A CORONER has found a Maryborough Correctional Centre prisoner who hanged himself in his cell had received adequate psychiatric care before his death.
Charles Kingston Hurst, 38, used a laundry bag and a sheet to take his own life.
He was found dead in the early hours of November 7, despite the fact that he was being monitored every two hours by prison officers.
In his findings, State Coroner Terry Ryan said the prisoner had been placed in the safety unit in the months before his death after he told officers at the correctional centre he was feeling suicidal.
Mr Ryan said before his suicide, Mr Hurst had never attempted suicide or self-harmed during his incarceration but he told prison staff he had a "history of suicide attempts" outside the prison.
Mr Hurst had been in and out of prison throughout his life and had been diagnosed with schizophrenia, depression and anxiety.
When he failed to comply with the terms of his parole, Mr Hurst was returned to the correctional centre in August.
He initially suffered severe withdrawal symptoms from alcohol and drugs.
He was referred to the prison's Mental Health Service and was seen regularly by Dr Vikram Goel from September 17, 2012.
On August 10, Mr Hurst approached a Corrective Services Officer stating he was delusional, hearing voices, sweating and shaking. He said he was having suicidal thoughts.
A Notice of Concern was generated and when he was assessed, Mr Hurst was found as being at "medium" risk of suicide or self-harm.
He was again assessed in October after he received news that his uncle had died and, as part of his medium risk classification, Mr Hurst was observed on an hourly basis.
A meeting on November 5 resulted in Mr Hunt's risk classification being changed to "low".
That meant he would be observed every two hours and he was returned to his unit on November 6.
Mr Hurst was locked in his cell just before 6pm on November 6 and when he was checked about 12.55am, a prison officer saw him roll over on his bed.
About 2.25am, another officer checked on Mr Hurst and found him hanging.
A code blue medical emergency was called and nursing staff attended promptly, but Mr Hurst was declared dead at the scene.
Mr Ryan said he considered the quality of psychiatric care provided by the Prison Mental health Service was adequate and commensurate with what Mr Hurst might have expected to receive in the community.
He was also satisfied the centre's "at risk" procedures were applied properly and to a high standard.
Mr Ryan found the design of the laundry bags was clearly a failure which ultimately contributed to the ease with which Mr Hurst was able to take his own life.
But, he noted, the bags were withdrawn from all Queensland prisons after Mr Hurst's death and bags now use a zip mechanism rather than drawstrings to help prevent another tragic incident in the future.
If you or anyone you know needs counselling, phone Lifeline Australia's helpline on 131 114.