Timothy Smith was found dead in his cell after his mum raised concerns with the prison
An inmate died after his mum reported how he had accumulated “drug debts”. Timothy Smith was initially sentenced to two-and-a-half years in prison in October 2016 for actual bodily harm.
Smith was released in January 2020 but was recalled to HMP Forest Bank in March that year before being transferred to HMP Risley later that month. In a Prisons and Probation Ombudsman report published on Thursday, December 19, it explains how Smith had a long history of mental health issues, substance misuse and self-harm.
He was supported by the mental health team in the prison and was prescribed medication to treat his symptoms of depression and anxiety. The report outlined how he was compliant with taking his medication. It was reported how the 29-year-old was unhappy about the lack of time prisoners were able to spend outside of their cells due to the Covid-19 pandemic.
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On April 27, 2020, Smith told a mental health nurse during a telephone review how the lack of time outside of his cell had resulted in him having thoughts of self-harm and “hearing voices”. The report said: “However, neither health care nor prison staff raised any concerns about him or considered starting suicide and self-harm procedures.”
It continued to explain how Smith’s mum raised concerns with staff at the Cheshire-based prison about how he had accumulated drug debts, although Smith did not tell staff about this and there was no reported evidence that he had misused illicit substances, he was in debt or he had been bullied.
But on May 20, Smith rang his mum, with her later describing the phone call as “bad” to investigators. That afternoon, a welfare check was conducted on the prisoner at around 3.15pm. When the officer looked through the cell door he saw Smith hanging at the back of the cell before shouting for assistance.
Two other officers arrived at the cell within seconds before an emergency code blue was called in meaning the inmate is unresponsive or not breathing and an ambulance must be called. Chest compressions were started and another officer arrived with an emergency medical bag as they attempted to resuscitate the inmate. Two nurses arrived at 3.24pm followed by a GP two minutes later who stopped resuscitation efforts and pronounced Smith dead at 3.27pm in his cell. Paramedics arrived at the cell at 3.34pm who agreed he had died.
An inquest in November this year concluded he had deliberately applied the ligature but it could not be said whether he intended the act to be fatal.
The report, written by Sue McAllister, recommended to the prison:
- The Governor and Head of Healthcare should ensure that staff take into account all relevant risk information about prisoners when assessing their risk of suicide and self-harm and start ACCT procedures when appropriate.
- The Head of Healthcare should ensure that healthcare staff share important information about a prisoner’s risk to himself with prison staff.
- The Head of Healthcare should share this report with Nurse A and discuss the Ombudsman’s findings with her.
Following the investigation into the death, an action plan was created for the prison which included reminding staff to “take account of all available risk information” when considering mental health support. It also included healthcare staff sharing important information about prisoner’s risk to themselves with prison staff and sharing the report with certain staff.
A Prison Service spokesperson said: “Our thoughts remain with the family and friends of Timothy Robert Smith. HMP Risley has made significant improvements since his death in 2018. This includes a new induction process and improved mental health assessments for all new prisoners, enhanced training for staff to better manage prisoners at risk of suicide or self-harm, and better processes for information sharing between healthcare and prison staff.”
