Finding into death of Craig Geoffrey Rickard
Deceased
Craig Geoffrey Rickard
Demographics
55y, male
Date of death
2020-01-15
Finding date
2024-04-15
Cause of death
Hanging
AI-generated summary
Craig Geoffrey Rickard, aged 55, died by hanging on 15 January 2020, three days after release from custody serving a Community Corrections Order. He had presented to mental health services multiple times in September 2019 with suicidal ideation and attempts, precipitated by relationship breakdown and alcohol/methamphetamine use. Following release in December 2019, he disclosed suicidal ideation to his Community Corrections case manager on 7 January 2020. A risk management plan was implemented including GP notification, crisis team contact details, and advice to attend ED if deteriorating. The coroner found his suicide was likely impulsive in response to frustration over inability to contact his former partner (subject to a Family Violence Intervention Order). While discharge planning from mental health services lacked formal mechanisms for re-referral post-release, the coroner found no causal relationship between this and his death. The response by corrections and primary care was deemed reasonable and appropriate.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
Contributing factors
- Suicidal ideation triggered by relationship breakdown and inability to contact former partner
- Alcohol and methamphetamine use
- Recent incarceration with mental health service engagement interrupted
- Impulsive suicidality in response to external stressors
- Lack of established mechanism for mental health re-referral after release from custody
- Absence of formal policies/procedures for managing mental health patients with interrupted care due to incarceration
Coroner's recommendations
- Grampians Health is invited to consider implementing a framework for mental health patients whose management is interrupted by episodes of incarceration, and how best to re-engage with such patients on release from custody
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