Mental health deaths inquiry to probe alleged failings on a ‘shocking’ scale

An inquiry examining the deaths of almost 2,000 mental health patients in Essex will investigate alleged failings on a “scale that’s deeply shocking”, its chairwoman has said.

Baroness Kate Lampard CBE said as she opened the Lampard Inquiry that “we may never have a definitive number of deaths put forward within the inquiry’s remit”.

She said she is “committed to publish” a number but “this number is only ever likely to be approximate and I find it shocking we may never be able to say for sure how many people died in the remit of this inquiry”.

However, she said the figure will be “significantly in excess” of 2,000.

A number of bereaved parents and families gathered outside the inquiry venue in Chelmsford on Monday, laying placards on the pavement with photos of loved ones who had died.

Among the banners on display was one saying “We will not be silenced”, another read “We demand truth justice accountability change” and a third stated: “Failed by Essex mental health services”.

Some bereaved parents had indicated that they would protest outside the venue because they had been refused core participant status in the inquiry, a special status which grants participatory rights including being able to suggest lines of questioning via counsel to the inquiry.

The Lampard Inquiry will investigate the deaths of people who were receiving mental health inpatient care in Essex between 2000 and 2023.

This will include people who died within three months of discharge, and those who died as inpatients receiving NHS-funded care in the independent sector.

The Essex Mental Health Independent Inquiry was established in 2021 without statutory status.

It was upgraded to a statutory footing last year, which means it has legal powers to compel witnesses to give evidence.

Opening the inquiry on Monday, Baroness Lampard said hearings will be “investigating matters of the gravest concern and significance”.

She said the inquiry will “investigate alleged failings on a scale that’s deeply shocking”.

She extended her “deepest sympathy” to the loved ones of those who have died, and held a minute’s silence as a mark of respect.

“Each death represents a tragedy,” she said, and praised the “courage, resilience and strength the families have demonstrated in some of these most tragic circumstances, including bringing to light some of the issues”.

“Without their dedicated and tireless campaigning it’s unlikely we would be here today,” Baroness Lampard said.

Nicholas Griffin KC, counsel to the inquiry, said evidence will be heard throughout 2025 and into 2026.

He said commemorative evidence from families and friends of those who died will be heard next week, with further virtual hearings for more commemorative statements from November 25 to December 5.

Mr Griffin said it was thought important that an inquiry “with an Essex focus should hold its opening hearings in Essex”.

But he said organisers were “aware of the sensitivities of a number of locations in this county”, which includes places that people took their life.

He said that, with this in mind, a “neutral venue” in London had been identified for hearings next year.

He said that Arundel House, near Temple underground station, also had “trauma-informed space… allowing access to emotional support”.

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