Inquest to examine the role of mental health services in death of trans woman Alexandra Greenway

9 October 2020

Before HM Senior Coroner Dr. P. Harrowing
Avon Coroner’s Court, Old Weston Road,
Bristol, BS48 1UL 

Opens 12 October 2020, scheduled for five days

Alexandra Greenway was 23 years old when she died on 11 May 2019. She became unresponsive after excessive vomiting that night, having potentially ingested a toxic substance. Alexandra was a transgender woman, who experienced mental ill health and was under the care of Avon and Wiltshire Mental Health Partnership NHS Trust and her local GP. In the weeks before her death she reported increasing distress relating to a desire for the gender affirming treatment of hair removal.

Alexandra was from Bristol. She loved literature and enjoyed playing the guitar. Her family say that as a child, she had an inquisitive mind. She could read by the age of three and was regarded as a gifted child at school. She was interested in political controversy and human rights. She chose to study clinical psychology at university, because she was interested in what made people tick.

Alexandra identified as a transgender woman. She had previously accessed some gender affirming treatment including a surgery in 2017, but her family report she had very difficult experiences with this including poor treatment by NHS staff. Alexandra also had complex mental health needs. Trans people are at disproportionately high risk of mental ill health and suicide.

Stonewall report that almost half of trans people (46%) have thought about taking their own life in the past year. In the National LGBT Survey a picture was painted by trans respondents of hard-to-access services for gender transition and gender identity, a lack of knowledge among GPs about what services are available and how to access them, and the serious consequences of having to wait.

Healthwatch UK report that trans people’s experiences of long waits for gender affirming support and treatment, such as hair removal, affect their mental health. However, there is little official guidance available for GPs on how to treat trans people who look for support, despite their key role in supporting people to access services.

Just over a month before her death, on 10 April 2019 Alexandra was detained by police (under Section 136) after attempting to jump from a bridge. She was taken to the Bluebell Unit at Green Lane Hospital, who assessed that there was no imminent risk to her safety. Alexandra was discharged to the care of her GP and she was provided the number of a crisis line in case things got worse.

Her parents report they were not informed about this incident, and no care plan was recorded. No discharge letter was ever sent to her GP. Alexandra was awaiting referral to Bristol Well-Being Therapies. At the time of her death she was not receiving mental health treatment, with the exception of anti-depressants. In the days leading up to her death, Alexandra’s boyfriend, who she lived with, reported that she appeared increasingly unhappy and distressed. He woke to Alexandra vomiting, and called an ambulance, but she could not be saved.

Alexandra’s family hopes the inquest will consider:

  • Whether the mental health support leading up to Alexandra’s death was adequate,
  • The quality of risk assessment following Section 136 detention and discharge,
  • The monitoring of the medication she was prescribed.

The coroner did not grant the family’s request for a wider ranging inquest (under Article 2) which could have examined the broader circumstances surrounding Alexandra’s death, including her access to gender affirming treatment and the regard given to her higher risk of suicide as a transgender person. This also meant that the family were not able to access legal aid for representation, despite public services involved having publicly funded representation.

ENDS

NOTES TO EDITORS

For further information, interview requests and to note your interest, please contact INQUEST Communications Team: 020 7263 1111 or [email protected]; [email protected]. A photo of Alexandra Greenway is available here. 

Journalists should refer to the Samaritans Media Guidelines for reporting suicide and self-harm and Trans Media Watch guidelines for reporting on transgender people.

Alexandra’s family are represented by INQUEST Lawyers Group members Beth Grossman from Doughty Street Chambers on a pro bono basis. The family are supported by INQUEST caseworker Selen Cavcav.

Other interested parties represented at the inquest are Avon and Wiltshire Mental Health Partnership NHS Trust, and a GP involved in her care.  

The inquest into the death of student Natasha Abrahart in 2018 previously found failures in the actions of Avon and Wiltshire Mental Health Partnership NHS Trust. See media release, May 2019.

Further information: