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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

With several UK-grown courgette varieties now at their most abundant, we wanted to share some of our favourite at-home recipes for dishing up the best of this season’s courgette harvest. Best enjoyed between the months of June and October, courgettes are the perfect vehicle for taking your cooking from summer into autumn. A versatile yet budget-friendly staple, they are equally delicious served raw, fried, roasted or even in cake. So, from comforting courgette fritto, courtesy of Brighton’s Tutto, to Acme Fire Cult’s grilled trombetta courgettes (elevated with the addition of a vadouvan butter) there’s something for everyone. Courgette fritto Recipe from: Tutto ,Brighton Ingredients: 6 large green courgettes Squeezy honey Grated pecorino Fresh rosemary Lemon wedges Salt and pepper Extra flour for dusting For the batter: 200g gluten-free self-raising flour 320g water 2g ground cumin 2g onion powder 2g salt Equipment: Deep fryer (or deep frying pan and a thermometer) Method: Using a bowl and whisk, mix all the dry ingredients for the batter. To prevent lumps, add half the water to create a smooth slurry, then add the rest and whisk to an even consistency. Slice the courgettes at an angle into long discs approximately 3-5mm thick. Set the deep fryer to 180C. Dust the courgettes lightly with some extra gluten-free flour and shake off the excess. Submerge in the batter, drip off the excess, and gently fry for 45 seconds on each side. Once golden brown, drain onto paper towel. To finish, arrange onto a plate, drizzle with honey and season with salt and pepper, sprinkle with grated pecorino and chopped fresh rosemary. Serve with a lemon wedge. Grilled trombetta courgettes with vadouvan butter Recipe from: Daniel Watkins, chef and co-founder at Acme Fire Cult, London Serves: 4 Ingredients: For the courgettes: 4 trombetta courgettes For the vadouvan butter (makes a portion for 8; freeze half): 400g dairy-free butter 220g shallots 11g madras curry powder 11g turmeric 6g each of the following: Fennel seeds Cumin seeds Salt Cardamom Black Peppercorns Mustard seeds Red chilli, finely diced 3 garlic cloves, minced Peel of 1 orange 2 inch ginger finely chopped For the chickpea purée: 800g tinned chickpeas 5 tbsp olive oil 2 bay leaves 1 tsp thyme leaves Juice of half a lemon Confit garlic (optional) For the tofu whip: 1 pack silken tofu Juice of 1 lemon Salt Method: For the trombetta courgettes: Simply wash and cut down into the desired portion size. Add a little olive oil and seasoning. Grill all sides until they start to soften, depending on temperature of fire. Trombettas lend themselves really well to live flames. For the vadouvan butter: Sweat down shallots and all the other ingredients, cook out slowly (without colour) for approximately 2-3 hours. Take off the heat and let it stand for 30 minutes. Once the mix has cooled a little, place the mix in a high speed blender until smooth. Taste, check the seasoning and add a little salt. This can be frozen and makes for a great accompaniment for most vegetables but particularly works well with the courgettes. For the chickpea purée: Boil the chickpeas in a pan of water with the bay leaves and thyme (approximately 30 mins). Drain the chickpeas, keeping back 2 tablespoons of the cooking water and discard the bay leaves. In a blender, purée the beans to a soft cream with the reserved cooking liquid and the olive oil, then squeeze in the lemon and salt to taste. At this stage, add more lemon juice, olive oil or confit garlic, if you like. For the tofu whip: Blend all ingredients in Thermomix, until smooth and cream-like. Store in a squeezy bottle. To finish: On a plate, take a generous amount of chickpea puree on to the center of the plate, place the grilled courgettes in the center. Spoon over generous amount of butter. To finish, add some tofu whip or creme fraiche. Whole roasted courgette with manouri cheese, tabbouleh and basil sauce Recipe by: Fionnan Flood, head chef at The Chelsea Pig, London Serves: 2 Ingredients: 1 yellow courgette 100g freekeh (cracked wheat) 1 plum tomato 50g Manouri cheese (a Greek cheese that’s creamier than feta) 1 bunch basil 20g confit garlic 5g capers Olive oil Chives Parsley Lemon juice and zest Micro basil (for garnish) Method Top and tail your courgette then finely crosshatch score the inside flesh before putting aside. Boil (blanch) the freekeh in heavily salted water until tender and leave aside to cool down – ideally spread out onto a tray to speed the cooling process. Finely chop the chives and parsley, and also finely dice the flesh from the tomato (leaving aside the seeds). Make your basil sauce by blitzing in a food processor: basil, olive oil, confit garlic and capers – blending until smooth then adjusting the seasoning to taste. Now, assemble the tabbouleh – mixing the freekeh, chopped herbs and tomatoes. Next, add lemon juice and zest to taste, alongside seasoning (salt and pepper). In a frying pan on medium heat, place your courgette flesh side down, and colour it until golden brown. Place the pan in the oven for about 5 minutes at 180C until cooked through. For plating: place the basil sauce on the bottom on the dish (feel free to express yourself here), then add a few piles of tabbouleh around then place your courgette on top. Crumble some manouri cheese over, and add your micro basil (optional for garnish/presentation) . Read More How to cook to keep your gut healthy Leave Rick Stein alone – it’s totally reasonable to charge £2 for mayo and ketchup After Le Gavroche, Michel Roux is taking his cooking back to basics Three recipes from Michel Roux’s new fuss-free French cookbook London’s best new restaurants from the past 12 months The dish that defines me: Michele Pascarella’s Neapolitan ragu

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If you are bored with day-in, day-out sports like basketball or swimming or volleyball, then check out the Asian Games when they open in Hangzhou, China