Prisoner 'misdiagnosed' before fatal fire

A woman's mental health issues were misdiagnosed before she died in a prison cell fire, an inquest was told.

Clare Dupree, 48, from Cardiff, died on 28 December 2022, at Southmead Hospital in Bristol, two days after a vaping device caught fire in her cell at HMP Eastwood Park.

An independent consultant forensic psychiatrist, Dr Inti Qurashi, told the inquest at Avon Coroner's Court that Dupree should have been admitted to hospital in August 2022, but instead she was left homeless.

Qurashi said Dupree had been misdiagnosed as having a personality disorder, but Qurashi believes she actually had bipolar.

Towards the end of Dupree's first period in custody at Eastwood Park between 11 May and 10 August, she was referred to a psychiatric intensive care unit over concerns about her mental health.

But a psychiatrist deemed she did not meet the threshold to go into hospital, so she was instead discharged into the community, where she had nowhere to live.

"If her mental illness had been properly treated, her risk behaviours would have been reduced, my view is that she wouldn't have ended up in prison," the expert witness told the inquest.

"Her contact with the police was driven by her paranoid beliefs about the people around her.

"She was sent out homeless into the community, which increased her likelihood of her coming into contact with the police and being put back into prison," the witness said.

During contact with the community mental health team in September, Dupree reported she had tried to kill herself, that her family had been raped and murdered, and she was hearing them screaming and begging for help.

"I was surprised that she hadn't been referred for a consultant psychiatric review while she was in the community to see if she needed an inpatient admission," Qurashi said.

Dupree was later sent back to prison in November after threatening a security guard with a knife when he caught her trying to steal a pregnancy test.

Concerns were immediately raised about her psychotic symptoms when she went into prison, but taking antipsychotic medication meant her mental health was improving by the time a fire broke out in her cell on Boxing Day.

The expert witness also said that Dupree had been misdiagnosed with a personality disorder. In 2013, her previous diagnosis of bipolar was revised to one of emotionally unstable personality disorder.

"They are mis-attributing her symptoms of mental illness to a personality disorder," the expert said.

"This is a clear example of diagnostic foreshadowing. Clinicians are simply accepting the diagnosis of being correct without adopting a degree of critical analysis."

The view of the psychiatrist who concluded that Dupree was not unwell enough to go into hospital in August was that her psychotic episodes were drug-induced.

But this was also challenged by Qurashi, who said: "This is not a case of drug-induced psychosis," instead suggesting that she was seeking to use drugs to help deal with her symptoms.

The inquest continues.

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