Jason Lee McQuoid 'failed' by prison's mental health team

Jason Lee McQuoid, from Winsford, died age 37 when he took his own life at HMP Risley, in Warrington, on March 2, 2021.

A jury inquest heard by assistant coroner Charlotte Keighley at Cheshire Coroner’s Court found multiple failures with his care.

Mr McQuoid’s aunt, Joyce McQuoid, said: “Jason died in the most inhumane of conditions.

“He died alone, in a cell which is horrific – it’s a little tiny claustrophobic and barren room with just a bed and bedsheet. He’d been left there for days, crying for help and threatening to kill himself and he did.

“And that only happens in a medieval setting. We are utterly bereft and devastated that someone we loved died in those conditions.

"It is beyond comprehension how somebody in the 21st century is allowed to die in those conditions.”

She continued: “Every level of support that could have been offered to him, failed him and he was dismissed consistently.

“It’s a hidden underworld. Nobody wants to talk about prisoners, nobody wants to talk about mental health institutions.

"They’re the bottom of the pile, but unless it is out there in the public arena and people are made aware of because it is in their interest, then nothing is going to change.

“Jason was loved by many and has left a huge void in our lives. I want people to know Jason mattered to me, to his family, and he should not just be a statistic.”

Ms McQuoid added: “The coroner we had was phenomenally brilliant. She was great, I couldn’t fault her.

“Coroners get a lot of flak and negativity, but she was incredible – very humane, very caring, and very understanding. She’d done her homework.”

Mr McQuoid took his own life on March 2, 2021 (Image: Supplied)

Mr McQuoid arrived at HMP Risley in January 2021, weeks after the murder of his friend Keagan Crimes, having been jailed for a string of offences including multiple thefts and failing to comply with the probation service.

As part of his reception screening, the father-of-two requested mental health intervention, however no such referral was made.

A few weeks later, his mental health deteriorated and over the space of five days.

He displayed paranoid and ‘bizarre’ behaviour, set a fire in his cell, was restrained and segregated in the Care and Separation Unit, and was monitored under suicide and self-harm prevention procedures known as Assessment, Care in Custody and Teamwork (ACCT).

The inquest heard how the mental health practitioner at the initial ACCT review did not know his history, did not consider his records and was not aware of his recent presentation. The initial ACCT was closed within hours of being opened.

It was re-opened the next day, when he set a fire in his cell.

He also said, on more than once, that he was going to hang himself and made a further request to see the mental health team.

On the night of his death, Mr McQuoid was on hourly observations under the ACCT process.

However, the inquest jury concluded that ‘a lack of a robust handover procedure and the observations not carried out irregularly to the stated frequency on the balance of probability did contribute more than minimally to Jason’s death’.

The jury also recorded ‘inadequate communication’ between prison officers and the mental health team.

Speaking after the inquest concluded on October 15, Alice Wood of Farleys Solicitors, who represented Mr McQuoid’s family, said: “The jury’s findings show how Jason wasn’t able to access mental health care despite multiple requests to see a mental health practitioner.

“Further, the ACCT process is extremely important in a prison setting to ensure the safety of individuals at risk and it is worrying that the officer carrying out the ACCT on the night of Jason’s death did not seem to grasp the importance of these processes.

"We are grateful to the coroner and the jury for their consideration of these matters.”

Jodie Anderson, senior caseworker at the charity INQUEST, added: “Yet again we see the toxic combination of a dehumanising prison environment, a lack of professional care or curiosity and zero attempts to look at the underlying causes of Jason’s behaviour and distress.

“Jason’s ‘bizarre’ behaviour was wrongly dismissed as being due to a mistaken perceived drug use, an excuse which meant that staff took no proactive steps to ensure Jason received the care he needed.

“Failures in processes will continue to lead to deaths but of equal concern is the apparent ease with which a person’s dignity, care and access to support simply evaporates when they enter those four walls of HMP.

“Just a month before his remand, Jason witnessed his friend being murdered. Imagine what society would look like if we prioritised addressing the root causes of mental ill health over punishment.”

The Prison Service say that multiple improvements have been made at HMP Risley since Mr McQuoid’s death.

This includes weekly diagnosis meetings by the mental health team and changes to the referral process to mental health.

A spokesperson said: “We offer our condolences to the family and friends of Jason Lee McQuoid.

“Since 2021, HMP Risley has made changes to ensure crucial information is better shared between staff and agencies and will consider the inquest’s findings.”

If you have been affected by the issues raised in this article, or you are struggling with your mental health, help is available.

Please call Samaritans for free on 116 123 or go to samaritans.org

For practical, confidential suicide prevention help and advice, you can also call PAPYRUS HOPELINE247 on 0800 068 4141, text 88247 or email pat@papyrus-uk.org