PFD report

Stephen Kurt Beadman · Prevention of Future Deaths report

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Issued 23 Jun 2023•West Yorkshire Eastern

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

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Concerns
3

Raised in this report

Recipients
3

Named on the report

Responses found
0

Of 3 recipients

Stated actions
0

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

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Concerns raised3

  1. Failure to restrict access to potentially harmful male-grooming equipment for prisoners with an identified history of self-harming
    Part of recurring concern: Inadequate control of access to means of self-harm
  2. Insufficient specialist psychiatric care for prisoners
    Part of recurring concern: Insufficient mental health service capacity for timely patient carePart of recurring concern: Unreliable access to specialist mental health treatment for serious mental illness
  3. Failure to withdraw potentially harmful male-grooming equipment from use in the prison
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

No linked response statements

No respondent-stated action or position is clearly linked to these concerns.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to restrict access to potentially harmful male-grooming equipment for prisoners with an identified history of self-harming

Wider context from the report

“1) Mr Beadman had a history of self-harming ████████. Nonetheless, he was permitted ████████ in his possession when alone in his cell. 2) For the avoidance of doubt, Mr Beadman took his own life later in the afternoon of 7th April 2021 by applying a ligature to his neck, ████████ to take his own life. 3) The issue of ████████ gives rise to a foreseeable risk. 4) Only six weeks before the 7th April 2021 incident, another prisoner, Carl Shaun Langdell had used a similar type of ████████ to inflict a fatal wound to his neck. A Prevention of Future Death Report dated 21.10.22 was made in that case. A copy is attached, along with the response received from ████████ dated 23.12.22. 5) Evidence was taken at the Inquest in which several people working at the prison expressed support for such ████████ to be withdrawn from use in the prison. 6) It is acknowledged that consideration has been given within the prison service nationally to the withdrawal of ████████ of this type and that this work (including various pilot projects) is ongoing. It is further acknowledged that the difficulties in identifying a workable alternative system of male grooming are considerable. This does not, however, obviate the need to remove a clear source of potential harm from those with an identified history of self-harming. ”

Is this part of a recurring concern?

Yes — Inadequate control of access to means of self-harm.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Insufficient specialist psychiatric care for prisoners

Wider context from the report

“2) Despite this complex cohort of prisoners, the prison only has one day per week of consultant psychiatrist resource. As the professed principle is equivalence of care with the community, this seems not to be achieved, particularly having regard to the psychological make up of the prisoner population. 3) Evidence taken at the Inquest indicated that further senior psychiatric doctor resource would enable the prison to provide better for the needs of the prisoners. 4) For the avoidance of doubt, it is accepted that Mr Beadman himself was able to see the consultant psychiatrist on 19th October 2021 for 1 hour and again on 25th January 2021 (at which time he was discharged). Notwithstanding that his death on 8th April 2021 cannot be attributed to a lack of psychiatric attention, there is a concern that other long-term inmates in the prison are not receiving the specialist care they probably need. This in turn gives rise to a concern that other deaths may occur. ”

Is this part of a recurring concern?

Yes — Insufficient mental health service capacity for timely patient care; Unreliable access to specialist mental health treatment for serious mental illness.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to withdraw potentially harmful male-grooming equipment from use in the prison

Wider context from the report

“1) Mr Beadman had a history of self-harming ████████. Nonetheless, he was permitted ████████ in his possession when alone in his cell. 2) For the avoidance of doubt, Mr Beadman took his own life later in the afternoon of 7th April 2021 by applying a ligature to his neck, ████████ to take his own life. 3) The issue of ████████ gives rise to a foreseeable risk. 4) Only six weeks before the 7th April 2021 incident, another prisoner, Carl Shaun Langdell had used a similar type of ████████ to inflict a fatal wound to his neck. A Prevention of Future Death Report dated 21.10.22 was made in that case. A copy is attached, along with the response received from ████████ dated 23.12.22. 5) Evidence was taken at the Inquest in which several people working at the prison expressed support for such ████████ to be withdrawn from use in the prison. 6) It is acknowledged that consideration has been given within the prison service nationally to the withdrawal of ████████ of this type and that this work (including various pilot projects) is ongoing. It is further acknowledged that the difficulties in identifying a workable alternative system of male grooming are considerable. This does not, however, obviate the need to remove a clear source of potential harm from those with an identified history of self-harming. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026