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The death of a mentally ill teenager after he drank excessive amounts of water may have been prevented if his care and treatment had been delivered differently, an investigation has found. The 18-year-old was admitted out of hours to an adult mental health service inpatient unit in a health board neighbouring his own on 5 December 2018 as there were no local beds available – a move described in the report as a “high-risk action”. On the evening of 7 December, he suffered a seizure after drinking too much water and was transferred to intensive care. He died three days later from the consequences of water intoxication. The teenager, referred to as Mr D, had previous contact with Child and Adolescent Mental Health Services (CAMHS), where he had been treated after drinking an excessive quantity of water. He was diagnosed with early onset psychosis and received two years of community-based CAMHS care. An anonymised investigation by the Mental Welfare Commission for Scotland concluded there were “aspects of the care and treatment delivered by each health board which had it been conducted differently, might have prevented Mr D’s death”. The report, which made 10 recommendations, also said: “A more assertive approach to the treatment of Mr D’s psychotic illness in the two years before his death was warranted.” Mr D’s death came almost two years after he was first admitted as an emergency to an acute general hospital in January 2017 following a seizure due to water intoxication, aged 16. The seizure was induced by drinking large quantities of water, which he believed would remove toxins from his system. This affected his sodium metabolism (blood salts) with near fatal consequences. He later spent more time as an inpatient and turned 18 while still under the care of the CAMHS specialist psychosis service. The transfer of a very unwell young man with a complex clinical history to another health board area during the night was a high-risk action Suzanne McGuinness, Mental Welfare Commission The service was moving away from a treatment model that supported young people with first onset psychosis for at least three years from the point of diagnosis, towards one in which transition to adult mental health services began around the age of 18. He was admitted to a hospital in Scotland in December 2018 while detained under the Mental Health Act. The investigation also found that during the 70 hours after that admission to hospital, Mr D’s case records from his years of contact with the CAMHS community team were unavailable. The report said: “The failure to impart key clinical details to the treating ward staff during his final admission, both in the provision of all relevant case files and the creation of an informed and updated risk assessment and care plan, meant Mr D was able to engage in risky and ultimately fatal psychosis-driven behaviour without mitigations having been put in place.” The report makes recommendations for change to bodies including the health boards involved, the Royal College of Psychiatrists, NHS Education Scotland and the Scottish Government. They include that the Government should set standards within the next six months for the safe transfer to, or management of patients who present from other health boards. Suzanne McGuinness, executive director for social work at the Mental Welfare Commission, said: “This was a tragic death of a young man while he was being cared for in hospital. “Our report details the actions and decisions taken by teams at the two health boards involved in the lead-up to his death.” She said the risks associated with psychotic illness were “not coherently managed”. She added: “We also found that there were problems in Mr D’s transition from child and adolescent mental health services to adult mental health services. Existing guidance was not adhered to. “We found that although the service had no other viable option, the transfer of a very unwell young man with a complex clinical history to another health board area during the night was a high-risk action. “Mr D’s family told us they felt that they had not been listened to. They felt their concerns were not given due credence.” She urged mental health services across Scotland to read the report and take action where they believe they can make improvements. A Scottish Government spokesperson said: “The death of any person in care is not acceptable. “It is vital that people using our mental health services feel safe and know they will receive the right help, in the right place when they need it. “The relevant health boards and health and social care partnerships in this case have been issued with specific recommendations and learning points alongside general recommendations for all health boards and HSCPs. We expect the commission’s recommendations to be fully implemented. “The Mental Welfare Commission recommended that the Scottish Government set standards for the safe transfer of patients between health boards. “We will publish core mental health standards in the coming weeks to set clear expectations for transitions between and within mental health services.” Read More More parents letting children skip school and take term-time holidays post-Covid Student accused of fatally shooting UNC professor may be mentally unfit for trial Family of man who died while being admitted to psychiatric hospital agrees to $8.5M settlement Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live

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Azerbaijan's president on Wednesday hailed the country's restoration to "full sovereignty" over the breakaway Nagorno-Karabakh region as ethnic Armenian forces agreed to lay down their weapons. Authorities in the Armenian region declared that the local defence force will disarm and withdraw all weaponry under a Russia-mediated ceasefire following the latest bout of fighting in the decades-long separatist conflict. President Ilham Aliyev in a televised address hailed his soldiers, while offering the ethnic Armenians of the Nagorno-Karabakh region prospects of cooperation, reconciliation and joint development. "In just one day, Azerbaijan fulfilled all the tasks set as part of local anti-terrorist measures" and "restored its sovereignty", the president said, adding he now wished to integrate Karabakh's population and turn the region into "paradise". He said Azerbaijan had nothing against Karabakh's Armenian people – "they are our citizens" – but only against their "criminal" separatist leadership. His words appeared aimed at addressing allegations by Armenian leaders that Baku planned to "ethnically cleanse" Karabakh's 120,000-strong Armenian population amid decades of mistrust between the two nations. The Azerbaijan army on Tuesday launched an "anti-terrorist" operation, unleashing an artillery barrage and drone attacks against outnumbered and undersupplied pro-Armenian forces. Nagorno-Karabakh human rights ombudsman Gegham Stepanyan said at least 200 people, including 10 civilians, were killed and more than 400 others were wounded in the fighting. He said earlier that children were among the dead and wounded. Russia and America condemned the “bloodshed” and called for an “immediate” end to hostilities between Azerbaijan and Armenians in the contested region. French president Emmanuel Macron spoke with Mr Aliyev and "condemned Azerbaijan's decision to use force ... at the risk of worsening the humanitarian crisis" and "compromising ongoing efforts to achieve a fair and lasting peace", his office said. Russian peacekeepers in a statement on Thursday said they have taken in about 5,000 Karabakh residents after evacuating them from dangerous areas. Thousands of Armenians also gathered at the airport of the regional capital, Stepanakert, in a bid to flee the conflict. Armenian prime minister Nikol Pashinyan in an address to the nation said the fighting decreased following the truce, emphasizing that Russian peacekeepers in Nagorno-Karabakh are fully responsible for its residents’ security. "If peacekeepers have proposed a peace deal, it means that they completely and without any reservations accepted the responsibility of ensuring the security of Nagorno-Karabakh Armenians, and provide the conditions and the rights for them to live on their land and in their homes safely," he said, according to the Associated Press. Mr Pashinyan, who has previously recognised Azerbaijan's sovereignty over Nagorno-Karabakh, said Armenia wouldn't be drawn into the fighting. He said his government didn't take part in negotiating the deal, but "has taken note" of the decision made by the region's separatist authorities. Protesters rallied in the Armenian capital of Yerevan for a second straight day Wednesday, blocking streets and demanding that authorities defend Armenians in Karabakh. Azerbaijan's move to reclaim control over Nagorno-Karabakh raised concerns that a full-scale war in the region could resume between the two nations, which have been locked in a struggle over Nagorno-Karabakh since a separatist war there ended in 1994. During another war that lasted for six weeks in 2020, Azerbaijan reclaimed broad swaths of Nagorno-Karabakh and adjacent territories that were held for decades by Armenian forces. More than 6,700 people died in the fighting, which ended with a Russian-brokered peace agreement. Moscow deployed about 2,000 peacekeeping troops to the region. Read More Ceasefire agreed after Azerbaijan unleashes military strikes in Nagorno-Karabakh Why new fighting in Azerbaijan's troubled region may herald a new war Nagorno-Karabakh: Fears of full-scale war as Azerbaijan launches attack on Armenian positions The Body in the Woods | An Independent TV Original Documentary The harrowing discovery at centre of The Independent’s new documentary