148 results
29y · Male·Hanging
Craig Mark Allen, aged 29, died by hanging in cell 211 of Yatala Labour Prison on 16 October 2000, six days after admission for assault. Critical failures in prisoner management contributed to this preventable death. The…
43y · Male·Hypoxic/ischaemic encephalopathy resulting from asystolic cardiac arrest due to …
Gregory David Couper, 43, with chronic schizophrenia, experienced a psychiatric crisis at a supported residential care facility on 2 December 1998 and died the next day from restraint asphyxia. Police responded to calls …
21y · Male·multiple injuries from fall from water tower
A 21-year-old man with acute psychosis was admitted involuntarily to a psychiatric ward after being found climbing a power pole. After 8 days, despite being assessed at moderate suicide risk and displaying poor insight i…
15y · Male·compression of the neck by hanging
A 15-year-old Aboriginal male, Johnno Wurramarrba, from Groote Eylandt died by hanging in Don Dale Juvenile Detention Centre on 10 February 2000, while serving a 28-day sentence for property offences. Key preventable fac…
74y · Male·myocardial infarction
A 74-year-old male aged care resident died of myocardial infarction while detained under the Mental Health Act at Royal Adelaide Hospital. He had presented with hypokalaemia and sigmoid volvulus, refusing initial treatme…
33y · Male·Postural asphyxia due to restraint (Posey Poncho vest)
A 33-year-old male admitted after drug overdose died from asphyxiation while restrained in a Posey Poncho vest. Successfully treated for overdose complications, he developed drug-induced delirium with agitation, promptin…
21y · Male·Suffocation from hanging
Shannon Robert Camden, a 21-year-old with longstanding mental health difficulties and previous suicide attempts, died by hanging in cell A1 of the Belconnen Remand Centre on 15 April 1996 while on remand awaiting trial f…
52y · Male·Unascertained
GM, a 52-year-old man with bipolar affective disorder, died of unascertained causes after absconding from a mental health inpatient unit on 2 December 2015. He was admitted voluntarily for management of a suspected manic…
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