Coronial

95 results for adolescent suicide

VICcommunity2023-11-24

Finding into death of Geelong Youth Suicide Cluster Finding

Male·suicide

This cluster finding examined five suicides of males aged under 18 in Greater Geelong between February-June 2020. All deaths were temporally, spatia…

psychiatrygeneral practice
QLD2015-03-24

E, aged 14 - Non-inquest findings

14y · Male·hanging

A 14-year-old Aboriginal boy died by suicide by hanging at his school. He had experienced childhood trauma including neglect, domestic violence, and p…

psychiatrygeneral practicediagnosticmarijuana
VIC2024

Finding into death of J Q

16y · Female·Plastic bag asphyxia

…e or unwilling to restrict access to argon gas or implement design modifications to prevent its misuse in suicide.

VIChome2024-01-25

Finding into death of Lachlan John Howe

13y · Male·Hanging

…nizing family violence as a primary mental health stressor requiring targeted intervention, not treating adolescent suicidality in isolation, ensuring timely mental health referrals are completed and followed up, and con…

paediatricspsychiatrycommunicationsystem
VIChome2017-09-21

Finding into death of ALJW

21y · Male·Combined effects of heroin toxicity and plastic bag asphyxia

…rated psychological support during transition from paediatric to adult care, and failure to identify high suicide risk were significant contributing factors. Key lessons: holistic assessment of mental health in chronic …

cardiologypsychologycommunicationsystemheroin
SA2006-01-25

Coroner's Finding: GREENLAND Daniel Aaron

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

Daniel Aaron Greenland, 18 years old, died from a self-inflicted gunshot wound to the head on 3 February 2003 after shooting his stepmother. Evidence shows he attended the shed with pre-formed suicidal intent, writing fa…

VIChospital2014-11-28

Finding into death of Taylor Page Janssen

16y · Female·Multisystem organ failure and cerebral hypoxia secondary to hanging

Taylor Janssen, 16, died by hanging after the suicide of her recent ex-boyfriend Zac Harvey. She was found in her home garage on 27 March 2009 and died in hosp…

psychiatryemergency medicinesystem
VIChome2014-11-28

Finding into death of Chanelle Amy Rae

14y · Female·Compression of the neck in circumstances of hanging

…d online. She had no prior mental health history or significant stressors. The coroner identified a youth suicide cluster in Geelong in 2009, with seven deaths aged 18 and under that year. Key clinical lessons include: …

psychiatrypublic healthsystemdelay
VIChome2024-10-11

Finding into death of XY XY

16y · Male·Gunshot wound to the head

A 16-year-old boy with autism spectrum disorder and history of self-harm died from a self-inflicted gunshot wound. He had attended Headspace for mental health support and seen a GP who identified previous suicidal ideati…

psychiatrygeneral practicecommunicationsystem
TAShome2013-08-09

Coroner's Finding: Miss N de-identified

20y · Female·injury caused by hanging

…h a long history of eating disorder, obsessive-compulsive behaviours, and adjustment difficulties died by suicide in October 2009. She had received treatment at the Bronte Centre in Melbourne and outpatient mental healt…

psychiatrypsychologysystemdelaymethylphenidate
SAhome2003-09-25

Coroner's Finding: SAMMUT-SMITH Jason Peter

16y · Male·fresh water drowning

…al distress in the weeks before his death. While the precise circumstances remain undetermined (accident, suicide, or homicide), the coroner concluded on the balance of probabilities that Jason's father, Peter Smith, wa…

forensic medicineemergency medicinesystemdelaydiazepam
VICcommunity2015-04-13

Finding into death of KJ

18y · Female·Multiple injuries due to impact by train

KJ was an 18-year-old girl who died by suicide by train on 30 November 2012, six months after a suicide attempt. She had a complex trauma history, inclu…

psychiatrygeneral practicediagnosticcommunicationfluoxetine
VICcommunity2025-04-14

Finding into death of Jodus Tenetahi Murphy

18y · Male·Unascertained; likely hypothermia possibly in combination with drowning

…equipped for outdoor survival, lacking appropriate clothing and shelter. The coroner found no evidence of suicide or foreseeability of harm. Toxicological evidence and witness accounts supported consumption of illicit d…

forensic medicinetoxicologymethamphetamine
QLDhome2022-06-17

CJ - Non-inquest findings

14y · Male·Hanging

…ate interagency coordination, and a critical absence of trauma-informed responses to a highly vulnerable adolescent.

paediatricspsychiatrydiagnosticcommunicationcannabis
VIChome2012-10-09

Finding into death of Sue Hui Wang

15y · Female·compression of the neck

…y whether Sue died by intentional self-harm or injuries inflicted by her mother, Li Zhen Gao, who died by suicide in the garage. Sue's death occurred in the context of acute family stress following her parents' separati…

general practiceforensic medicinecommunicationdelay
WA2025-12-17

Inquest into the Death of Child RK (Name Subject to Suppression Order)

14y · Female·ligature compression of the neck (hanging)

Child RK, aged 14, died by suicide while in Department of Communities care at a therapeutic residential group home on 20 April 2022. She had…

paediatricsgeneral practicecommunicationsystemmelatonin
QLDhome2010-03-05

Child at Mackay

15y · Female·Ligature compression of the neck (hanging)

A 15-year-old Aboriginal girl died by suicide by hanging on 29 November 2007. She had a transient lifestyle with unstable housing, moved frequently bet…

paediatricspsychiatrysystemdelayalcohol
NThome2024-06-27

Inquest into the death of Grace

13y · Female·Self-inflicted single gunshot wound to the chest

…ember 2021, but this disclosure was not adequately responded to. Key clinical lessons include: inadequate suicide risk assessment using unstructured methods without documented frameworks; failure to conduct safety plann…

psychiatrypaediatricsdiagnosticcommunication
VIC2016-12-13

Finding into death of Finding

16y · Female·mixed drug toxicity (oxycodone, citalopram, fluoxetine and quetiapine)

…sought before placement decisions; face-to-face communication of decisions affecting emotionally fragile adolescents is essential; and therapeutic rather than standard residential facilities are needed for complex cases.…

psychiatrypaediatricscommunicationsystemoxycodone
SAcommunity2014-06-17

Coroner's Finding: HUGO-HORSMAN Jason William

15y · Male·compression of the neck consistent with hanging

…old in Year 10, died by hanging while alone at home on 9 October 2010. He had been referred to Child and Adolescent Mental Health Services (CAMHS) in December 2009 and saw various therapists, primarily social worker Vina…

psychiatrypsychologydiagnosticcommunicationdiazepam

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