Man visited hospital days before death
A man went to Waikato Hospital’s emergency department after a mental health incident but was not seen by a doctor, and was found dead days later, a court has heard.
Hamilton man Liam Jacob Phillips, 24, was found dead at his home on August 9, 2016, and a three-day coronial inquest is now looking into the circumstances of his death.
On the first day of the hearing on Monday, coroner Louella Dunn says the inquest would investigate the psychiatric care Liam received before his death, his treatment in Waikato Hospital’s emergency department, and the exact cause and circumstances of his death.
Liam was a talented footballer, having played in national youth teams and received a scholarship for the sport.
But in 2014, he developed a pulmonary embolism, suffering severe and chronic pain, and was on a variety of pain medications to treat that, inquest officer senior Constable Lisa Herewini says.
He suffered from an anxiety disorder, had been self-harming and developed an addiction to opioid medication.
Liam had spoken to his GP about his pain and anxiety, and had been seeing a clinical psychologist at the pain clinic in 2016. He had also been seeing a local counsellor about his anxiety.
Several weeks before his death, on July 18, Liam was referred to Waikato DHB’s mental health crisis team by his GP.
He was seen by mental health crisis registrar Dr Angelina Yue and associate charge nurse Glen Horrack for mental health assessments.
They prescribed non-addictive, anti-anxiety medication and spoke to Liam about over-medicating, and a plan for ongoing care, but did not deem Liam to be at high risk of suicide.
He was discharged to community mental health services for follow-up appointments.
On August 6, Liam went to Waikato Hospital’s emergency department after 11pm following a mental health incident.
A nurse completed a partial assessment of him while he was there, but he was not seen by a doctor, and after waiting several hours he discharged himself in the early hours of the morning.
Angelina says she was “concerned” Liam had arrived at ED but hadn’t been seen by a doctor.
“I am concerned he was left waiting when he had voiced about his risk and hadn’t been seen by a psychiatric person, someone from the mental health team.
“Especially when he stuck to the risk management plan, he stuck to the safety plan, he rang for help, he did everything that he agreed to do with us in his joint planning around safety … I am very sad to hear he wasn’t seen that night in ED.”
She says she would have expected ED staff to contact a mental health doctor after Liam arrived, but she was not sure whether they could access his mental health notes.
“You’d seen Liam on two occasions … he indicates to you at the last meeting on 28 July that he’s still self-harming and has on and off suicidal thoughts, but doesn’t act on them. Does that presentation concern you given his ultimate discharge?” the coroner asks.
Angelina says the usual process for dealing to self-harm was to arrange community care for ongoing psychological help, and Liam did not express “a plan” for suicide.
Clinical psychologist Dr Karma Galyer saw Liam in 2016 at the pain clinic due to his pulmonary embolism condition.
She says Liam’ physical pain and anxiety had returned in 2016, though she understood he had suffered anxiety since about 14 years old.
Karma says Liam was dealing with addiction, overusing medication and relying on recreational drugs, as a way to manage anxiety and pain.
He had to stop playing soccer in 2016 due to medication for his condition, which had taken a toll.
“When he was playing soccer, things like anxiety and pain and drug regulation was better.”
Despite this, Karma says Liam was a young man with a “positive outlook on life” throughout treatment.
He had goals and hopes about an upcoming treatment for his condition and engagement to his fiancé, though he struggled with intense moments of anxiety, she says.
She thought he did not present to mental health services as consistently distressed or suicidal.
“This is a young man who liked his job, wanted to be better at it … he was intending to get married.”
The inquest continues.
Where to get help
1737, Need to talk? Free call or text 1737 any time for support from a trained counsellor
Lifeline – 0800 543 354 or (09) 5222 999 within Auckland
Youthline – 0800 376 633, free text 234 or email email@example.com or online chat
Samaritans – 0800 726 666
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
What's Up – 0800 942 8787 (for 5–18 year olds). Phone counselling is available Monday to Friday, midday–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.
Kidsline – 0800 54 37 54 (0800 kidsline) for young people up to 18 years of age. Open 24/7.
thelowdown.co.nz – or email firstname.lastname@example.org or free text 5626
Anxiety New Zealand - 0800 ANXIETY (0800 269 4389)
Rural Support Trust - 0800 787 254 (0800 RURAL HELP)
Supporting Families in Mental Illness - 0800 732 825