Coronial

157 results for chronic psychosis

VIChome2023-10-17

Finding into death of J H

15y · Male·Electrocution

JH, a 15-year-old with Autism Spectrum Disorder and Major Depressive Disorder, died by electrocution at home on 16 September 2019. He had been experiencing suicidal ideation for months and was discharged from inpatient p…

psychiatrypaediatricssystemcommunicationfluoxetine
WAprison2025-09-16

Inquest into the Death of Owen Duker Nugget WEAZEL

41y · Male·ligature compression of the neck (hanging)

Owen Weazel, a 41-year-old Wakka Wakka man with chronic mental health issues, substance use disorder and previous suicide attempts, was found hanging in his cell…

psychiatrypsychologysystemcommunicationamitriptyline
WA2012-01-12

Inquest into the Death of Brennan

38y · Male·Exsanguination due to penetration of arm veins

…resourced, preventing adequate stabilisation of forensic patients; release of un-medicated prisoners with chronic mental illness to community care poses significant risk; and consideration should be given to Community T…

psychiatrycorrectional healthsystemdelaylithium
WAmental health2015-11-30

Inquest into the Death of Frances May COOPER

48y · Female·Head injury

Frances May Cooper, a 48-year-old woman with chronic paranoid schizophrenia, died from head injuries after being struck by a train on 30 October 2011 while on…

psychiatryemergency medicineproceduralsystemrisperidone
NThospital2011-07-29

Inquest into the death of Nicholas Edward Spring

25y · Male·hanging

A 25-year-old university student with a complex history of schizoaffective disorder and substance misuse died by hanging during family leave from a mental health ward. He had been stable on depot antipsychotic medication…

psychiatryemergency medicinecommunicationsystemzuclopenthixol decanoate
WAprison2022-07-22

Inquest into the Death of Callum MITCHELL

26y · Male·ligature compression of the neck (hanging)

Callum Mitchell, aged 26, died by ligature compression of the neck (hanging) in his cell at Hakea Prison on 21 April 2019. He had a longstanding history of self-harm, severe personality disorders (borderline and antisoci…

psychiatrycorrectional healthsystemcommunicationtramadol
NSW2025-01-16

Inquest into the death of Tammy Michelle Shipley

47y · Female·hyponatraemia arising from primary polydipsia and complications of schizoaffecti…

Tammy Michelle Shipley, a 47-year-old Aboriginal woman with chronic schizoaffective disorder and bipolar disorder, died in custody on 20 December 2022 from hyponatraemia ari…

psychiatryemergency medicinediagnosticcommunicationbuprenorphine
VICpsychiatric inpatient unit2020-01-31

Finding into death of Damon Brenden Amiet

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

Damon Brenden Amiet, a 25-year-old with schizoaffective disorder, borderline personality disorder, and antisocial personality traits, was admitted to a psychiatric inpatient unit (IPU1) on 12 April 2013 following a serio…

psychiatryemergency medicinecommunicationsystemolanzapine
VIChospital2022-12-22

Finding into death of Paige Dent

25y · Female·Injuries sustained in a single vehicle motor vehicle incident in which Ms Dent w…

Paige Dent, 25, died in a single-vehicle motor accident after absconding from hospital on 6 October 2018. She had a 19-year history of psychiatric admissions for schizophrenia, borderline personality disorder, and substa…

psychiatryemergency medicinesystemcommunicationmethamphetamine
NSWmental health2019-11-22

Inquest into the death of David Dungay

29y · Male·cardiac arrhythmia

David Dungay, a 29-year-old Aboriginal man with chronic schizophrenia, type 1 diabetes, and obesity, died on 29 December 2015 in Long Bay Hospital's Mental Healt…

psychiatryemergency medicineproceduralcommunicationmidazolam
VIChospital2015-08-28

Finding into death of Moufid Sawan

61y · Male·Complications of cutaneous burns

A 61-year-old man with severe chronic schizophrenia and extensive history of arson, suicide attempts and self-harm was admitted as a voluntary …

psychiatryemergency medicinecommunicationdiagnosticrisperidone
NSWhome2025-06-24

Inquest into the death of Jade

3y · Female·Bilateral Bronchopneumonia (Streptococcus Pyogenes/Staphylococcus Aureus) with k…

…e child's respiratory infection progressed untreated for days, becoming fatal. Systemic failures included chronic caseworker shortages, premature case closure, delegating statutory responsibilities to non-government age…

paediatricspsychiatrydiagnosticcommunicationquetiapine
QLDmental health2013-07-02

Justin

35y · Male·Choking due to impaction of soap in airway

A 35-year-old man with treatment-resistant depression and complex psychiatric presentation died from choking on a bar of soap while in involuntary psychiatric care. He had attempted multiple suicides previously. Clinical…

psychiatryintensive caresystemcommunicationrisperidone
WAhospital2022-10-07

Inquest into the Death of Justine PAINTER

51y · Female·Multiple injuries sustained from a fall from the top floor of a multi-storey car…

Justine Painter, aged 51, died from multiple injuries sustained jumping from a multi-storey carpark while an inpatient at Royal Perth Hospital (RPH). She had severe treatment-resistant schizoaffective disorder, command h…

gastroenterologypsychiatrycommunicationsystempaliperidone
NSWmental health2026-02-05

Inquest into the deaths at Westfield Bondi Junction Executive Summary

41y · Male·Gunshot wounds to neck and chest (perpetrator Joel Cauchi); stab wounds (six vic…

On 13 April 2024, Joel Cauchi stabbed 16 people at Westfield Bondi Junction, NSW, fatally wounding six: Dawn Singleton, Jade Young, Yixuan Cheng, Ashlee Good, Faraz Tahir, and Pikria Darchia. Cauchi was shot and killed b…

psychiatrygeneral practicediagnosticcommunicationclozapine
WA2026-04-28

Inquest into the Death of Corey Desmond DEVREE

41y · Male·Ligature compression of the neck (hanging) and penetrating sharp force injury (s…

Corey Desmond Devree, aged 41, died by suicide in Bunbury Regional Prison on 14 October 2024 through ligature compression of the neck and a self-inflicted stab wound to the chest. Key clinical and systemic lessons includ…

psychiatrygeneral practicediagnosticcommunication
WAmental health2015-12-31

Inquest into the Death of Anthony Ian EDWARDS

Female·Multiple causes: Ruby Natasha Nicholls-Diver: ligature compression of neck (hang…

…ndividual management and risk assessment plans must be documented for all patients, especially those with chronic suicide risk; (2) Families/carers should be proactively contacted regarding discharge, not excluded on co…

psychiatryemergency medicinediagnosticcommunicationantidepressants
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