Lee Spencer PURKIS · Prevention of Future Deaths report

On 14 March 2023 I commenced an investigation into the death of Lee Spencer PURKIS aged 54. The investigation concluded at the end of the inquest on 25 June 2024. The conclusion of the inquest was that:

Lee Purkis was aged 54 at the time of his death. He was found in a state of advanced decomposition on the floor of his home on 9 March 2023, having been there for up to two months. The cause is unascertainable; he not been seen since 6.1.23.

Lee Purkis was aged 54 at the time of his death. He was found in a state of advanced decomposition on the floor of his home on 9 March 2023, having been there for up to two months. The cause is unascertainable; he not been seen since 6.1.23.

My concern here is that Lee Purkis had been, in the period leading up to his death, the subject of a mental health treatment requirement (MHTR) imposed by the Crown Court as part of a community order, but the Trust that ended up treating him were not aware of it, and discharged him from its care without learning about it. There is no evidence that it made any difference in this case but that is because of the particular (and unfortunate) circumstances of how long it took to find Mr Purkis and the corresponding absence of evidence about how he died. There is, however, a real risk that it might make a difference in another case. This order was handed down by a sympathetic Crown Court judge, supported by probation in the pre-sentence report, and it seems to have been a potentially creative solution for a complex man. The use of MHTRs is, it seems to me on the evidence, to be encouraged, but that objective will be undermined if they are not understood and administered properly and so people don’t see them working. In Mr Purkis’s case, the particular problem appears to have occurred because the Trust that agreed the order (a requirement of it being imposed in the first place) then transferred the care because the accommodation area changed. That is not unusual, but the relevant Trust then failed to transfer or inform the receiving Trust of the fact of the MHTR and what it required. This means that it was, of course, a Trust error, but I am sending this report to probation because the evidence suggests that it is probation that should have oversight, and it should be ensuring all involved in the administration of the requirement are aware of it. I therefore consider there is a risk associated with these circumstances, and that action should be taken, such as ensuring that probation officers keep an eye on MHTRs when they have them, and ensure the other services do so too. There are not many of them; there probably should be more; but again, that means ensuring the ones that there are get used properly.