A YOUNG nurse who specialised in helping people with psychiatric problems took her own life after failings in her own care, an inquest heard.

Melody Vazquez, from Finchampstead, was found dead near Sand Martins Golf Club following a previous suicide attempt.

A coroner heard that the 23-year-old was sent home from hospital after receiving psychiatric help, without any plan to monitor her condition, or a nominated counsellor to check on her progress.

Heidi Connor, senior coroner for Berkshire, said she would write to the trust involved, after hearing how she had been failed by her own mental health colleagues.

Speaking outside the inquest at Reading Town Hall, her former boyfriend Adam Wilson slammed the trust for the lack of care she was given before her death from an overdose.

He said: "The opportunity to have averted this was with post discharge care. There was no discharge care, they were playing catch-up and expecting it to work.

"I think the way that the trust handles this sort of thing is primarily focused on absolving themselves from responsibility.

"She is dead and she should not be. What happened to her is really not unusual," said Mr Wilson, who met Ms Vazquez while also a patient at Prospect Park Hospital in Reading.

"There were five people I made friends with when I was in hospital. Four of them are now dead - Melody was the fourth."

Earlier the coroner had heard how the body was found by a passerby on April 12 this year in a field near a golf course.

A police officer who attended the scene told the inquest her mother had reported her missing at midnight on the same day.

The coroner heard that officers found a letter in a bag near her body and it was later discovered she had earlier posted on Instagram, stating her intentions.

The medical cause of death was established as drug toxicity and the coroner drew attention to a toxicology report, which listed a fatal cocktail of drugs.

The coroner criticised the trust for the way it had handled post-discharge care, saying: "It is clear to me from the evidence that there was increasing concern about Melody, to the extent that Kay Longworth [a psychotherapist] asked the crisis team to speak to her on the April 11."

Giving evidence, Ms Longworth said that call was never made because a member of the crisis team had failed to log Melody's name. The coroner said: "So, it wasn't that the crisis team was too busy or under-staffed, they just didn't note down which patient it was? Is it as simple as that?"

Ms Longworth said time pressures at the crisis team were common but the coroner said: "The bottom line is that this person had the time to take the call but never wrote it down. So it seems slightly more than being too busy."

Ms Longworth said the trust had since taken action to better log such calls and told the inquest: "There is now a centrally located referral access point within the shared drive for people to access."

The care co-ordinator was on sick leave during the month after she was discharged in January and the inquest heard Ms Vazquez was given no other care co-ordinator because she was not deemed to be at risk.

On March 22, concerns were brought to the attention of Dr Banu Isik-Canpolat, a consultant psychiatrist who went to see her.

Although she discussed thoughts about suicide in that meeting she was not deemed to be a risk.

She had initially been admitted to hospital on October 24 after she had attempted to take her own life.

Ms Connor added: "She was seeing signs that affirmed her belief she needed to end her life to bring peace to the world. She insisted she attempted to end her life to save mankind from their sins.

"It does not necessarily follow that one further appointment or one further phone call would have changed the outcome. However, I intend to write to the trust to ask for further information about this, to ask if the trust has a plan in place for this kind of scenario.

"The fact that she's carried out this act in a secluded place where she was unlikely to be observed leads me to a conclusion of suicide.

"The current standard of proof is on the balance of probabilities. If the standard were beyond reasonable doubt, I would still make the same ruling."

A memory giving page has been set up following Ms Vazquez's death, which includes tributes and the opportunity to donate.

For confidential support in the UK, call the Samaritans on 116123, email jo@samaritans.org or visit a local Samaritans branch. See samaritans.org for more details.