Deceased
Madeline Howe
Demographics
20y, female
Date of death
2019-05-08
Finding date
2024-01-11
Cause of death
Complications of neck compression in the setting of partial suspension
AI-generated summary
Madeline Howe, a 20-year-old Aboriginal woman, died by suicide on 8 May 2019 following partial suspension. She had experienced significant trauma including parental separation, family violence, and her brother's death by suicide eight months prior. She was under care of North East and Border Mental Health Service (NEBMHS) with documented suicidal ideation, previous attempts via overdose and other means, and a complex psychiatric history. While NEBMHS provided appropriate initial assessment and safety planning, continuity of care was interrupted during her case manager's leave without documented handover, occurring during the anniversary period of her brother's death—a time of recognised vulnerability. The coroner found no adverse findings against NEBMHS but noted the treatment plan was not followed during the leave of absence. Family violence exposure significantly contributed to her mental health deterioration and suicide risk.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
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