The inquest into the death of Kenan Canalp has concluded, finding that neglect and serious failures by South London and Maudsley NHS Foundation Trust contributed to his suicide – and that inadequate levels of observation caused his death.
Kenan was 27 years old when he died whilst detained in the Maudsley Hospital in Camberwell in the early hours of 8 March 2018.
After hearing eight days of evidence, the inquest jury concluded that Kenan’s death was suicide. In a narrative conclusion, they found that a failure to place Kenan on 1:1 observations on ES2 ward contributed to his death. They found this amounted to neglect because it was a failing of basic care and a “gross failure due to serious risk of suicide”.
South London and Maudsley NHS Foundation Trust admitted this failure during the inquest, stating that the whole of the risk assessment should have been reviewed as part of the decision regarding his level of observations on ES2 ward in particular. Some of the nurses caring for Kenan were unaware he had been admitted to hospital because of an attempt on his own life, and so were unaware of Kenan’s suicide risk.
The family are represented by INQUEST Lawyers Group members Claire Macmaster and Christopher Callender of Simpson Millar solicitors, and Rachel Barrett of Cloisters Chambers.