Failings were identified at mental health services in Kent in the wake of three deaths last year.

Kent and Medway NHS and Social Care Partnership Trust (KMPT), which provides inpatient and community services across the county, was told to make improvements following the patients’ deaths.

The failings have been revealed following a Freedom of Information Act request by the Kent Messenger.

Warnings came from coroners, who used so-called Regulation 28 powers that allow them to make recommendations to bodies to change to prevent further fatalities.

The suicides of architect Joanna Bowring, 32, and a 54-year-old woman from Canterbury highlighted failings, as well as the death of a Dover man.

Miss Bowring was hit by a high-speed train at Boxley in June after being denied in-patient care at Medway Maritime Hospital.

A coroner voiced concerns her parents, who were caring for her, were not adequately involved in her treatment or informed of ‘red flags’ to look out for.

She also said a care plan should always be given to a patient upon leaving hospital.

Another woman hanged herself last April after being taken to St Martin’s Hospital, Canterbury, under the mental health act following an attempted suicide.

She was discharged with a care plan and was contacted by the trust’s crisis team the following day which reported she was suicidal.

Several efforts were made to contact her but her family weren’t informed. She was found dead at home by police more than 24 hours later.

An inquest found the protocol for when to request a welfare check was not clear and even after steps were taken by KMPT to educate staff, a shift co-ordinator remained unclear on trust policy.

Schizophrenic Karl Williams, from Dover, died in September after stepping in front of a lorry.

The 49-year-old had discharged himself from William Harvey Hospital, Ashford, after cutting his wrists. He had been waiting for two hours and there was no on-duty psychiatric specialist present.

A coroner advised steps should be taken to ensure round-the-clock psychiatric care is available at the hospital’s A&E department.