Coronial

118 results for polysubstance abuse

WAcommunity2008-02-25

Inquest into the Death of Kimberley Coronial Report

Multiple causes across 22 deaths: ligature compression of the neck (17 hangings)…

…es increased dramatically in 2006 (100% increase), with deaths strongly correlated to alcohol and cannabis abuse. The primary cause of death across most cases was ligature compression of the neck (hanging). The inquest …

public healthpsychiatrysystemdelayalcohol
VIC2016-11-22

Finding into death of Mahmoud Taiba

36y · Male·Hanging

A 36-year-old male prisoner with complex psychiatric history, substance use disorder, and recent cancer diagnosis died by hanging in prison. Recent mental health assessments (within 3 days) had classified him as low suic…

psychiatrycorrectional healthcommunicationsystemolanzapine
NSWhome2025-05-09

Inquest into the death of Malcolm Brown

33y · Male·sharp force injuries of the neck

Malcolm Brown, a 33-year-old Aboriginal man with a history of methamphetamine use, mental health crisis, and self-harm threats, died from sharp force injuries to his neck on 29 June 2022 following a NSW Police operation.…

psychiatrytoxicologycommunicationdelaymethamphetamine
VICmental health2012-10-12

Finding into death of Grant Elliot Phillips

29y · Male·Multiple injuries sustained in a train incident (intentional self-harm)

Grant Phillips, 29-year-old with schizophrenia and complex psychiatric history including multiple suicide attempts, was admitted involuntarily to Broadmeadows Inpatient Psychiatric Unit on 5 May 2007. Despite being asses…

psychiatrydiagnosticsystemdextroamphetamine
QLD2025-10-08

Inquest into the death of Peter Owen Pilkington

48y · Male·gunshot wound to chest

Peter Owen Pilkington, 48, died from a gunshot wound sustained during a police siege on 6 December 2021. After escalating behaviour at his NDIS support office in Stretton, Queensland, Peter produced what police believed …

emergency medicinetrauma surgerysystemmethamphetamine
QLDmental health2013-01-25

SH and AW

25y · Female·Chest injuries due to fall from height

…ats; failure to assess deteriorating mental state; lack of structured behavioural programmes for substance abuse; inappropriate facility unsuitable for long-term rehabilitation; and inability to enforce leave restrictio…

psychiatrydiagnosticcommunicationhaloperidol
NSWhospital2026-01-22

Inquest into the death of JC

30y · Male·hanging

JC was a 30-year-old with a long history of benzodiazepine dependence and previous psychiatric episodes triggered by withdrawal. He presented to Calvary Mater Hospital after a deliberate overdose of 48 Etizolam tablets w…

emergency medicinepsychiatrydiagnosticcommunicationetizolam
WA2000-04-07

Inquest into the Death of Kenneth John Groth

47y · Male·Ligature compression of the neck (hanging)

Kenneth John Groth, aged 47, died by hanging in Casuarina Prison on 9 April 1998. He was a sentenced prisoner convicted of sexual offences, serving a 10-year sentence. His appeal was adjourned and legal aid was refused, …

psychiatrycorrectional healthdiagnosticfluoxetine
NTPodcast2001-10-15

Inquest into the death of Bryan G (aka) Abell Dallos

25y · Male·multiple injuries sustained in aircraft crash

Bryan G (Abel Dallos), a 25-year-old man with longstanding paranoid schizophrenia and treatment resistance, died in an aircraft crash after stealing an unlocked Piper Warrior from Alice Springs Airport and attempting to …

psychiatryaviation medicinecommunicationsystemhaloperidol
NSWmental health2019-11-29

Inquest into the death of Harold EDWARDS (a pseudonym)

49y · Male·Hanging

A 49-year-old man with major depression, suicidality and previous suicide attempts was admitted to the Acute Mental Health Unit at Nepean Hospital under involuntary detention. He died by hanging on 27 May 2017 during an …

psychiatrydiagnosticcommunicationtemazepam
NSW2018-07-13

Inquest into the death of Fenika Junior Tautuliu Fenika (Junior Fenika)

24y · Male·Massive blood loss caused by incised wounds of left upper extremity

A 24-year-old man with schizophrenia and psychotic symptoms died from massive blood loss after self-inflicted wrist lacerations in prison custody. He called for help twice via the cell alarm system at 9:17pm and 9:23pm, …

psychiatryemergency medicinecommunicationsystemamisulpride
NSW2017-08-31

Inquest into the death of David WOTHERSPOON

31y · Male·Hypoxic encephalopathy caused by neck compression due to hanging

David Wotherspoon, a 31-year-old Aboriginal man with schizophrenia, died from hypoxic encephalopathy following hanging in a prison mental health unit. Despite being psychotic and refusing medication, he was not transferr…

psychiatrycorrectional healthsystemcommunicationrisperidone
QLD2015-05-28

Vetters, Farrin John

26y · Male·Neck compression from hanging

A 26-year-old man died by hanging in his correctional centre cell on 26 October 2011. He had a history of mixed personality disorder, anxiety, opiate dependence and previous suicide attempt (age 13), but was not assessed…

psychiatrycorrectional healthsystemcommunicationfluvoxamine
WA2025-06-12

Inquest into the Death of Sam Phillip Chisholm LYNCH

27y · Male·effects of fire

Sam Lynch, aged 27, died from effects of fire while in remand at Hakea Prison on 5 March 2024. Following a dispute over undelivered canteen items, Sam set his mattress ablaze with a lighter. The response was catastrophic…

systemcommunicationdiazepam
WA2005-01-14

Inquest into the Death of Hendrik Jan Groothedde

39y · Male·Ligature compression of the neck (hanging)

Hendrik Jan Groothedde, a 39-year-old remand prisoner at Hakea Prison, died by ligature compression of the neck (hanging) on 31 January 2003. He had been admitted to custody in December 2002 following stabbing an ex-girl…

psychiatrycorrectional healthcommunicationsystemantidepressants
VIChospital2023-05-16

Finding into death of Mathew James Luttrell

43y · Male·Hanging

…a 43-year-old Aboriginal man with borderline personality disorder, chronic suicidal ideation and substance abuse, was admitted to Mildura Base Hospital following a suicide attempt on 11 November 2018. He was placed on a…

psychiatryemergency medicinecommunicationdelayolanzapine
TAS2023-07-05

Coroner's Finding: Crump, Damian Michael

36y · Male·Mixed prescription drug toxicity (morphine, lignocaine, amiodarone and midazolam…

Damian Crump, aged 36, was an intensive care paramedic with Ambulance Tasmania who died by suicide on 23 December 2016 by deliberately consuming fatal quantities of morphine, lignocaine, amiodarone and midazolam stolen f…

paramedicinepsychiatrysystemdelaymorphine
NSWprison2021-11-19

Inquest into the death of Danny Whitton

25y · Male·Multiple organ failure due to acute paracetamol poisoning

Danny Whitton, a 25-year-old Aboriginal prisoner at Junee Correctional Centre, died from acute paracetamol toxicity causing multi-organ failure. He presented to the prison medical clinic on 5 November 2015 with vomiting …

emergency medicinetoxicologydiagnosticcommunicationparacetamol

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