The Inquiry’s Approach to taking evidence from Core Participants with lived experience of mental health inpatient services in Essex

Introduction 

1. This Framework sets out the Inquiry’s approach to requests for evidence under Rule 9 of the Inquiry Rules 2006 from Core Participants with lived experience of mental health inpatient services in Essex during the relevant period. It has been developed in conjunction with the Inquiry’s Chief Psychologist.
2. The Framework has been updated following the Inquiry’s careful consideration of comments on it in draft form received from Core Participants and their Recognised Legal Representatives (RLRs).
3. The key proposed steps are set out in a flowchart that can be found at Annex A.
4. The Framework should be read alongside the Inquiry’s Protocol on Vulnerable Witnesses here and the Inquiry’s Protocol on Restriction Orders, Redactions, Anonymity and Special Measures here. Objective
5. The aim of this Framework is to establish a structured yet flexible and supportive process for gathering evidence from this group of Core Participants, ensuring that each Core Participant is assisted by the Inquiry to give their evidence as safely and as comfortably as possible, minimising distress or trauma as far as is possible and ensuring that each Core Participant has access to support that is tailored to their individual needs.
6. For that reason, arrangements for the provision of written and/or oral evidence by this group of Core Participants will be made in collaboration with each Core Participant and their RLR following receipt of the Inquiry’s pre-statement questionnaire and any subsequent liaison with the Inquiry in relation to any vulnerabilities, special measures or adjustments.

Key Principles

7. The Chair places substantial value on hearing evidence from those who have experienced mental health inpatient care from services in Essex during the relevant period. Those who are prepared to contribute that evidence to the Inquiry are to be commended for their courage and resilience in coming forward to assist. Their evidence will be of considerable benefit in informing the Inquiry’s investigations into the deaths of inpatients under the care of NHS Trusts in Essex during the relevant period. Evidence from those with lived experience may also assist the Chair in making recommendations for the provision of mental health inpatient care. 
8. The Chair recognises that those providing evidence of their experiences of mental health inpatient care may be vulnerable. Individuals will be asked to provide evidence which is personal and sensitive in nature and they may find that recounting those experiences causes them to experience distress. The Chair does not wish to exacerbate trauma or distress. The Chair also recognises that there may be individuals within this group of Core Participants who do not currently consider themselves to be vulnerable or to have any relevant diagnosis. The Chair recognises that engagement with it may nonetheless result in some individuals with historic vulnerabilities experiencing distress as a result of triggering their past trauma. 
9. For that reason, it is important that comprehensive steps are taken, in line with the Inquiry’s Vulnerable Witness and other relevant protocols, to identify any needs, concerns or vulnerabilities of those with lived experience on an individual and, where needed, ongoing basis. The Inquiry can then work with each Core Participant and their legal representative to put in place any adjustments that are reasonable and appropriate when a vulnerability/individual need is identified. The Inquiry recognises that further assessments of vulnerability may be needed, and that any adjustments may need to alter and adapt to each individual at different stages of their engagement with the Inquiry and in the process of providing evidence.
10. The process set out in this Framework recognises the importance of choice and of allowing each Core Participant to decide, with appropriate support, how they wish to provide their statement in the way that would suit each of them best.

Inquiry Support

11. The Inquiry provides a dedicated independent emotional support service for those engaging with us. This service is managed by the Inquiry’s Chief Psychologist and is delivered by Hestia, an experienced provider of emotional support.
12. The focus of this emotional support is to offer a safe space for individuals to express any concerns or emotions related to the Inquiry. It also includes a range of techniques and strategies to help manage difficult emotions and memories, as well as personal strategies to maintain individual wellbeing.
13. Emotional support is intended to assist individuals during their engagement with the Inquiry and is not an offer of long-term counselling. The Inquiry encourages anyone who requires ongoing support for mental health or wellbeing concerns to speak to their GP.

Anonymity

14. The Inquiry published a Note here in July 2024 explaining the Chair’s decision to exercise her discretion under section 19 of the Inquiries Act 2005 to anonymise all those with lived experience who are engaging with the Inquiry. This means that all Core Participants with lived experience will be provided with a cipher. They will be referred to by this cipher in their engagement with the Inquiry and in any documents which are published. All ciphers for individuals with lived experience start with the letter “X”.
15. The Chair is aware of the highly sensitive nature of the evidence which is to be provided by those Core Participants. All evidence submitted by Core Participants with lived experience to the Inquiry will be read and carefully considered by the Inquiry. The use of a cipher in no way reduces the impact or importance of the evidence provided to the Chair. 
16. There are a number of ways in which ciphered individuals can provide oral evidence to the Inquiry, should they wish to do so, while ensuring that their identity is protected.  Those include, for example, giving evidence during a private session, or at a hearing where public attendance is restricted, or in pre-recorded evidence to be viewed by the Chair. Where a Core Participant from this group does decide that they wish to provide oral evidence, the Inquiry will work collaboratively with the individual and their RLR to ensure that any arrangements are tailored to suit the needs of the Core Participant as far as is possible.  

Safeguarding

17. The Inquiry takes very seriously its safeguarding responsibilities to ensure the welfare and safety of those we engage with. It is important for individuals engaging with the Inquiry about their lived experience to understand how information may be shared if a safeguarding concern arises.
18. If we identify a risk, we may need to take action to address it. While the Inquiry will always aim to seek the consent of those involved before making any safeguarding referrals, there may be situations where we are required to share information without the consent of the individual(s) involved. This would include if:
    • we identified a risk of significant harm to a child;
    • we identified a risk of significant harm to an adult;
    • we identified a risk relating to a serious crime; or
    • we were ordered by a court of law or required by some other legal reason.
19. In such cases, we would need to share information about this risk to the relevant authority, such as the police or the local authority. In some cases, the information we share may include details that identify the individual we are engaging with. Unless it would place the individual engaging with us, or anyone else, at risk, the Inquiry team will inform the individual about the information we are sharing, to whom we are sharing it with, and why.
20. Please note, there may be instances where a safeguarding concern related to patient safety arises, in which case the Inquiry may need to make safeguarding referrals to Essex Partnership University NHS Foundation Trust (EPUT). In such cases, the Inquiry will involve the Integrated Care Board (ICB) to provide oversight of the process.

Pre-Statement Questionnaire

21. Prior to seeking a statement from any Core Participant with lived experience of mental health inpatient services in Essex during the relevant period, each Core Participant will be sent, via their RLR, a questionnaire. The questionnaire has been designed in consultation with the Inquiry’s Chief Psychologist. The purpose of the questionnaire is: 
    
    1. to allow each Core Participant the opportunity to raise any particular vulnerabilities or needs they may have;
    2. to address and acknowledge any vulnerabilities previously identified;
    3. to help the Inquiry to assess if a person may be vulnerable;
    4. to offer each Core Participant the opportunity to engage in a more detailed assessment with the an independent psychologist;
    5. if a vulnerability is identified, to enable the Inquiry to work with Core Participants and their RLRs to identify what individual approaches or additional measures may be required, in accordance with the Inquiry’s Vulnerable Witness Protocol, to assist each Core Participant in providing their evidence to the Inquiry;
    6. to establish logistical preferences for the Core Participant engaging with the process, tailored to the individual needs of each. 
22. The proposed questionnaire can be found at Annex B to this Framework. As well as some basic information about where and when each Core Participant received mental health inpatient care, it covers communication needs and reasonable adjustments that may be needed. In addition, the questionnaire will ask Core Participants to decide, with advice and support from their RLR, how they would prefer to respond to provide evidence to the Inquiry. 

The options for providing evidence

23. The Inquiry intends to take a flexible approach to obtaining evidence from this group of Core Participants. In all cases where the individual wishes to provide evidence, the Inquiry intends to provide a written Rule 9 request for evidence.
24. Thereafter, there are four options for the Core Participant’s preferred method for giving a written statement: 
    1. By providing a written statement in answer to the written Rule 9 request from the Inquiry. The Rule 9 request will set out the areas on which evidence is requested and invite the individual to provide a response in the form of a written statement. 
    2. In a session or number of sessions with a member of the Inquiry Legal Team (in person or remotely), supported by the Core Participant’s RLR (this is known as a “proofing session”). Through this proofing session, the individual will provide information about their experiences and respond to questions.
       This will help the Inquiry Legal team to draft a statement for the individual, based on the information which they have provided. 
    3. By receiving a written Rule 9 request to review and begin to formulate answers, followed by (a) shorter session(s) with a member of the Inquiry team (in person or remotely), supported by the Core Participant’s RLR to finalise a written statement.
    4. If any witness is unable to produce a written statement, they can provide an account by way of a recorded interview with a member of the Inquiry Legal Team, supported by the Core Participant’s RLR. 

Proofing sessions

25. If a proofing session is the preferred option, the statement-taking team would be made up of members of the Inquiry Legal Team, with the core Participant’s RLR present to assist, advise and support. A Member of the Inquiry’s Emotional Support Team can also be present if requested. 
26. It is anticipated that no more than two proofing sessions/interviews should be required per witness, but this could increase depending on the individual needs of each Core Participant. The time and date for those sessions would be arranged with each Core Participant and their RLR. It is expected that the sessions would take place over a period of approximately two weeks. However, a longer period may be applied if a witness needs support after their initial session and before continuing with another, or if a longer period of time is needed for any other reason to assist the witness to give their best evidence.

Format of Statements 

27. Statements for those with lived experience will be drafted as formal witness statements. Once prepared as a final draft, they will be provided to the witness and their RLR to check for any issues, errors or matters which they wish to amend. Sufficient time for this to be undertaken will be factored into the process.

Documents 

28. The Inquiry is currently gathering evidence from those affected by the issues which it is investigating. As part of that process, the Chair has asked that those with lived experience share their concerns around inpatient treatment and any views as to recommendations to improve care in the future. If there are any documents held by those with lived experience which may be relevant to the Inquiry’s investigations into inpatient deaths, then we ask that those with lived experience let the Inquiry know. There is no need at this stage to provide any documents to the Inquiry (including medical records). Once the statement has been completed (or a recorded interview has been submitted), the Inquiry will be in touch, should any documents be required. 

For Annex A and Annex B please refer to the document below.