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A mother has blamed a hospital for the death of her son after an inquest jury confirmed it contributed to his death.
"He need not have died," said an angry Beverley Brenchley.
Her 22-year-old son, Ollie Hedges, had been taken to Littlelebrook Hospital, Dartford, after a string of suicide attempts - but escaped and was killed when he ran in front of a lorry.
It is officially recognised as one of a handful of places of safety across Kent where disturbed people can be assessed.
But Beverley said: "That's not a place of safety. He clearly wasn't kept safe."
Hospital staff admitted they were understaffed at night and had few people trained to restrain excitable patients.
Sportsman Ollie, who lived with his mother in Swanley, was arrested on October 31, 2010.
He had been trespassing on the railway and admitted he planned ot kill himself.
Worried transport police took him to the hospital for assessment, but he later forced his way out of the hospital through three sets of locked doors.
Half an hour later at the nearby Dartford Crossing, he ran in front of a lorry in lane two and was killed.
The jury criticised the care and the training of Littlebrook's staff, and said CCTV cameras were needed to watch assessment areas.
They found Ollie took his life while his mind was disturbed.
North Kent coroner Roger Hatch has been formally requested by the family's legal advisor, Rob Harland, to write to the hospital trust drawing attention to the jury's criticisms.