A mother has paid tribute to her "gentle, kind and loyal" child following an inquest into their death.

Virgil Rhone, aged 15 years of Kipling Close, Bicester, was a transgender pupil and born female but from a young age did not fit into the conventional stereotypes of a girl, their mother told the coroner.

Struggling with mental health and suicidality following being bullied at school, Virgil’s parents, Vanessa, and Peter Rhone decided to home-school them.

At the time of their death, Virgil was studying animal care at college, participating in the National Art Club and attending a youth club.

Virgil had been under the care of Oxfordshire Child and Adolescent Mental Health Service (CAMHS) since 2019 and there had been two previous suicide attempts before their death.

On March 1 2022, Virgil was found with a ligature at home and was taken to the hospital where they died two days later.

Oxfordshire coroner Darren Salter found that Virgil had taken the action to tie a ligature which caused his death, but the evidence did not clearly show intention so the death will not be recorded as a suicide, but instead as a narrative.

The coroner also said he would be writing a letter to Oxford Health, Oxford University NHS Foundation Trusts and Virgil's GP, to insist that medical notes can easily be shared with each other so that a patient gets the help they need.

Vanessa Rhone, Virgil’s mother, said: “We are so grateful to have had Virgil in our lives and will be forever transformed and better people as a result.  We miss him with all our hearts.

"As Virgil’s mum, I was often frustrated at the apparent lack of urgency in the two and a half years that Virgil was under the care of CAMHS.

"I feel that the lack of treatment of the causes of Virgil’s anxiety and suicidal ideation led to depression and further complications.  

"I believe that if Virgil had received earlier support, these complications would not have arisen.

"We are devastated by Virgil’s death and are very keen to do anything we can to ensure that other young people have better support and are not dismissed as ‘not engaging’ with services.

"These young people are often autistic like Virgil and need reasonable adaptations to their care.

"We are pleased that the coroner has now encouraged the NHS to take action on taking a better approach to multi-disciplinary cases.

"While the NHS did not meet Virgil’s needs, the support we received from the charity Nai’s House shows what is possible.

"Virgil was able to engage with their services from the start and gained confidence, friendships and opportunities through their support. 

"We continue to raise money for Nai’s House in Virgil’s name.”

Oxford Health, the NHS trust that looks after mental health hospitals in the region, has offered its condolences to the family following the inquest.

A spokesman said the trust participated fully with Virgil's family during the inquest process.

READ MORE: Health bosses send condolences as inquest into teen's death ends

And he emphasised the trust will continue to speak to the family and "examine ways of improving the delivery of effective healthcare".

Lucy McKay, a spokeswoman for the charity INQUEST who are supporting the family, said: “INQUEST cases have consistently evidenced serious gaps in mental health services for both young trans people, and young people with autism.

"There is a lack of specialist care, as well as failures in mental health services more broadly, which is allowing children and young people like Virgil to fall through the gaps.

"Virgil’s positive experiences of care with the charity Nai’s House show that another way is possible.

"The NHS and government must take action to create appropriate services for children like Virgil, and improve mental health services for all children to prevent future deaths.” 

The Samaritans 24 hour helpline is 116 123.