A CORONER has ruled while some chances were missed in the way mental health services and a GP treated a teenager, who took his own life, it cannot be shown they contributed significantly to his death.

An inquest into the death of Matthew Young at Rochdale Coroners’ Court heard the 17-year-old, who attended Bacup and Rawtenstall Grammar, died in Bury after leaving school and not returning home in September last year.

The inquest heard he had been encountering mental health difficulties and had been treated by his GP and Healthy Young Minds Bury for two years before his death.

It also heard he was admitted to an accident and emergency ward two weeks before his death after his mother found him in a “trance-like state” and he admitted he had taken ketamine.

His mother, Jacquelyn Young said she rang Healthy Young Minds to tell them about this but was put on hold for more than an hour and was not called back for a fortnight.

A review by Pennine Care NHS Foundation Trust into the service said there was not a core case worker and staff absences were a problem in the care Matthew received. They also did not conduct a review into his medication after 2019.

GP Paul Wallman told the hearing a receptionist cancelled an appointment due to take place in September with Matthew over concerns about confidentiality, which they should not have done.

He said this emerged in the course of an investigation into the treatment.

Recording a suicide conclusion, Coroner Catherine McKenna, said: “The court has to consider whether any missed opportunities that have been identified in this inquest have more than minimally caused Matthew’s death. The evidence is not there to support such a finding.”

The coroner opted not to send letters requiring improvements to either the GP or Healthy Young Minds Bury.

The inquest heard Matthew,of Bentley Meadows, Walshaw, had sent a series of e-mails during lockdown to school highlighting concerns, saying he had no motivation and was “back to where he was last year.”

His parents said they should have been made aware of these.

The court heard during his final day at school he asked to see a counsellor in morning break, but was told he could be seen that afternoon.

Samuel Heald, a physics teacher, recorded that he was disengaged in class.

The coroner said there was nothing in his “interactions with others” which suggested he was intending to “self-harm” or had “suicidal ideation” after he returned to school.

Later in a statement Ian and Jacquelyn Young, Matthew’s parents, said they were disappointed the inquest did not address a Pennine Care serious incident case review which identified 13 clinical and service issues and nine further immediate actions to ensure safety of patients accessing Healthy Young Minds.

Mr Young said though the coroner had considered the matters with “immense detail.”