Content warning: This article contains references to suicide and self-harm
Natasha Abrahart was a physics student at the University of Bristol. She suffered from severe social anxiety and dreaded the presentations she had to give as part of her undergraduate course.
The 20-year-old, during her second year of studying in 2017 and 2018, failed to attend several of her oral assessments and performed poorly in the ones that she did. In other aspects of her studies she was doing well.
In April 2018, the day before she was due to speak at a laboratory conference in a 329-seat lecture hall, Natasha took her own life. She was one of at least 12 students to kill themselves at Bristol within five years.
In 2019, an inquest into Natasha’s death ruled that neglect by Avon and Wiltshire Mental Health Partnership NHS Trust contributed to her suicide. Following the verdict, the spotlight turned to the university, with Natasha’s parents accusing it of attempting to “shut down” any meaningful examination of its actions.
Some four years after their daughter’s tragic death, Margaret and Robert Abrahart’s civil action against the university has reached court. It’s the first time parents have sued a university in such circumstances.
The Abraharts claim the university owed Natasha a duty of care and that she was a victim of indirect discrimination as a disabled student with social anxiety disorder. They said the institution could have made “several reasonable adjustments” for her, including replacing oral assessments with written ones.
The landmark five-day case at Bristol County Court concluded on Tuesday evening, after the court heard evidence from university staff in its school of physics, Natasha’s friend, her mother and two clinical psychiatrists. Judgement will be delivered at a later date.
‘Why is no one helping me here?’
Jamie Burton QC, who opened the case last week, said Natasha was a “conscientious and bright” student but from a young age had suffered a “debilitating social anxiety”. He said she would often “shut down” when the centre of attention.
Burton, representing the family, said Natasha’s anxiety “spiked” and became “clinically significant” at university. He told how she struggled in particular with a module that required her to take part in oral assessments.
The court heard how Natasha was “reluctant” to seek help from the university’s support services due to her condition. Burton said that, despite this, more could have been done to assist her.
Rajan Palan, a friend of Natasha’s, said he accompanied her to several medical appointments and did his best to persuade her to access any support services available to her during her second year at Bristol.
Giving evidence, Palan admitted that he had become “exhausted” trying to help Natasha. “I felt angry with the university, with her parents and with myself for not doing more… I felt like: ‘Why is no one helping me here?’”
He said he knew the university was aware of one of Natasha’s suicide attempts, but not of a subsequent one. The court heard that she had attempted to take her own life twice before her death.
“I made the very difficult decision that I needed to trust other people who were helping her”Natasha’s mother, Margaret Abrahart
Palan said he was “relieved” when Natasha contacted a student administrator to share the issues she was having with her mental health. He said he believed she had meetings with doctors, but was “not sure what good they did”.
He added: “It wasn’t clear to me what the university or anybody could have done in this case.”
Natasha’s mother also gave evidence. She told the court Natasha had never complained to her that she was struggling at university, and that she wasn’t aware her daughter had attempted suicide until she was informed by one of her friends in Bristol.
“[Natasha] found it very difficult to talk about personal things,” she said. “There are lots of things people don’t tell their parents… I knew something was upsetting her but I didn’t know what it was.”
She added: “I made the very difficult decision that I needed to trust other people who were helping her.”
University employee knew about suicide attempt
Barbara Perks, a student administrator in the university’s school of physics, said she had spoken to and emailed Natasha about her struggles with the oral elements of her course, and was told about issues with her mental health.
She told the court that her role was “passing people that needed help to those who are better qualified”. She said, however, that on one occasion she accompanied Natasha to a GP appointment.
“You were in contact with support services and you didn’t tell them about this significant development?”Jamie Burton QC, representing the Abraharts
The court heard that Perks had been made aware Natasha had attempted suicide but that she didn’t raise it with wellbeing support services, or with senior lecturers or tutors in the university’s school of physics.
“You’re the only person other than Rajan who knew that Natasha had attempted suicide,” Burton, representing the family, told Perks during cross-examination.
“You’re the only person that goes with her to a doctor’s appointment… [this was] clearly not in your job description,” he said. “You were in contact with support services and you didn’t tell them about this significant development?”
Burton asked Perks whether she had enough training to deal with “this kind of scenario”. She replied by saying that she had been on a mental health first aid training course.
Paul Stagg, representing the university, suggested that if Perks had told a senior tutor of Natasha’s self harming it would have been a “gross breach of confidence”. He said that she “did the right thing” by referring her to a GP.
Adjustments could have been made
Part of the case was focused on the assessments used in Natasha’s physics course, including a laboratory conference where she was expected to take part in a group presentation to about 50 people in a large lecture theatre.
Burton said the university failed to make “reasonable” adjustments for Natasha to help her cope with speaking in front of a group. She was also neglected and a victim of indirect discrimination as a disabled student with social anxiety disorder, he said.
Perks said she suggested that Natasha could have pre-scripted questions and answers for interview sessions. The court also heard that Natasha was told she would not have to speak at the laboratory conference, if she “negotiated” with others in her group on how to show her contribution to the work in another way.
For “adjustments” to be made, however, the court heard that Natasha would herself have needed to make arrangements with disability support services and complete an extenuating circumstances form.
Burton said Natasha had been “nervous” about contacting the service to ask for help, so Perks had emailed on her behalf. However, he said, when the service invited Natasha for an appointment she did not reply.
Karen Hocking, head of disability services at the university, was also cross-examined during the case. Burton asked her if she thought sending a single email to Natasha and not following it up was “adequate”.
Hocking agreed that it was “regrettable” the team would not routinely follow up on emails and that no further action was taken. She said there would have been a different approach if they knew Natasha was at risk.
Dr Adrian Barnes, a senior tutor in the university’s school of physics, said he had met with Natasha, discussed that she was having trouble with oral elements of the course and recommended that she speak to disability support services.
He was asked under cross-examination if Natasha was told that if she didn’t seek this help, then the university wouldn’t be able to help her. Barnes said that he didn’t “insist” Natasha see a GP and support services because that would imply that he would “wash his hands” of the issue if she didn’t. “What option do I have but to refer [Natasha] to the appropriate services?”
People with Natasha’s condition ‘rarely seek help’
Dr Sally Braithwaite, a consultant psychiatrist who was called as an expert witness for the claimant, told the court that people with social anxiety disorder tend to see their condition as a “personality flaw”.
Natasha would have found it hard to discuss her condition with people she didn’t know, Braithwaite said, especially with those in a position of authority such as medical professionals and university staff.
Asked how it would have been for Natasha to have to personally obtain evidence from a medical professional in order for “allowances” to be made on oral elements of her course, Braithwaite said: “Extremely difficult.”
The court also heard that people suffering with social anxiety disorder, according to NICE guidance, would be unlikely to seek help.
“She would have been crushed… It was fuelling her depression.”Dr Sally Braithwaite, consultant psychiatrist
Having to negotiate with her fellow students about how she would contribute to the laboratory conference other than speaking also would have been a hard task for someone with Natasha’s condition, Braithwaite told the court.
“She would have to explain why she wasn’t able to contribute… Having to explain that to people she didn’t know would have been very difficult.”
She told the court that Natasha wanted to do well at university, but that this was in conflict with her fear of public speaking. Asked how this conflict, and attending the interviews but performing poorly, would have had an impact on her, Braithwaite said: “She would have been crushed… It was fuelling her depression.”
Professor Tom Burns, a clinical psychiatrist called by the university in the case, was asked under cross-examination if he believed it was a “coincidence” that Natasha took her own life the day before she was due to speak at the conference. “I don’t know,” he replied. “Clearly these exams were a big problem.”
Burns agreed that Natasha’s depression would have caused her anxiety “when she was the focus of attention”, but he disputed that she suffered separately from social anxiety disorder. He claimed that it was a “relatively rare” disorder and that its diagnosis was often “oversold”.
Did the university owe Natasha a duty of care?
Stagg, defending the university, said Natasha was not given a “psychiatric diagnosis” because of a lack of contact and communication, and said the institution was unaware of Natasha’s interactions with Avon and Wiltshire Mental Health Partnership NHS Trust.
He warned of the “danger of hindsight” when searching for answers in cases such as this one. “What may now seem obvious after several days of evidence of the events… may not have been obvious at the time.”
He said that Natasha had been “reluctant” to take up the help from various support services available to her because of the mental health issues that she was grappling with during her second year.
“The need to assess a student is a highly relevant factor in deciding what a university is to do in response,” he argued, saying that it may not be reasonable for a university to take steps before an assessment has happened.
“By doing the wrong thing, you might just make things worse,” he said. “It is felt very keenly by the university’s witnesses that [this case] was an attack on them,” he said, adding that staff were faced with an “extremely difficult dilemma”.
The court heard that Natasha wrote notes to herself expressing “despair” over her shyness, and that from an early age she had “difficulty interacting within a group of people” at school.
“It would be grossly unjust to effectively hold the university responsible for the entirety of [Natasha’s] condition, which was already serious and chronic,” he told the court.
He also said it was important, given the strong interest in this case, that the university’s denial of a duty of care should not be misunderstood. “There is a distinction between duty of care and everyday language,” he added.
“You’re saying the university cares but doesn’t have a legal duty,” the judge asked, to which Stagg replied: “Precisely.”
Stagg said the notes that Natasha made in 2017 were a “snapshot of what was in her mind” and made clear that she was already “severely troubled”. He said evidence showed that her issues with social anxiety dated back to childhood.
Burton, representing Natasha’s parents, said it should be made clear they are not arguing that the university owed the student a duty of “clinical” care. “This is very much about the provision of support she was getting in the academic context,” he told the judge in his closing arguments on Tuesday.
He told the court: “Early on, [the university] should have swapped out oral assessments with written ones… Everyone just waited and hoped that Natasha would engage with [support] services.” He said that it was “simply inconceivable” that the university didn’t owe a duty of care to the student.
Judge Alexander Ralton, presiding over the case, said it would take him “some time” to draw up his judgement, and that before it is made public a draft will be sent to counsel for corrections. No indication was given on when the judgement would arrive.
The University of Bristol said in a statement following the case’s conclusion: “Like all universities, schools and colleges, we are deeply concerned by the increase of mental health issues amongst our young people nationally.
“We do our very best to support any student who is struggling with their mental health and have a wide range of services available. However, it is important that students receive appropriate specialist care under the NHS.”
It added: “Our thoughts and sympathies are with her family and friends, as well as our own staff members who worked incredibly hard and diligently to support Natasha with her studies.”