach raised concerns with social care at Essex County Council that Scotty had hurt animals and may "do something extreme to win back his family member's affection".

A request was made for a psychiatry review in June 2023 but was declined, and mental health services were reassured that Scotty was not depressed, the report added.

His family also raised concerns he was not being seen by the correct professionals and "wanted him to have a review".

"This did not happen," Hayes said.

The coroner gave a narrative conclusion to the inquest, which is a factual statement to explain the broader circumstances surrounding the person's death.

A spokesperson for Essex County Council said it had made a "number of improvements to strengthen our safeguarding practices".

"We offer our sincere condolences to the family of Scotty Henniker during this very difficult time for them," they said.

The North East London NHS Foundation Trust, which runs mental health services, said work was "ongoing" following Scotty's death.

"This was a devastating loss, and our thoughts remain with all those who loved and knew him," they said.

"We are committed to taking action and continuing to make improvements to our services to protect our service users."

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