25y · Female·Compression of the neck
…5-year-old woman, died by suicide via neck compression while intoxicated. She had a history of substance misuse (cocaine, alcohol), anxiety treated with Zoloft, and was taking alprazolam. On the morning of her death, sh…
26y · Male·acute cocaine and alcohol toxicity
AAB, a 26-year-old man with a history of substance abuse and mental health issues, died from acute cocaine and alcohol toxicity while in police custody. He presente…
44y · Male·multiple injuries from fall from cliff
A 44-year-old man with familial Mediterranean fever (FMF) and bipolar affective disorder with drug-induced psychosis died following a fall from a cliff at Vaucluse during a police rescue operati…
46y · Male·neck compression due to hanging
…suicide attempt by hanging (1997), prior suicidal ideation presentation (2021), and chronic methamphetamine use. Despite appearing compliant and reporting no mental health concerns on 7 March 2022, toxicology revealed c…
20y · Male·Mixed drug toxicity (ethanol, cocaine, etizolam, diazepam, nordiazepam and oxyco…
Ryan Chisholm, a 20-year-old with a history of substance abuse and mental health concerns including anxiety and depression, died from mixed drug toxicity after consuming …
26y · Male·Drug toxicity (1,4 butanediol, gamma hydroxybutyrate, methylamphetamine, cocaine…
…ck Atkinson, 26 years old, died from mixed drug toxicity involving GHB/1,4-butanediol, methylamphetamine, cocaine, novel benzodiazepines (bromazolam, flubromazepam), nordiazepam, and ketamine. He had a history of substa…
48y · Female·Mixed drug toxicity (morphine, codeine, venlafaxine, amitriptyline and zopiclone…
A 48-year-old woman with depression, anxiety, and bipolar disorder died from mixed drug toxicity while on voluntary inpatient psychiatric admission. She had undisclosed sig…
56y · Female·acute pentobarbitone toxicity
…r Sydney apartment on 27-28 May 2016. She had a long history of mental health issues, depression, substance use, and prior self-harm. She had recently obtained pentobarbitone from Mexico via internet, which her partner …
33y · Male·multiple gunshot wounds to the head, trunk and limbs
Daniel King died following multiple gunshot wounds sustained during a police operation. He had acquired a firearm and attended three locations in western Sydney, discharging it before arriving at Penrith Police Station w…
19y · Male·Multiple injuries sustained on a train impact (pedestrian)
…f mental ill health including depression, psychotic symptoms, and suicidal ideation, alongside substance misuse involving methamphetamine, cannabis, cocaine, and alcohol. He was enrolled in the Headspace Youth Early Psy…
31y · Male·Gunshot wounds to the neck and chest
…rontation at his estranged partner's parents' home in Queensland. He had a history of violence, substance abuse (methamphetamine, cocaine), and untreated mental health issues including drug-induced paranoia. Despite rep…
45y · Male·bronchopneumonia and combined drug toxicity
…is Drleski, a 45-year-old with treatment-resistant chronic paranoid schizophrenia, antisocial personality disorder, and polysubstance use disorder, died from bronchopneumonia and combined drug toxicity. He was managed in…
26y · Female·Multiple stab wounds
ZSQ, a 26-year-old woman, was fatally stabbed by her intimate partner MJD in April 2020 after a relationship marked by escalating family violence. Critical clinical and systemic lessons include: (1) Recognition of intima…
19y · Male·mixed drug toxicity (methadone and diazepam)
… male died from mixed drug toxicity following ingestion of illicit methadone and diazepam. He was a regular user of illicit substances and prescription medications obtained without medical supervision. He had anxiety ma…
28y · Male·Multiple head, facial and spinal injuries sustained in a single vehicle motorbik…
… (benzodiazepines, opioids, antidepressants). Key clinical lessons: (1) Mr Tyrrell had documented substance use disorder with clear drug-seeking behaviour recognised by most treating doctors; (2) prescribing of multiple…
31y · Male·Mixed drug toxicity (heroin, bromazolam, metonitazine, protonitazene, methamphet…
Ryan Robinson, a 31-year-old man with longstanding opioid use disorder and complex mental health conditions, died from mixed drug toxicity involving heroin, novel psycho…
27y · Female·Hanging
… a 27-year-old woman with a long history of borderline personality traits, depression, anxiety and eating disorder, died by hanging on 17 May 2020. In the preceding two weeks, she presented to Alfred Hospital following a…
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 at Albany Regional Prison on 10 Augus…
36y · Male·multiple injuries consistent with a fall from a height
A 36-year-old man with severe depression, social isolation, and recent life crises (job loss, marital breakdown, reduced child contact) posted suicidal messages on social media and stood on a cliff ledge. Police negotiat…
27y · Male·suicide by hanging
Luke Anthony Rich, age 27, died by suicide by hanging in a prison cell in the Alexander Maconochie Centre (ACT) on 1 February 2022, one day after being remanded in custody on domestic violence allegations. The coroner fo…
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