An inquest has shed further light on a mum's calls to an emergency NHS hotline weeks before she drowned her twins - with health workers saying they didn't feel there was an immediate risk to her children.
Samantha Ford killed 23-month-old Chloe and Jake at their Margate home on Boxing Day 2018.
Today, on the second day of an inquest into the twins' deaths, a coroner was told Ford had spoken to several health workers on the NHS 111 hotline three weeks before her terrible act.
But the staff said they "didn’t feel there was any immediate risk to the children" during their conversations with Ford.
The mum had told them that although she was struggling with suicidal thoughts and had not slept properly in five weeks following the breakdown of her marriage, she posed no risk of violence to others.
But lawyers representing Ford have questioned why concerns were not raised about the welfare of her children.
She and her husband Steven had moved back to Kent from Qatar in early 2018, after having the twins through IVF, but separated later the same year.
Ford's mental health deteriorated, and she relocated to Margate to be nearer her family.
Just after 10am on December 7, her sister Amanda Emptage called NHS 111 on her behalf.
Ford had run out of medication prescribed by a GP at her former address to help with her mood and sleep problems, and was keen to speak to a doctor to get another prescription.
At today's hearing, coroner Christopher Sutton-Mattocks read out lengthy transcripts of the phone conversations.
Ms Emptage told the call handler how Ford had recently separated from her husband.
“She’s just not getting any sleep, and she’s not able to cope with the kids in the day," she said.
The handler spoke directly to Ford, who said she was having suicidal thoughts and had thought about how she would take her own life, before she was passed to clinician Daniel Lopez.
Mr Lopez advised she should try contacting her GP or visiting A&E, but that failing that, an out-of-hours doctor may be available if she called NHS 111 again after 6.30pm.
Cross-examining Mr Lopez at today's hearing, lawyers representing Ford asked if he had any concerns for the wellbeing of Ford's young children.
"I didn’t," he said.
"She had had thoughts of suicide, and when that subject was discussed with Mrs Ford, she immediately said she had kids, so she wouldn’t (take her own life).
"Which I took to mean the children were the reason why she wouldn’t do anything to harm herself.”
Ford's lawyer Brenda Campbell QC drew attention to safeguarding guidelines, which say that where parents are experiencing mental illness, "it is essential always to ensure to examine implications for each child."
She added that "breakdown of a relationship" is specifically listed as a risk factor, before questioning whether Mr Lopez thought to contact social services.
She said: "Here we’ve got a mum who’s struggling to cope during the day with children under the age of two.
"Why didn’t you think about any extra support Samantha Ford would need in relation to the children?"
But Mr Lopez said he believed Ford had "good family help", with her sister and other family members living nearby.
"There was the fear or worry maybe that if I then referred her to social services, that might prevent her in future trying to seek help for herself, because she’d be worried it was assumed she was incapable of looking after the children," he said.
"I didn't feel that there was any concerns for the children during the assessment I carried out.
"I didn't feel a referral to children's social services was a thing that was needed at that time. I was hopeful a GP would help her manage her mental health, which would in turn allow her to improve and continue to look after the children as she had been with the support of the family."
Following Mr Lopez's advice, Ford's sister called 111 again just after 6.30pm.
During a discussion with another handler, she told how Ford had been “very low and depressed”, adding she had “been very bad” that day and “we don’t feel like we can leave her at the moment”.
Ford then added that she had "not been like this before" and said her state of mind was getting "more erratic".
But asked if she felt there was an immediate risk of violence, she said: "To who? Someone else? No."
“Good," replied the handler. "That’s what we like to hear.”
Mental health nurse Natalie Bradley then called her back just after 7.45pm, and Ford this time broke down in tears as she again ran through her situation.
Cross-examining Ms Bradley, Ms Campbell asked why she did not make inquiries about the extent of family support at Ford's disposal.
"Maybe on reflection I should have asked if she was managing to care for the children and felt she needed any more support," said Ms Bradley.
"However I didn’t feel there was any immediate risk to the children in terms of violence, and she certainly didn’t give me any indication that the children were at risk."
Ford was called back by an on-duty doctor later that night, and an appointment was made for her to see a GP the following day.
On December 8, Ford visited Dr Anita Jain, a senior partner at The Limes Medical Centre in Margate, and was seen with her sister Amanda present in the room.
Dr Jain reported that Ford "made good eye contact" and "appeared calm and well-kept".
While she reported she had been feeling low, and was not eating or sleeping well, Dr Jain said it was not made clear either by Ford, or in her notes, that she had been experiencing suicidal thoughts.
The GP prescribed her diazepam - an antidepressant that also helps with sleep.
Dr Jain said: “It would have helped if there was mention of suicidal ideation in the notes.
“My questioning would have slightly changed.
“If it was there in black and white, I would have probed more. I’d have asked her 'would you feel more comfortable speaking alone?'
"But I don’t know if the answers would have been different.”
She added that, had she known she was "actively suicidal", she would likely have referred Ford to A&E.
During a trial at the Old Bailey in 2019, Ford's actions were described as a twisted act of vengeance against her estranged husband.
She was also described as a narcissist by a psychiatrist, and it was said she was fixated on getting her husband back.
After he refused, she warned him in one message: “If this continues it’s going to lead down a horrible path.”
She also Googled how to drown someone in the weeks before she killed the twins and made chilling searches on the day of their deaths.
She admitted manslaughter by reason of diminished responsibility and was jailed for 10 years for killing Jake and Chloe.
The inquest continues.