26y · Female·Asphyxiation due to Ligature Compression of Neck
…st 2003 after presenting with wrist lacerations and reported tablet ingestion. She was assessed as moderate risk and placed on 15-minute observations. Dr A. instructed close monitoring and mentioned possible transfer to …
42y · Male·Multiple injuries sustained in a fall from a height
Mr LY, a 42-year-old compulsory inpatient with extensive mental health history, died by suicide when he jumped from the Belford Road overpass during approved unescorted leave. Key clinical events inclu…
58y · Male·Shotgun wound to the neck
Mark Edward Elliott, a 58-year-old prominent lawyer, died by suicide on 13 February 2020 following a shotgun wound to the neck. He was experiencing significant occupational a…
30y · Male·neck compression
Mohamed Omar, a 30-year-old man with schizophrenia, died in Melbourne Assessment Prison on 25 June 2017 from neck compression while on remand. He had a history of command auditory hallu…
82y · Male·Self-inflicted partial contact shotgun wound of the head
…n January, he told his GP the treatment made him feel 'terrible' and he'd 'rather be dead,' but no formal suicide risk assessment or mental health referral was documented. No communication occurred between treating onco…
50y · Male·hanging
…9) and complex mental health issues including depression, anxiety, personality traits, and multiple prior suicide attempts. Following his brother's suicide in April 2011, he increased substance use. On 1 July 2012, he c…
Male·Self-inflicted hanging
Leon Mark Carroll died by hanging in prison while on remand for sexual offences. Initial assessment identified significant suicide risk, but this was reversed by the High Risk Assessment Team after only 5…
24y · Male·Neck compression in the circumstances of hanging
…n 19 May 2019 following a relationship breakdown. He had a history of depression, self-harm, and previous suicide attempts. In the weeks before his death, he experienced multiple psychosocial stressors including relatio…
40y · Male·neck compression consequent upon hanging
…engage with recommended psychiatric care. Clinicians identified suicidal ideation during his MBCP intake assessment but conducted no formal suicide risk assessment. His violent behaviour and alcohol consumption escalated…
65y · Male·Hanging
…Police found him with a blood alcohol concentration of 0.118 (twice the legal limit) and were aware of a 'suicide flag' in his records from a 2002 self-harm incident. Despite the flag, officers assessed him as calm and …
36y · Male·hanging, with contributing factors of alcohol dependence and depression
…. He was discharged from Northside Mental Health Unit on 9 June 2021 following admission for overdose and suicide attempt. The coroner found no deficits in his treatment or care, and that procedures and protocols were c…
28y · Male·In keeping with Hanging
…al interviews with witnesses before searching for him. The deceased left the house undetected and died by suicide in a remote shed on the property. Although the deceased had texted his sister at 9.02am stating he had a …
58y · Male·unascertained
Peter James Guidera, a 58-year-old man with a history of depression, suicidal ideation, and previous suicide attempts, disappeared on 8 May 1998 from Narrogin, Western Australia, shortly after receiving a distressi…
24y · Male·Gunshot wound to the head
…n with bipolar disorder and ADHD died by gunshot wound to the head approximately 5 months after a serious suicide attempt by overdose. He had been assessed as fit to hold a firearms licence by his treating psychiatrist …
37y · Female·Hypoxic brain injury consequent upon hanging
…Mother and Baby Unit on 7 December 2007. She had severe recurrent postpartum depression and had attempted suicide two weeks prior (overdose). Despite being assessed as high-risk on 4 December and placed on hourly observ…
21y · Female·Multiple injuries sustained from being struck by a train; death by suicide while…
Alana Goldsmith, a 21-year-old woman with long-standing anorexia nervosa, died by suicide on 22 July 2011 after stepping in front of a train at Summer Hill Railway Station. She was admitted to We…
45y · Male·hanging
…ion, suicidal ideation, and alcohol misuse was admitted to Spencer Clinic following a medication overdose suicide attempt. During his six-day admission, he improved clinically, denied suicidal ideation, and was assessed…
68y · Male·Hanging
…acted his mental health and quality of life. Despite referral to mental health services and a reasonable assessment by a psychiatric nurse on 7 December, he died three days later. The coroner identified tinnitus-related …
40y · Female·hypoxic ischaemic encephalopathy due to ligature compression of the neck
…burglary, she was held at Knox Police Station on 2 December 2021. Police delayed completion of her Detainee Risk Assessment (DRA) despite her having a 'S4' suicide risk rating on the system. She was issued a standard bla…
75y · Male·neck compression due to hanging
…He had been admitted after allegedly assaulting his daughter-in-law during a psychotic episode. Clinical assessment found no documented evidence of suicidal ideation despite a remote history of suicidal thoughts. The cor…
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.