The suicide of a violinist days after she gave evidence about the sexual abuse she suffered at the hands of an ex-choirmaster "could and should" have been prevented, a serious case review has found.
Frances Andrade, 48, killed herself at her home in Guildford, Surrey, a week after testifying against "predatory sex offender" Michael Brewer.
Brewer, who taught at the prestigious Chetham's School of Music in Manchester, was jailed for six years at Manchester Crown Court last year.
He was stripped of his OBE awarded for services to music after being convicted of five counts of indecently assaulting Mrs Andrade when she was 14 and 15.
His ex-wife, Hilary Kay Brewer, was jailed for 21 months after she was convicted at the same trial of indecently assaulting Mrs Andrade when she was 18.
A serious case review said Mrs Andrade, referred to as Mrs A, was "let down" by mental health services who failed to realise how vulnerable she was as she fought for justice.
Proper care measures and adequate risk assessments were not put in place as she made increasingly serious suicide bids, the report noted.
Its authors called for criminal justice professionals to improve the support offered to sex abuse survivors and recognise their "vulnerability" when facing their abusers in court.
Mental health services should increase their alertness to the fall-out of sexual exploitation and the risks of suicide and self-harm, the report by Surrey Safeguarding Adults Board added.
The review also said the media had a role to play, saying that journalists, broadcasters and editors "should be mindful of the way a person's mental health and their credibility are discussed throughout court proceedings".
Part of the 87-page report said: "The panel considered that this was a suicide that could and should have been prevented.
"Mrs A had reasons to live and she continued to ask for help throughout this period. We therefore invite all the agencies concerned to take real and concrete steps towards improving their practice."
The serious case review said that music schools, along with other "hothousing establishments", create a "backdrop" of "very particular and potent form of grooming".
The report's panel said "boundaries were blurred" and some staff appeared to act at times "with impunity".
Teachers were placed in an "exclusive and powerful" position over their proteges amid an atmosphere of elite performance, it went on.
The trial heard that the abuse took place in Brewer's office and in his camper van, which he used to drive Mrs Andrade out of the school grounds and get her to perform oral sex on him.
He was cleared of raping her when she was 18 at his then home in Chorlton, Manchester.
Sentencing him, Judge Martin Rudland labelled Brewer "a predatory sex offender" and said he used his powerful position to select and groom his victims.
Brewer also targeted a 17-year-old student at Chetham's whom he fondled in his office and admitted in court that he fell in love with at the age of 49, while another 17-year-old girl was said to have been pinned up against a wall during a school trip and sexually propositioned.
Brewer resigned as music director at Chetham's at about the same time he was awarded his OBE after the affair with the girl he fondled in his office was uncovered.
But the affair was hushed up, his trial heard, and Brewer went on to become the artistic director of the National Youth Choirs of Britain, to direct the World Youth Choir, serve as an adjudicator in international competitions and lead BBC workshops for the programme Last Choir Standing in 2008.
The abuse Mrs Andrade suffered only surfaced decades later when she confided to a friend at a dinner party in 2011.
Alarmed that Brewer was still teaching and had access to other aspiring musicians at a national level, she contacted Surrey Police.
It led to an investigation by Greater Manchester Police whose catchment area the crimes took place and where the abusers continued to live.
Mrs Andrade was at risk of causing herself harm by recalling the abusive experiences she suffered in court, the report said.
But she was concerned that, if her mental ill-health became common knowledge, her credibility in front of the jury would be undermined.
"She therefore seems to have made a principled decision to put her own well-being on hold in order to underline the clarity and, she hoped, the effectiveness of her evidence," it said.
The report added that court officials should pay more attention to victims' mental welfare and ability to make decisions about what special measures to accept.
And following publication of the report, Victim Support said an inquiry should be held into how the criminal justice system treats victims with mental health issues.
Surrey Police said they accepted that "more must be done" to recognise the needs of vulnerable people in historic child abuse cases.
Assistant Chief Constable Stuart Cundy said the force has since Mrs Andrade's case issued further guidance on pre-trial therapy and support.
He said: "In line with the national recommendations of the serious case review, we are also working to scope additional training for officers to help in the assessment of mental trauma."
Detective Chief Superintendent Vanessa Jardine, head of Greater Manchester Police's public protection division, said it was tragic that Mrs Andrade was unable to see justice served.
She said the force will be reviewing its policy relating to inquiries of rape and serious sex offences to make sure "the best possible standard of care" for every victim.
The NSPCC said there was an urgent need to reform how vulnerable people are treated in court.
Its head of public affairs, Alan Wardle, said victims have spoken of cross-examination in court being almost as bad as the original abuse.
He said: "We know of victims who were cross-examined by eight different barristers for days on end, others who were called liars or asked to relive horrific details of their life that were not relevant to the trial.
"This is not worthy of our world-renowned justice system and a change is a must."
Victims' Commissioner Baroness Newlove, whose husband Garry was killed by a gang vandalising his car, said that "mental health should never be a barrier to justice".
She said: "The tragic death of Frances has shown how crucial it is for all involved to truly understand and work together to protect vulnerable victims as soon as they enter the criminal justice system."