CORONER’S INQUEST

The following is an overview of the findings on 13 tragic deaths of young people in Western Australia. The contents may be distressing to some readers.

A 373 page report detailing the Inquest into the deaths of thirteen children and young people in the Kimberley Region of Western Australia was delivered in February 2019, following an inquest hearing which was conducted between June and September 2017.

The Coroner’s Court stated that the 13 deaths, which occurred between 2012 and 2016, “were investigated at the one Inquest because there were similar circumstances, life events, developmental experiences and behaviours that appear to have contributed to making them vulnerable to suicide.” The Coroner wrote that “the recommendations are aimed at preventing deaths occurring in similar circumstances, through healing and supporting communities that have been marginalised and disadvantaged over generations.”

The Coroner reported that FASD was likely to have played a part in some of these youth suicides, stating “I have not found that any of the children and young persons had FASD but a number of them were clearly vulnerable to the development of this disorder. Further, whilst none had been diagnosed with FASD, the circumstantial evidence would suggest that a number of them were likely to have been on the spectrum for FASD.”

The report makes 42 recommendations aimed at preventing similar deaths in the future. The first six recommendations concern taking action on FASD, and are listed below:

 Recommendation 1 – FASD and screening

1. that there be universal screening for FASD at the following points: during infant health assessments and upon a child entering into the child protection system or justice system for the first time;
2. that all children identified as at risk of neurodevelopmental impairment on the basis of antenatal exposure to alcohol or early life trauma be assessed by a paediatrician for developmental and 830 ts 287 to 288. 831 ts 288 to 289. 832 ts 737. Inquest into the deaths of thirteen children and young persons in the Kimberley Region, Western Australia Page 268. behavioural impairments at the age of one year and in the year prior to school entry;
3. in respect of a child entering the child protection system for the first time in addition to FASD universal screening:
   • that preliminary assessments and screening be undertaken by Department of Communities’ district psychologists;
   • that referrals be made for comprehensive IQ and functional capacity assessments where and when required by presentation and behaviours; and
   • that there be referrals to other treatment and therapy services for trauma-related developmental and behavioural issues, including mental health issues, impulsivity, and harmful sexual behaviours, that may or may not include cognitive impairments and neuro-disabilities such as FASD.

Recommendation 2 – FASD and NDIS

1. that neurodevelopmental impairment (an umbrella term which includes behavioural, developmental and cognitive impairments) incorporating the criteria defined in the Australian Guide to the diagnosis of FASD be recognised as a disability within the National Disability Insurance Scheme (“the NDIS”);
2. that where FASD has actually been diagnosed at the appropriate level of severity, it is separately recognised as a disability within the NDIS.

Recommendation 3 – FASD and Medicare item number

That consideration be given to whether appropriate Medicare Benefits Scheme item numbers ought to be allocated for FASD

Recommendation 4 – FASD and diagnostic capacity

That consideration be given to additional funding for primary care services in areas with a high burden of neurodevelopmental impairment to increase diagnostic capacity for complex conditions including FASD, and to respond to the diagnosis by way of therapeutic services for children and young people diagnosed with FASD.

Recommendation 5 – “Making FASD history”

That there be Government funding to extend to other regional centres in the Kimberley the “Making FASD History” project that ran in the Fitzroy Valley, adapted as appropriate to the prevailing circumstances of those communities.

 Recommendation 6 – FASD education campaigns

That education campaigns be conducted in all secondary schools in Western Australia to alert students to

• the dangers of consuming alcohol during pregnancy and
• the prevalence of FASD (with a culturally relevant education campaign for Aboriginal children).

Follow this link to read the full report.

Aboriginal & Torres Strait Islander Social Justice Commissioner June Oscar has called on the Government to implement all the recommendations made by the Coroner.

FASD and suicide risk

Limited research has been conducted into rates of suicide amongst those with FASD, however in one study Thanh and Jonsson (2016) found that suicide was the leading cause of death for those with Fetal Alcohol Syndrome (FAS). Huggins, Grant, O’Malley and Streissguth (2008) calculated that adults with FASD are 5 times more likely to attempt suicide than those in the general US population, and Streissguth, Barr, Kogan and Bookstein (1996) reported that over 10% of individuals with FASD in the 12-20 year age bracket had attempted suicide and over 20% of adults had attempted suicide.

The increased risk of suicide for those with FASD is attributed to a range of factors including experiences of abuse and victimization, poor executive functioning, impulsivity, and secondary conditions such as mental illness, substance misuse, social isolation, and contact with the criminal justice system (Salvatore, Brown, Martindale, & Harr, 2016). Missed diagnosis and a lack of community understanding could also be contributing factors.

Early recognition and diagnosis of FASD with appropriate management and intensive family support is a strong protective factor, with individuals being 2 to 4 times less likely to develop secondary conditions if they are diagnosed before the age of 12 (Streissguth et al., 2004).

If you are concerned about the wellbeing of yourself or someone in your family please reach out for support. The following helplines are not necessarily FASD-informed but are valuable supports for those experiencing mental health difficulties or suicidal thoughts.

Lifeline 13 11 14

Suicide Call Back Service 1300 659 467

Kids Helpline 1800 55 1800

MensLine Australia 1300 78 99 78

Beyond Blue 1300 224 636

Emergency 000

You may also call NOFASD on 1800 860 613 to discuss FASD questions and concerns.

Read more NOFASD Australia blogs here.

References

Huggins, J. E., Grant, T., O’Malley, K., & Streissguth, A. P. (2008). Suicide Attempts among Adults with Fetal Alcohol Spectrum Disorders: Clinical Considerations. Mental Health Aspects of Developmental Disabilities, 11(2), 33.

Salvatore, T., Brown, J., Martindale, J., & Harr, D. (2016). Fetal Alcohol Spectrum Disorder (FASD) and Suicidal Behavior: An Introduction for Criminal Justice and Mental Health Professionals. Forensic Scholars Today, 2(1), 4.

Streissguth, A., Barr, H., Kogan, J., & Bookstein, F. (1996). Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) : final report. University of Washington School of Medicine, Dept. of Psychiatry and Behavioral Sciences: Center for Disease Control and Prevention. Retrieved from http://lib.adai.uw.edu/pubs/bk2698.pdf

Streissguth, A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D., O’Malley, K., & Young, J. K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Journal of Developmental and Behavioral Pediatrics: JDBP, 25(4), 228–238.

Thanh, N. X., & Jonsson, E. (2016). Life Expectancy of People with Fetal Alcohol Syndrome. Journal of Population Therapeutics and Clinical Pharmacology, 23(1), 53–59.