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The Bristol Post
Estel Farell Roig Senior reporter
18:00, 20 OCT 2020
Alexandra Greenway started to show signs of gender dysphoria at the age of 15. bristolpost
At the time of her death, Alexandra Greenway was experiencing mental health problems.
A grieving mother feels her transgender daughter was let down by mental health services in the Bristol area.
Alexandra Greenway, 23, died on May 11, 2019 after becoming unresponsive following excessive vomiting that night, and the inquest into her death at Avon coroner’s court last week recorded a conclusion of suicide.
At the time of her death, Alexandra was experiencing mental health problems and was under the care of Avon and Wiltshire Mental Health Partnership NHS Trust and her local GP.
However, she did not receive the support she needed from mental health services, apart from prescriptions for anti-depressants.
Avon and Wiltshire Mental Health Partnership NHS Trust said Alexandra’s death was tragic and offered their condolences to the family, encouraging people struggling with their mental health to speak with someone.
In relation to this inquest, the coroner didn’t write a report to prevent future deaths as required to do so by law when a coroner believes action should be taken by an organisation to prevent future deaths.
Alexandra’s mother Jacqueline Greenway claimed her daughter self-referred to Bristol Wellbeing Therapies in 2018 after a discussion with her GP about her depression, but was later told she was not suitable for that service.
Mrs Greenway added Alexandra had been sectioned by police a month prior to her death after a suicide attempt and was taken to a mental health facility in Wiltshire – but was released later that same day because she was deemed too low risk to be kept in the hospital.
The mother-of-two said her daughter was stuck in a limbo and never received cognitive behavioural therapy (CBT), which is what she wanted.
Mrs Greenway said the way she was treated made it worse for her daughter, adding: “There is no provision in the middle, it is just this huge black hole.
“[A few days prior to her death], she phoned me in tears because she was getting nowhere with getting help.
“She wanted something other than tablets. “She said to me once ‘unless you are cutting your wrists in from of them, they won’t help you’.
“From my point of view, she had been completely let down by services for many, many years.”
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Mrs Greenway criticised the provision in the area for not being tailored and instead taking a one-size fits all approach.
Mrs Greenway said Alexandra started to show signs of gender dysphoria at the age of 15 but didn’t get diagnosed until a couple of years later.
Unable to get hormones via the NHS, she ended up buying them over the internet and, in 2017, she went through gender reassignment surgery.
After graduating in clinical psychology, she moved down to Bristol in 2018 to live with her boyfriend in the city centre, working in care at first before starting a job as a recruitment consultant.
Her mother said Alexandra had been to her GP because of her depression and that, over the years, she was given a number of antidepressants which always had serious side effects on her.
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Mrs Greenway said Alexandra self-referred to Bristol Wellbeing Therapies in 2018 but was later told she was not suitable for the service.
She was offered support with a couple of Bristol organisations, the mother added, but these organisations were also inundated and what Alexandra wanted was properly accredited one-to-one therapy.
“Alexandra was gifted and very intelligent,” the 55-year-old said. “She loved literature and had an informed opinion on many things – she was one of those people who wanted to change the world.”
In the weeks before her death she reported increasing distress relating to a desire for the gender affirming treatment of hair removal.
She was sectioned by police on April 10, 2019, and was taken to a mental health facility in Wiltshire but was released later that same day because she was deemed too low risk to be kept in the hospital.
Her mother said that, after being sectioned, Alexandra started receiving phone calls from the Bristol’s crisis team to check on her, describing these as “cursory”.
Mrs Greenway said professionals assessing her suicide risk prior to her death failed to take account of her long-standing dissatisfaction and distrust of medical professionals, which was developed through her negative experiences of GPs, the gender identity clinic and mental health services generally.
“She felt constantly marginalised and fobbed off,” she continued. “We believe that there were systemic failings in Alexandra’s medical care.
“All services appeared to be under too much pressure. Communications were confused, and there was lack of immediate local services.
“People were not available to place phone calls, and Alex seemingly never saw the same person twice.”
The mother said the assessment of Alexandra’s suicide risk was not cognisant of her true personal
Mrs Greenway said Avon and Wiltshire Mental Health Partnership NHS Trust carried out a serious incident review after her daughter’s death and identified seven failings including a lack of clarity for the required care and follow up plan, no formal care plan recorded and her risk’s formulation not being fully completed in line with guidance.
Other failings included the fact she was not left a voice message by the Bristol Wellbeing therapies service and the fact the Crisis Team didn’t send a discharge letter to her or her GP.
“Possibly, Alex simply got tired of waiting in a vacuum,” she continued. “I think she was treated appallingly.
“Nobody cared enough and the services were not delivered quickly enough.
“They completely under assessed the risk and we [her family] were not involved at all.
“She was let down and treatment she received was completely inadequate and not tailored to the fact she was transgender.
“I am distraught and the impact [of her death] on us has been horrendous.”
Selen Cavcav, senior caseworker at INQUEST, a charity which provides expertise on state related deaths and their investigation, said the inquest looked at the final weeks of Alexandra’s life.
She said: “She was a young woman trying to access suitable therapy and support but passed from pillar to post.
“With oversubscribed, disconnected and under supported mental health services, she simply did not get the help she needed.
“Now more than ever, access to gender informed specialist mental healthcare must be a priority in Bristol and nationally.
“Urgent national action is required to ensure the needs of transgender people are met at every level of our NHS, from GPs to A&Es to specialist mental health services.”
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