Deceased
Paul Hannan
Demographics
59y, male
Date of death
2020-09-03
Finding date
2023-03-28
Cause of death
Hanging
AI-generated summary
Paul Hannan, a 59-year-old man with significant alcohol dependence and prior mental health issues including depression, died by hanging in custody at Metropolitan Remand Centre in September 2020. He was referred for custodial mental health assessment on arrival but the mandatory formal assessment forms were not completed—the mental health nurse conducted only an informal assessment despite policy requiring completion of either a triage or assessment form. The psychiatry registrar noted a need for review 'possibly on Monday' but this did not occur. While staff regularly observed Mr Hannan and he denied self-harm, the absence of proper documented mental health assessment represented a significant gap in care. Justice Health subsequently amended policies to mandate completion of formal assessment forms for all referred patients.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
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