Coronial

402 results for suicide risk high

VICcommunity2021-03-10

Finding into death of Jack David watson

26y · Male·Plastic bag asphyxia in the setting of a vitiated atmosphere with inert gases

…re he was treated under a Temporary Treatment Order, he was discharged on voluntary basis despite ongoing suicide risk and concerning statements to his father about manipulating doctors. The transfer to Alfred Health wa…

psychiatryemergency medicinecommunicationsystemdextroamphetamine
VIC2014-10-02

Finding into death of Jayson Peter Hawkins

37y · Male·hypoxic brain injury secondary to airway obstruction

…lastic bag and ligature in his cell. Key issues included inadequate prevention of access to plastic bags in high-risk units despite suicide and self-harm risk protocols in place. Unit 8 was not compliant with procedures …

emergency medicineintensive caresystemprocedural
NSWmental health2024-03-06

Inquest into the death of RA

64y · Female·hypoxic ischemic encephalopathy caused by neck compression and hanging

…epression was admitted to an acute mental health unit (Kurrajong Unit) under involuntary care following a suicide attempt. Within 24 hours, she accessed a cord/drawstring and died by hanging. The death occurred in the c…

psychiatryemergency medicinesystemproceduralmirtazapine
VICpsychiatric inpatient unit2020-01-31

Finding into death of Damon Brenden Amiet

25y · Male·Injuries sustained when struck by a train (suicide)

…sonality traits, was admitted to a psychiatric inpatient unit (IPU1) on 12 April 2013 following a serious suicide attempt by hanging. He died the next day after being struck by a train. Critical deficiencies were identi…

psychiatryemergency medicinecommunicationsystemolanzapine
VIChospital2012-01-31

Finding into death of Lee Patrica Collings

51y · Female·Multiple injuries sustained when struck by a car while lying on the Mornington P…

Lee Collings, 51, died by suicide after absconding from an Emergency Department. She presented with suicidal ideation and was triaged as Me…

emergency medicinepsychiatrycommunicationsystemsodium valproate
VICcommunity2015-05-29

Finding into death of Craig Doherty

49y · Male·Multiple injuries from a fall from height

Craig Doherty, a 49-year-old man with Bipolar Affective Disorder and significant alcohol use, died by suicide on 14 January 2013. He had been admitted involuntarily to hospital in August 2012 for quetiapine overdose…

psychiatrygeneral practicelithium
VICmental health2014-01-23

Finding into death of Kate Tamma Miller

39y · Female·hanging

…g at The Melbourne Clinic on 11 October 2011. She had severe borderline personality disorder with recurrent high-lethality suicide attempts and chronic self-harm urges. A shared care arrangement between TMC and Alfred Ho…

psychiatryintensive caresystemdiazepam
VIChome2013-10-07

Finding into death of Imanthi Mayakaduwage

17y · Female·Hanging

Imanthi Mayakaduwage, a 17-year-old high-achieving international student from Sri Lanka, died by suicide via hanging on 5 May 2012. She had document…

general practicepsychiatrydiagnosticcommunication
NSWhospital2021-06-11

Inquest into the death of Sam Cain (a pseudonym)

23y · Male·hanging

…23-year-old male with treatment-resistant schizophrenia died by hanging while an involuntary patient in the High Dependency Unit of Royal North Shore Hospital. He presented acutely on 4 February 2019 with severe suicidal…

psychiatryemergency medicinecommunicationsystemaripiprazole
NSWhome2017-03-30

Inquest into the death of John Inman BALE

60y · Male·single gunshot wound to the head, self-inflicted

…his decision was made and terminated the call abruptly—a critical moment described as 'completion' of the suicide act. Contact was never re-established. The deceased died by gunshot within hours. The coroner found no po…

psychiatryemergency medicinecommunicationsystemolanzapine
SAmental health2002-01-03

Coroner's Finding: PETTITT Randall John

34y · Male·neck compression due to hanging

…st-September 1999 with active suicidal ideation and homicidal thoughts. Although inpatient treatment was of high standard, discharge planning was critically flawed. He was discharged on Saturday 4 September after only on…

psychiatrygeneral practicecommunicationsystemfluoxetine
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 h…

general practicepsychiatryantidepressant_medication
WA2026-03-13

Inquest into the Suspected Death of PARBHAT

24y · Male·unknown cause (fall from cliff at The Gap, Torndirrup National Park, resulting i…

…ng savings, mounting debts, and no prospect of supporting himself or his family in India, Parbhat died by suicide. The coroner found he walked to a cliff edge in darkness after heavy alcohol consumption and fell into th…

SAmental health2000-04-28

Coroner's Finding: SCOTT Laurie Joseph

53y · Male·asphyxia due to upper airway occlusion by a foreign body (blanket)

…epression, intellectual disability) died by asphyxiation after stuffing a blanket into his mouth while in a High Dependency Unit of a psychiatric hospital. He was detained under the Mental Health Act and being actively t…

psychiatryemergency medicinethioridazine
QLDhome2014-06-13

Mahlo, Karen Lee

52y · Female·stab wound to the chest

…ered major depressive disorder since 2006, was being treated by psychiatrist Dr F., and had made previous suicide attempts. The inquest concluded she intended her own death while severely distressed, alcohol-affected, a…

psychiatrygeneral practicecitalopram
WAhome2017-03-30

Inquest into the Death of Troy William MURRAY

34y · Male·ligature compression of the neck (hanging)

…istory of substance abuse (primarily amphetamine and alcohol), psychiatric illness, and multiple previous suicide attempts, died by hanging on 11 March 2012. He had been prescribed benzodiazepines (Valium, Xanax) and co…

psychiatrygeneral practicecommunicationamphetamine
VICmental health2014-10-07

Finding into death of Warren Guneratne

25y · Male·consistent with drowning in a man with multiple injuries

…id delusions, and recent illicit drug use. He was admitted to the Low Dependency Unit (LDU) rather than the High Dependency Unit despite documented high-risk presentation. Critical communication failures occurred: the mo…

psychiatryemergency medicinecommunicationsystemclozapine
VIC2021-04-28

Finding into death of Mohamed Omar

30y · Male·neck compression

…ession while on remand. He had a history of command auditory hallucinations instructing self-harm, recent suicide attempts, and polysubstance abuse. Despite appropriate clinical management by Forensicare including medic…

psychiatrycorrectional healthflupenthixol depot injection
VIChome2011-08-15

Finding into death of James Martin Todd

41y · Male·Neck compression subsequent upon hanging

…essants, and had completed an initial psychological assessment. Clinical lessons include: the importance of risk stratification in patients with suicidal thoughts and recent gestures; consideration of more intensive inte…

general practicepsychiatrysystemdelayparoxetine
VIC2022-07-15

Finding into death of Noel Thomas

42y · Male·hanging

Two prisoners at Karreenga Correctional Centre died by suicide within four months of each other. Mr Lowe, aged 35, hanged himself on 7 March 2017 after learning his pri…

psychiatrycorrectional healthsystemcommunication

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.