An Oxford graduate suffering with a mental health crisis went on to kill herself after a nurse sent her alone in a taxi to an assessment centre.
Georgina Hodson, 27, took her own life last April a day after she had been taken in an ambulance to St Thomas' Hospital in South London, where she was seen by psychiatric nurse Ifeoma Onuorah.
Under guidance, she put Ms Hodson in an unescorted taxi to the Mental Health Crisis Assessment Service (MHCAS) at St Charles Hospital in Kensington.
But rather than complete the journey, the 'exceptionally bright' woman diverted the taxi and instead went back to her flat in Victoria, where she ended her life.
Inner West London coroner's court heard the nurse considered the mental health facility, run by the Central and North West London NHS Foundation Trust (CNWL), to be the best treatment.
But Ms Onuorah failed to confirm with the team there that Ms Hodson would be arriving. She said she had been led to believe that MHCAS had been told about Ms Hodson being on her way.
An emotional Ms Onuorah told the inquest: 'I'm really sorry. In hindsight, I should have told MHCAS myself, and I should have arranged for her to have an escort or for her to go in an ambulance.'
Ms Hodson's family have condemned the nurse's actions as 'reprehensible' and 'very lackadaisical'.
Georgina Hodson, 27, was suffering with a mental health crisis and went on to kill herself after a nurse sent her alone in a taxi to an assessment centre
Her parents feared the worst when Ms Hodson, pictured with her mother Kate Grimwade-Hodson, didn't return their calls
Her mother, Kate Grimwade-Hodson, said: 'Georgie hated MHCAS. I spoke to her on the phone when she was in the hospital, and she said she wasn't going.
'Then she stopped answering my calls. If I had known, I would have got on a train and seen her.'
Ms Hodson had told Ms Onuorah that she did not have plans to kill herself but the nurse still had her concerns, so, rather than discharge her, she arranged for MHCAS to see her and arranged the taxi.
The court heard that MHCAS had heard from the hospital that Ms Hodson was with them, but received no further updates and had not been told that she was on her way.
She had been described as being 'ambivalent' about going but had been persuaded by Ms Onuorah.
Steven Badger, the general manager for the South London and Maudsley NHS Foundation Trust (SLaM) told the inquest that Ms Hodson should not have been sent off in the taxi without the destination hospital being told.
He said: 'There wasn't a follow up call, that was the key thing that was missed.
'Someone should have checked with the receiving team. The assumption that they knew she was coming was risky.'
Ms Hodson's sister, Becky Garnett-Buchma, said that her sister's treatment had been 'very lackadaisical'.
She added: 'I work in mental health, and if someone who worked for me behaved like that, they wouldn't be working for me any longer, they'd be up for a disciplinary and a referral.'
Her father, Nick Hodson, said: 'If the staff aren't doing their job properly, then another family will have to go through what we've gone through. It is absolutely reprehensible.'
He added: 'They knew Georgie...was liable to abscond, they should have at least put her in transport provided by the hospital.'
Mr Hodson called police to express how worried he was about his daughter that night.
When officers Joe Hedges and Gareth Baker attended the basement flat, they were unable to get an answer but, having heard the sound of running water coming from the property, thought she was in the shower.
When they tried again 15 minutes later, they were able to enter and found Ms Hodson lying on the floor.
An ambulance arrived and she was given CPR, but she was pronounced dead in the early hours of April 11.
A toxicology report found that Ms Hodson had taken an overdose.
Coroner Sophie Mortimer ruled her death a suicide.
Rather than complete the journey, the 'exceptionally bright' woman diverted the taxi and instead went back to her flat in Victoria, London, where she ended her life (pictured with her mother)
She also found that the psychiatric liaison team at St Thomas' should have been aware that Ms Hodson had suffered from longstanding mental ill health, that she had expressed a desire and a plan to take her own life, and that those things, coupled with a failure to either confirm with MHCAS that she was on her way or to send an escort with her or send her in hospital transport, played some part in her death.
However, she said that both the SLaM and CNWL had changed how they operated since the death, so would not be making a Prevention of Future Deaths report.
She said to the family: 'I would like to offer my sincere condolences. This has been a very difficult time for you.'
The inquest heard that Ms Hodson was born in Hunan Province, China, before being adopted at the age of 20 months by the Hodsons, who live in Chester, Cheshire.
Ms Hodson got top grades in her A-levels at King's School, Chester, and had been accepted to Girton College, Cambridge, but had not found it to her liking and had taken a year out before applying to Worcester College, Oxford, where she read philosophy and theology.
Her mother said: 'She had a wonderful sense of humour and an infectious smile. Georgie loved to play tennis, run and play piano.
'She loved her time at Worcester College and made lifelong friends there.'
She added: 'She was kind and compassionate and we miss her.'
However, the youngster suffered from anxiety at secondary school and her mental health took a turn for the worse during the Covid-19 pandemic.
She had what her father described as a 'mental health crisis'. She had also been diagnosed with autism and anxiety.
She had been working with young people to help them with their applications for Russell Group universities, but had changed direction and started working for North London NHS Foundation Trust as an associate mental health worker on a part-time basis.
She was also a patient representative for the Royal College of Psychiatrists.
The inquest heard that she was worried about being evicted from her home due to non-payment of rent and that she thought she would never marry, have children or find a full-time job.
- For confidential support, call Samaritans on 116 123, visit samaritans.org or visit https://www.thecalmzone.net/get-support
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