'Incredible, kind' woman, 27, was 'excited for future' before she accidentally took her own life
Emily Miller, 27, was found at her home on Clyde Road in Didsbury on October 23, 2023.
Known as Ems or Emmie to her family, the court heard she had been diagnosed with Emotionally Unstable Personality Disorder (EUPD) and often struggled with fluctuating moods and self-harm.
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A mental health practitioner herself, she had been in the care of a home-based treatment team from Greater Manchester Mental Health, who were represented at the inquest by Nicola Flood.
At Manchester Coroner's Court, Emily's sister Jessica described her as 'magnificent', 'vibrant' with a 'calming aura' that made her 'great at her job'.
She and her family raised concerns there had been failings in her care under the Greater Manchester Mental Health Trust.
But area coroner Zak Golombeck concluded today (May 21) that it had been 'appropriate and reasonable', with 'no clinical reason to escalate her care' in the days before her death.
Giving evidence on Tuesday (May 20), consultant psychiatrist Dr Faisal Farid said he was aware Emily had been self-harming most days. But he added that she described it as a method of 'control' and 'managing her stress' and was not intended to end her life.
Dr Farid told the court she had previously been admitted to hospital twice for short inpatient stays, but these were described as 'detrimental' to her progress.
He added she was offered a voluntary inpatient stay on October 16 - a week before her death - but she refused and continued to be seen by the home-based treatment team (HBTT) until her death.
The court heard she had been placed in the 'red zone', meaning her care was reviewed on a daily basis and she had contact with professionals most days.
On the day she died, Dr Farid told the court Emily had requested to be 'stepped down' from the HBTT because she felt she was 'taking up other people's time'.
'It wasn't because she felt the treatment wasn't working or wasn't helping her,' he said. 'It was about being stepped down, not discharged. We were monitoring her risk and her engagement with services.'
He added Emily had been 'making an effort' and 'engaging' with the team prior to her death.
He said the 'ambivalence' she showed at times towards her own life and the fluctuations in feelings about her treatment was 'typical' of the emotional dysregulation experienced by someone with EUPD.
The court then heard evidence from Lucy Swanson, a mental health practitioner and social worker, who carried out Emily's last formal risk assessment before her death, on October 10 - it followed her learning Emily had purchased items with which she would be able to self harm.
In the assessment, she noted Emily 'denied any plans or intent to end her life tonight' but 'remained consistent in stating she wants to die'. The court heard Emily was assessed as at moderate risk of self-harm and suicide but high risk of accidental injury.
Ms Swanson told the court she had a 'good therapeutic relationship' with Emily and had been 'surprised' and 'upset' to learn of her death.
Nicola Conoma, another mental health practitioner who worked closely with Emily told the inquest she had also been 'shocked' and 'devastated' by her death. She said she last saw her in person at her home on October 14, when Emily told her then she had not self-harmed in 'a couple of days'.
Ms Conoma said Emily had talked about plans for the future. "Her sister's birthday, her brother's wedding, their plans to go and see Taylor Swift in concert - lots of things.
"There were times when she was hopeful for the future. She had a place at uni for the following year. I think it was her wish to be alive."
Michelle Brown, counsel for the Miller family, contended that the purchase of a items intended for self-harm represented an 'escalation' of the risk - and that by October 19 Emily had been self-harming 'daily'.
"Would these facts together not lend themselves to a different approach?" asked Ms Brown.
"We did offer hospital admission, but she was quite clear she did not want to go into hospital. I did not feel use of the Mental Health Act would be appropriate," Ms Conoma replied.
Emily's sister Jessica read a statement to the court, describing her sister in a voice thick with emotion and at points choked with tears.
'I don't know how to find the words to get across the true essence of Ems or how much I absolutely adore her,' she said. 'I want her to be more than a name, more than a statistic, because although her ending was so tragic, she was not.
'When someone dies by mental health, they're defined by their death. But she was and is so much more than that.'
'I love my baby sis with every fibre of my being and I will never forgive myself for not doing my job as her big sister & protecting her.'
'Em touched so many hearts, I miss laughing with her, I miss sitting in her presence, I crave it all the time. I miss our 4 hour long phone calls, our walks, our long voice notes, our little adventures – everything about her.
'As beautiful as the thought is that she's always with me, it doesn't bring me comfort yet because she should be here."
She added: 'Please look at her and know that she was the most incredible, kind, beautiful [person]. Her body may not be here anymore but her soul is in every person she ever loved.
'I'll never find the words to describe how heart wrenching this loss is, how part of me died that day too. She's taken part of my soul with her but that's okay, she can keep it until I get there.'
The coroner confirmed that the medical cause of death was found to be hanging. He summed up the progress of Emily's treatment, including the multiple offers of hospitalisation which she repeatedly declined.
He confirmed that on October 19 there was a meeting concerning Emily's treatment plan. She would remain in the red zone and there was a plan for a transition to the Community Mental Health Team 'in a safe manner' from home-based treatment.
'Emily continued to self-harm on a daily basis,' Mr Golombeck said of this time. 'There was no meaningful escalation in her risk. She was not detainable.'
'On the 23rd there was another offer of voluntary admission but this did not mean that involuntary admission was the next step.'
'I find that the care was appropriate and reasonable. There was no clinical reason to escalate her care.'
The coroner reached a short form conclusion of misadventure – accidental death caused by a risk taken voluntarily – rather than suicide. 'I am not satisfied on the balance of probability that she intended to take her own life,' he said.
"There was a lack of expression of intent, there being note or communication to her family; and there was some evidence of her future planning.
'I find she did not intend to cause her own death. Her death arose from a deliberate human act, with some knowledge of the risks involved, which unexpectedly went wrong.'
The M.E.N has approached GMMH for comment.
At Emily's funeral the Miller family requested donations to Bags For Strife, a charity supporting families those bereaved by suicide. You can find their website here.
Emily's sister Jessica will also be taking part in the Baton of Hope in London this autumn, a nation-wide relay raising awareness for suicide prevention.
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Whatever you are going through, you don't have to face it alone. Call Samaritans for free on 116 123, email jo@samaritans.org or visit www.samaritans.org for more information
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