Recurring concern

Unreliable Haven at Millview service arrangements

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First reported 28 Oct 2022•Latest report 27 Apr 2026

Definition

What this concern includes

Includes failures in the dedicated Haven at Millview service arrangements, including defining and communicating its provision, roles and access, preparing staff who move into the service, and related operational controls needed to provide safe support.

Not included

  • Excludes generic police or nursing training deficiencies that are not specifically tied to the Haven at Millview service.
  • Excludes general mental-health service access, treatment or staffing failures where the Haven at Millview service is not the deficient process.
  • Excludes failures in other named Havens, services or care settings unless the assertion explicitly concerns the same Haven at Millview arrangements.
  • Excludes clinical-care failures after Haven at Millview responsibilities and service arrangements have operated reliably.
Reports
2

Distinct published reports

Individual concerns
2

A report can raise multiple concerns

Date range
2022–2026

First to latest report issue date

Stated actions
2

Described in published responses

Reports over time

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Most frequent recipients

Reports about this concern sent to each recipient.

Police and Crime Commissioner for Sussex1
Sussex Partnership NHS Foundation Trust1
Sussex Police1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

  1. West Sussex, Brighton and Hove

    AI-generated summary

    Amy Clare CHAPMAN · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Amy Clare Chapman, who was experiencing a mental health crisis and assessed as at high risk of suicide, was admitted to the Haven Unit at Millview Hospital on 23 March 2025. On 27 March, she was permitted to leave the unit twice without adequate checking of her records, family contact, or documentation, and later jumped from a bridge, dying from her injuries. The principal concerns included insufficient risk assessment and planning for trips out, failures to read and record notes, inadequate family involvement, uncertainty over care and safety plans, and gaps in training, alerts, checklists, and auditing.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Lack of training for nurses moving from different settings to the Haven

    Wider context from the report

    “7. There seems to be a lack of training for nurses moving from different settings to the Haven. ”

    Source location

    Amy Clare CHAPMAN · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Review and strengthen the Haven induction process and maintain consistent staff supervision.

    Verbatim wording from the response

    “Action has also been taken to review and ensure the Haven induction process is robust and that Supervision of staff is consistently in place to address any support needs of new staff.”

    Source location

    Response from Sussex Partnership Foundation Trust
    Page 4 · response
    Published 29 June 2026

    Open published response

  2. West Sussex

    AI-generated summary

    Jade Hutchings · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Jade Hutchings, who was 18, had been struggling with his mental health and using alcohol and drugs. After going missing while under their influence, he was found hanging at home and died in hospital on 23 May 2020. Concerns included inadequate police mental-health training and a lack of early-intervention provision for older children through the REBOOT scheme.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Confusion among police officers about the provision and use of the Haven at Millview service

    Wider context from the report

    “1. Inadequate Police training on Mental Health During the course of the Inquest officers involved in dealing with Jade (and in particular around the exercise of their Section 136 powers on 21/5/20) acknowledged that they had received very little mental health training. Some officers could not recall any additional training provided since their initial training when they first joined the force. The officers admitted that although they were aware of the Sussex Police mental health guide they had not read it in full. The expert police witness, ████████, told the Inquest that in his view the online training provision that we were told was being rolled out in Sussex was not sufficient. None of the officers involved in this case had yet undertaken this online training. It was his opinion that officers should be provided with the nationally recognised two day training course written by the College of Policing, The course is available for all Police forces to be rolled out locally. This training had not been adopted by Sussex Police. There was also confusion amongst Officers (and a lack of clear understanding) around the provision and use of service the Haven at Millview could provide. ”

    Source location

    Jade Hutchings · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Publish and add a concise Section 136 detention and Blue Light Line guide to the Crewmate application for frontline officer reference.

    Verbatim wording from the response

    “We understand this observation to relate to the wider context of the ‘Blue Light Line’ (of which the Haven at Millview forms part), the telephone provision provided by Sussex Partnership NHS Foundation Trust for officers to use for consultation about mental health incidents, namely when they are considering using their powers under s136 of the Mental Health Act (1983).”

    Source location

    Response from Sussex Police 21.12
    Page 5 · response
    Published 19 December 2022

    Open published response
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Data last updated 7 September 2026