Coroner's Court of Western Australia

Inquest into the Death of Nicholas Arthur CRIPPS

Inquest into the Death of Nicholas Arthur CRIPPS

Delivered on : 28 June 2023

Delivered at : Perth

Finding of : Coroner Jenkin

Recommendations : No

Orders/Rules : No

Suppression Order : N/A

Summary : Mr Nicholas Arthur Cripps (Mr Cripps) was 47-years of age when he was found deceased in his home in Doubleview on 31 May 2021.  Following a post mortem examination, the coroner determined that Mr Cripps died from combined acute effects of multiple drugs in obese man with enlarged heart and arterial hypertension.

Mr Cripps had an extensive mental health history and was diagnosed with treatment resistant schizophrenia and anti-social personality disorder.  The management of Mr Cripps’ mental health issues was complicated by his non-compliance with prescription medication, and by his persistent polysubstance use, including methylamphetamine, alcohol and cannabis.

For about 10 years, Mr Cripps had been successfully treated with clozapine, an antipsychotic medication regarded as “the gold standard” for treatment resistant schizophrenia.  Patients using this medication must submit to monthly blood tests to monitor side effects and Mr Cripps stopped taking clozapine in March 2003 because he refused to have the required blood tests.

At the time of his death, Mr Cripps was the subject of a community treatment order (CTO) and was under the care of a community psychiatric service.  His complex needs were managed by means of a fortnightly depot injection of antipsychotic medication, which Mr Cripps often declined.  As he was on a CTO, Mr Cripps was obliged to receive treatment, and when he refused his depot injection he was taken to Graylands Hospital (GH) by police.  Once at GH, Mr Cripps invariably accepted the depot injection and was discharged after a few days.

A CTO was required in Mr Cripps’ case because he was non-compliant with his medication, lacked insight into his mental health conditions and lacked the capacity to make treatment decisions about his mental health.  The coroner was satisfied that the decision to place Mr Cripps on successive CTOs was justified on the basis that this was the least restrictive way to ensure that Mr Cripps was provided with appropriate treatment for his mental health conditions.

Mr Cripps may have benefitted from a long-term admission to a facility where his mental health and polysubstance use issues could have been tackled together, however, no such facility was available.  Since Mr Cripps’ death, a facility known as a secure extended care unit (SECU) has been designed for the treatment of patients with severe and chronic mental health illnesses who have co-occurring polysubstance use issues and/or challenging behaviours.  A SECU is being planned for the Bentley Hospital Campus, and would provide treatment on an involuntary basis with the aim of transitioning patients into a “community care unit”, which would offer long-term treatment, rehabilitation and recovery care.

The coroner concluded that Mr Cripps’ management while he was an involuntary patient at GH, and in the community whilst he was the subject of a CTO, was reasonable when considered in the context of the resources available to clinicians at the relevant time.

Catch Words : Community Treatment Order Death : Treatment Resistant Schizophrenia : Co-existing Mental Health Conditions and Polysubstance issues : Long-term Treatment Options : Accident

Last updated: 6-Jul-2023

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