Coroner's Court of Western Australia

Inquest into the Death of Stephen Kenneth SHERWOOD

Inquest into the Death of Stephen Kenneth SHERWOOD

Delivered on : 11 September 2024

Delivered at : Perth

Finding of : Coroner Urquhart

Recommendations :N/A

Orders/Rules : N/A

Suppression Order : N/A

Summary : On or about 13 April 2022, Stephen Kenneth Sherwood (hereafter referred to as Stephen at his family’s request) died from ligature compression of the neck (hanging). He was 31 years old.

Although Stephen’s death was a reportable death under the Coroners Act 1996 (WA) (the Act), an inquest into his death was not mandatory. However, the State Coroner determined an inquest was desirable under section 22(2) of the Act to examine the circumstances of the death within the context of a 72-hour Police Order that had been imposed on Stephen on 12 April 2022.

In the four years before his death, Stephen had several presentations to EDs of hospitals when affected by methylamphetamine. He was diagnosed with drug-induced psychosis and encouraged to seek professional help to address his illicit drug use, which he did not do.

On 30 March 2022, Stephen self-harmed by cutting his wrist. He was taken by ambulance to St John of God Midland Hospital where he told health service providers that he had been feeling suicidal recently. Against medical advice, he left the hospital in the early hours of 31 March 2022.

On the night of 3 April 2022, Stephen and his partner unexpectedly arrived at his parents’ house in Narembeen with an intention to stay there.  Several hours later, his mother contacted police as he had threatened to kill himself with some knives. Police attended and spoke to Stephen who said he did not want to go to hospital and just wanted to go to bed. Before leaving, the police officers arranged for Stephen to have telephone contact with MHERL (the Mental Health Emergency Response Line).

On the afternoon of 12 April 2022, Stephen did not attend an appointment in Narembeen with a psychiatrist and his case manager that had been arranged by the Wheatbelt Mental Health Service.

At 5.19 pm on 12 April 2022, police were requested to respond to a family violence incident in which Stephen had allegedly hit his partner on the elbow with an axe handle. Due to the unavailability of the two police officers stationed at Narembeen, two probationary constables from Merredin Police Station attended.

The probationary constables spoke to Stephen and his partner separately and issued Stephen with a 72-hour Police Order which prevented him from having any contact with his partner for that length of time. As his partner did not want Stephen charged, he was not arrested, and the probationary constables retuned to Merredin.

That night, Stephen was by himself at his parents’ house as they were away on holidays. He was found the next morning hanging from a rope that had been placed around a rafter of the rear verandah of his parents’ house.

The Coroner was satisfied that Stephen had given no indication to the probationary constables that he was suicidal or had thoughts of self-harm. Apart from a missed opportunity to contact MHERL, the Coroner was also satisfied that the two probationary officers acted appropriately in their investigation of the family violence incident and the manner in which they interacted with Stephen.

In addition, the Coroner was satisfied with the level of supervision that the sergeant from Narembeen Police Station had provided to the probationary constables during the course of their investigation into the family violence complaint.

Although the Coroner did not find that the actions of the two probationary constables contributed to or caused the death of Stephen in any way, he remained concerned about the partnering of inexperienced police officers, particularly probationary constable, for operational duties. However, as the Coroner’s previous recommendations regarding this topic had not been endorsed by the police (including one made only three months ago), he concluded it would be an exercise in futility to make the same recommendation again.

Catch Words : Police response to mental health : Suicide


Last updated: 12-Oct-2024

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