Coronial

259 results for suicidal intent

NSWcommunity2019-09-11

Inquest into the death of G

34y · Male·Multiple injuries sustained when the car he was driving collided with a tree

A 34-year-old man with a history of depression and a previous suicide attempt died when he intentionally drove his car into a tree. He had been prescribed antidepressants by his GP following assessment fo…

general practicepsychiatryantidepressant_medication
TAScommunity2020-07-17

Coroner's Finding: Lyons, Matthew Clayton

47y · Male·mixed prescription drug toxicity (quetiapine, olanzapam, lorazepam and diazepam)

…died from mixed prescription drug toxicity (quetiapine, olanzapam, lorazepam, diazepam). He had expressed suicidal ideation multiple times in the months before death, including asking his caseworker how many tablets woul…

psychiatrygeneral practicecommunicationsystemquetiapine
SA2006-01-25

Coroner's Finding: GREENLAND Daniel Aaron

18y · Male·Gunshot wound to the head (self-inflicted)

…ead on 3 February 2003 after shooting his stepmother. Evidence shows he attended the shed with pre-formed suicidal intent, writing farewell notes before police arrived. One note referenced hearing voices commanding him t…

VIChome2011-08-10

Finding into death of B

17y · Male·Hanging

…following a relationship breakdown with his girlfriend. He had no prior psychiatric history but expressed suicidal intent via text message on the day of death. His girlfriend notified his brother of her concerns, but com…

WA2019-12-16

Inquest into the Suspected Death of Joseph Leon PATTERSON

30y · Male·Death by drowning at sea, likely following suicide. Exact manner not determined.

…act manner could not be determined. This case highlights the importance of taking seriously statements of suicidal intent and considering immediate intervention and support for individuals expressing such intentions, par…

delay
WA2019-02-15

Inquest into the Death of Henrick OOSTERBAAN

64y · Male·Unknown - coroner made no finding as to cause of death

…ng of a police investigation into historical child sexual abuse allegations. He left a note indicating his intention to end his life in a remote area near Menzies, Western Australia. Despite extensive searches of the har…

WAcommunity2017-02-28

Inquest into the Death of Colin John JOHNSTON

46y · Male·Unknown - possible causes include traumatic injury or dehydration in remote terr…

…being interviewed by police regarding possession of child exploitation material. He left notes indicating suicidal intent and drove to the park. Despite an extensive search, his remains were never found. The coroner esta…

WA2021-11-03

Inquest into the Suspected Death of Peter JOHNSON

71y · Male·undetermined - likely injuries sustained from fall at The Gap, but cannot exclud…

…cific cause (fall injuries versus exposure/immersion). This case highlights the importance of recognising suicidal intent in cancer patients declining aggressive treatment, maintaining close follow-up when patients expre…

oncologygeneral practicecommunication
SAhome2014-04-17

Coroner's Finding: KEITH George

80y · Male·gunshot wound to the head

…t and absence of documented depression. Clinicians should recognise that chronic pain patients expressing suicidal ideation require explicit assessment of intent and access to means, regardless of apparent personality co…

general practiceorthopaedic surgerydiagnosticcommunicationoxycodone
SAhome2021-05-28

Coroner's Finding: LOCKWOOD Andrew James

49y · Male·Shotgun wound to the head

…was prescribed sertraline in December 2016. His treating doctors assessed him as having only fleeting, non-intent suicidal ideation and deemed him not actively suicidal. Clinical lessons include the importance of compreh…

general practicepsychiatrysertraline
TAShome2022-09-20

Coroner's Finding: Hill, Sandra Germaine

67y · Female·mixed prescription drug toxicity (oxycodone and oxazepam); central nervous syste…

…ith her partner, she self-administered a fatal overdose of oxycodone and oxazepam tablets with documented suicidal intent (notes left, 'DNR' written on chest, farewell text message). Her prescriber appropriately assessed…

general practiceoncologyoxycodone
NSW2023-12-12

Inquest into the death of TH

57y · Male·Chronic Coronary Artery Atherosclerosis in the context of mirtazapine toxicity

… required courses, believing there was a conspiracy to keep him imprisoned. He made statements indicating suicidal intent, including telling a psychologist he would 'carry out their death sentence' if not granted parole …

mirtazapine
WAmental health2015-02-26

Inquest into the Death of Tracy Margaret MARSHALL

47y · Female·Ligature compression of the neck (suicide by hanging)

…ar-old woman admitted to Nickol Bay Hospital as a voluntary patient due to deteriorating mental state and suicidal ideation, left the hospital on 21 February 2011. She drove to a remote location in Millstream National Pa…

psychiatrysystemdelay
VICmental health

Finding into death of Rosemary Haldane

56y · Female·Combined drug toxicity

…bined drug toxicity while an inpatient at a private psychiatric hospital. She had been admitted following suicidal ideation and was initially on hourly observations. After apparent clinical improvement, she was granted a…

psychiatrygeneral practicealprazolam
WAcommunity2020-10-22

Inquest into the Death of Jordana KOSTOVSKI

27y · Female·Multiple injuries sustained in motor vehicle collision

…ailability of tyre deflation devices in regional areas hampered response options; and early indicators of suicidal intent (depressive messages, pet abandonment) were present but not acted upon by those who knew the decea…

forensic medicinetoxicologyalcohol
SAhospital2016-07-13

Coroner's Finding: NOAKES Geoffrey Scott

43y · Male·acute neck compression due to hanging

…l criteria for confirming detention were established but Dr L. gave undue weight to Mr Noakes' denials of suicidal intent while underweighting recent serious suicide attempts and planning.

psychiatryemergency medicinediagnosticcommunicationolanzapine
SA2019-05-08

Coroner's Finding: WILLIAMS Steven Malcolm

31y · Male·acute neck compression by ligature

…2014 (ligature around neck with prison pants), he was assessed and deemed not at acute risk after denying suicidal intent. He was removed from High Risk Assessment Team monitoring in November 2014. The coroner found, bas…

psychiatrypsychology
SAcommunity2000-04-14

Coroner's Finding: HUTCHINSON Robert

60y · Male·undetermined; presumed suicide by motor vehicle driving over cliff

…ecognising suicide risk factors including recent accusations of serious misconduct, explicit statements of intent to die, and concerning behavioural changes. Clinicians should maintain heightened vigilance for these warn…

VIChospital2014-02-10

Finding into death of Glenn Stewart Hayes

36y · Male·Hypoxic/ischaemic encephalopathy and hanging

…sive behaviour, and anger management issues related to amphetamine and cannabis use. He explicitly stated suicidal intent to multiple contacts. Clinical learning includes recognition of acute mental health crisis in pati…

intensive careemergency medicinediagnosticsystemmethamphetamine
VICcommunity2013-07-09

Finding into death of June Leslie Parker

45y · Female·Presumed drowning

…scribed her as passionate despite a quiet demeanor. The coroner found she presumably drowned, likely with suicidal intent. No clinical lessons are applicable as this was not a healthcare-related death. The case highlight…

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