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Coroner raises concerns after much loved dad dies three weeks after being discharged from crisis health team

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A CORONER has raised concerns after a local 21-year-old dad was found dead by his father only three weeks after being discharged from the crisis mental health team. 

In the early hours of March 27, 2019, Kieran Crimmins’ body was discovered close to his family’s house in Milford Haven.

Mr. Crimmins had been discharged from the Hywel Dda Crisis team three weeks prior, on March 5, despite displaying “maladaptive coping mechanisms” and repeatedly threatening to take his own life. 

Paul Bennett, a senior coroner for Pembrokeshire and Carmarthenshire, questioned whether it was wise to complete a multi-agency referral form (MARF) over the phone, whether there were “inconsistencies” in the manual diary system the Hywel Dda mental health team used to keep records, and whether there were “no effective means” of monitoring Kieran’s mental health after his release. 

Following a four-day inquest into the events leading to Kieran’s death, Mr. Bennett will now decide whether to make a Regulation 28 Prevention of Future Deaths Report (PFD), which would force Hywel Dda health board to rectify any potential weaknesses

Since he was a young child, Kieran had been under the supervision of the Hywel Dda Health Board’s mental health services and had frequently sought help at Withybush hospital.

Speaking after the inquest had concluded, his family said: “He was funny, entertaining, and an empathetic young man. He would brighten any room and would help anyone who asked, wanting nothing in return.”

However, beneath Kieran’s cheerful exterior was “a deeply troubled soul.” The inquiry learned that during his brief life, he experienced serious trauma, including the deaths of numerous dear friends and family members.

According to psychological testimony given at the inquest, his inadequate coping skills and pre-existing special educational needs made it difficult for him to handle the severe swings in his mental health. 

His family were his “protective” measures when things got tough.

Acting for Kieran’s family, Ben Blakemore said: “Kieran and his family did not feel listened to or recognised when begging for the intervention that it is clear, and hindsight shows, he desperately needed.” 

He was engaged with the Dyfed Drugs and Alcohol Service, and an inquiry into a drug-related driving offence was pending at the time of his death (DDAS).

Several witnesses, including those responsible for Kieran’s care and treatment for the Hywel Dda health board, testified in front of Mr. Bennett.

A crisis team practitioner with the Hywel Dda University Health Board pushed hard for Kieran to be admitted to the hospital on February 27, 2019, one month before he passed away, after he tried to end his life by overdosing on drugs.  

Dr David Sheppard interviewed Kieran at the time, who kept referring to suicidal thoughts and made several references to taking his own life.

Dr. Sheppard requested that a hospital bed be found for him that night in a conversation with Hywel Dda duty manager Donna Phillips, but Mrs. Phillips informed him that there were no beds available. 

Following that, Mr. Crimmins was offered the choice of staying at Withybush A&E or going back home with his parents. He made the decision to go home.

He returned to hospital the following day and was assured the Crisis team would visit him on a daily basis for the next two weeks. On March 1, a team member paid him a visit, and on March 2, he got a call from them, which is when the MARF referral happened. 

Kieran saw no one on March 3 or March 4. Despite going missing twice during that time and being located by police on one of those times, it was decided on March 5 that he should be released from their service.

Despite communication with DDAS and Hywel Dda’s integrated psychological therapies programme, Mr. Blakemore claimed that Kieran was “essentially left to his own devices.” Mr Bennett added: “I have some concerns around the decision making process.”

Three weeks later, on March 26, Kieran sent his former girlfriend and a friend of his each a message that raised concerns. When his parents learned that their son had left the house, they called the police and started looking for him.

Just after midnight, his father discovered his body. Despite paramedics’ best efforts to revive him with CPR and a defibrillator they had brought to the scene, Kieran was pronounced dead upon being taken to Withybush.

His sister, Katie Crimmins, who was only 18 when she learned that her older brother Kieran had passed away, claimed that hospital workers failed to provide any assistance to the family, leaving them to cope with the unbearable loss on their own.

Kieran, who had only recently become a father and was an avid fisherman and DJ, had long battled mental health problems including depression and PTSD.

His family claimed he struggled to receive the professional help he required. The transition of his care from child and adolescent mental health services (CAMHS) to adult mental health services allegedly ran into more issues.

As a result of the cell phone interaction, Mr. Bennett came to the conclusion that Kieran died by suicide as there was “sufficient evidence of Kieran’s intent to end his life and of him taking the steps to do so”. He added that he died of asphyxiation due to self-suspension. 

He added: “A decision was taken not to refer to the Community Mental Health Team for ongoing monitoring of his mental health and care co-ordination following his discharge from the Crisis and Home Treatment Team on March 5 due to the fact that he was receiving support from the Dyfed Drug and Alcohol Service and the Independent Psychological Therapy Service.”

After the inquest was over, Mr. Blakemore, who represented his family, released a statement saying: “Mental Health Service provision in Pembrokeshire and the wider Hywel Dda Health Board is long overdue a review so as to ensure that individuals do not believe that suicide is the only option they have. Kieran’s family has pursued change through this inquest forum, and hope it will follow.

“Kieran’s death must not be allowed to be just another statistic. Change is needed to avoid more people with vulnerabilities and thoughts such as those Kieran suffered from losing their life, and more families going through this hollow hell.”

Mr Blakemore urged Mr Bennett to consider making a Regulation 28 PFD report. Luke Garrett, representing Hywel Dda health board, made a submission that the matters raised by the coroner “will be considered” and that the use of the diary system would be “reviewed and strengthened” and the health board would “endeavour to provide information on MARFs on a face-to-face basis”.

Mr Bennett agreed to “give the matter due consideration” and will issue his decision within the next few days. 

He closed proceedings by expressing his condolences to Kieran’s family and commending them for the “way they conducted themselves” throughout. 

He added: “I’m sure there’s not much I can really add to the expressions of sympathy already shown.”

Kieran’s family also thanked the support they’d received from 2Wish and Get the Boys a Lift, and stated that without it, they would have been left “without any support at all at what has been the most horrific time of their lives”.

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Anticipation builds for more Northern Lights as solar activity peaks

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IN the wake of a mesmerising display of the aurora borealis last weekend, experts predict further celestial spectacles are imminent due to heightened solar activity. A substantial sunspot cluster, responsible for recent intense solar flares, is expected to face Earth again in approximately two weeks, potentially sparking more geomagnetic storms and Northern Lights displays.

Scientists at the Met Office, including space weather forecaster Krista Hammond, report that this activity is part of the approaching solar maximum, a peak phase in the Sun’s 11-year cycle marked by increased magnetic upheavals and sunspot production. This cycle, the 25th since systematic observations began in 1755, is proving more vigorous than anticipated.

Last Saturday’s geomagnetic storm, categorised as a G5—the highest alert level by both the Met Office and the US National Oceanic and Atmospheric Administration—was the most severe since 2003. Triggered by multiple coronal mass ejections (CMEs), the storm disrupted high-frequency radio communications globally and posed challenges to various satellite operations.

The aftermath of the storm highlighted our vulnerability to space weather. SpaceX’s Starlink satellites experienced significant strain, leading to voltage spikes, as reported by the European Space Agency (ESA). The added radiation also disturbed GPS signals, impacting everything from aviation—necessitating the reroute of a transatlantic flight—to precision farming, with reported disruptions in GPS-dependent agricultural machinery.

On Earth, the heightened electrical currents tested power grid robustness worldwide. In New Zealand, some circuits were temporarily shut down as a precaution, while the UK’s electricity network operators implemented measures like extra back-up generation to manage potential voltage fluctuations.

This heightened solar activity brings not only stunning natural displays but also underscores the critical importance of preparedness for space weather impacts. The UK government ranks extreme space weather as a significant threat on its national risk register, citing potential severe consequences such as widespread power outages and infrastructure damage.

According to Sean Elvidge, a professor in space environment at the University of Birmingham, the recent storm serves as a reminder of the potentially devastating effects of more powerful storms, like the historical Carrington Event of 1859, which disrupted telegraph systems and caused widespread fires.

As the Sun continues its active phase, the role of advanced forecasting and international cooperation in mitigating space weather effects becomes increasingly crucial. Agencies like NOAA and the Met Office are enhancing their monitoring capabilities, ensuring that critical infrastructure and governments worldwide are forewarned of impending solar storms, thus safeguarding both modern technology and the daily lives dependent on it.

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Gething crisis: Tory Leader signals no-confidence motion in First Minister

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IN a bold assertion that could intensify the political instability in Wales, the Conservative leader in the Senedd, Andrew RT Davies, has indicated that a motion of no confidence against First Minister Vaughan Gething is increasingly likely. This comes in the wake of recent revelations and internal disputes within Welsh Labour that have put Mr. Gething’s leadership under severe scrutiny.

The controversy escalated following the dismissal of Hannah Blythyn, the minister for social partnership, who was accused by Mr. Gething of leaking confidential text messages to the press—an allegation she firmly denies. The leaked texts were reportedly from a pandemic-era group chat, which Mr. Gething admitted to deleting, details of which were first reported by Nation.Cymru.

This incident is part of a broader series of challenges facing Mr. Gething, including scrutiny over the substantial donations made to his leadership campaign. It was disclosed that his campaign had received £250,000, with a notable £200,000 contribution from a company led by a businessman previously convicted of environmental crimes. Mr. Gething announced he would be returning £31,000 to Labour from the campaign funds amidst this controversy.

In crisis: First Minister, Vaughan Gething

Adding to the upheaval, Mr. Davies criticised the First Minister’s leadership on BBC Radio Wales, questioning Mr. Gething’s transparency and ability to govern effectively. He emphasised the urgent need for Mr. Gething to justify his actions, particularly the sacking of Ms. Blythyn, to restore public trust in the government.

On Thursday, in an interview with ITV Wales, Mr. Gething defended his decision, highlighting the importance of trust and confidentiality among ministers and maintaining that his team was aligned on government priorities. He underscored the challenges faced by his administration and the need to focus on issues crucial to the Welsh populace.

Despite the turmoil, any formal motion of no confidence is not expected to be tabled immediately, owing to procedural and logistical considerations. With Labour holding half of the seats in the Senedd, the success of such a motion would hinge on cross-party support or abstentions from within the Labour ranks.

As tensions mount, the political landscape in Cardiff Bay remains fraught with uncertainty, with the potential for significant shifts in governance depending on the developments in the coming weeks.

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Drive-through Starbucks could be coming to Pembrokeshire

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PLANS for what could be a drive-through Starbucks coffee shop accompanying an electric vehicle charging station at Haverfordwest’s Days Garage, are being recommended for approval next week.

An application – expected to create 20 jobs – by Magic Bean Company Ltd to site an Electric Vehicle (EV) charging station and drive through coffee shop on land adjoining Days Garage, Fishguard Road is recommended for conditional approval when it comes before Pembrokeshire County Council’s planning committee, meeting on May 21.

A report for planners says: “There are two principal elements to the proposed development. The provision of an EV charging station with eight charging points and a drive through coffee shop, which will provide 20 full time jobs.

“A further 13 parking spaces are provided to serve the development, including two spaces for people with disabilities. The coffee shop will be situated at the western end of the site opposite the proposed EV charging station, which is centrally located within the site. “

It adds: “The coffee shop building will be single storey with a ‘tower’ feature in the west elevation where the customer collection point will be located beneath a timber finished pergola.”

The report says the existing use of the site as ancillary parking for Days garage “is inappropriate for the locality,” adding it is “located within an area that is characterised by large-scale community, commercial and employment uses, albeit all falling outside the defined Settlement Boundary”.

It adds: “Officers acknowledge that the proposed development will constitute a more effective use of the application site than its existing use for car parking and which will provide 20 jobs.”

10 representations from members of the public have raised concerns about the proposal, issues including: no need for additional coffee shops locally, adverse impact on existing small local coffee shops and that the planning authority should not be supporting “multinational businesses,” and littering and highway issues.

Magic Bean Company Ltd, on its website, says: “Established in 2014, The Magic Bean Company opened our first store and became the first licensee to open a Starbucks Drive Thru.

“Since then, we have gone on to become Starbuck’s only national growth partner covering England and Wales, developing our green electric vehicle Starbucks platform.”

It adds: “All Magic Bean stores are designed by Starbucks to the highest standard, taking pride in the quality and finish of all the stores they have developed.”

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