Warning: This story contains details which may be distressing for some readers.
- The court heard three children used volatile substances over an extended period
- They all had poor school attendances and were known to Territory Families
- Counsel assisting the coroner said all three were "denied treatment plans"
The family of a 12-year-old boy was told he was "too young" for rehabilitation three times in the year leading up to his death from petrol sniffing, the Northern Territory coroner's court has heard.
The child's death is one of three being examined at a joint inquest underway in Darwin, the second combined inquiry in a month called to cover the deaths of multiple young people and the failings of government agencies including health, education and child protection authorities.
At the inquest opening on Tuesday, the court heard the three children died in separate Arnhem Land communities — the 12-year-old and a 13-year-old boy as a result of petrol sniffing and a 17-year-old girl by suicide months after she was kicked out of rehab for unruly behaviour.
The children's families requested their full names not be used.
In his opening address, Counsel Assisting the Coroner Kelvin Currie said the inquest aimed to understand why the children were "unable to be assisted away from solvent abuse".
"There were multiple interactions with government departments due to the harm they were causing to themselves. None seemed successful in keeping them away from solvents for very long."
The court heard all three children had used volatile substances over an extended period, had poor school attendances and were either considered for rehab or attended rehab prior to their deaths.
'Nowhere' for child to get treatment
The inquest heard health staff did not immediately escalate the case of the then-11-year-old Master W to the Chief Health Officer (CHO) when residential rehab facilities repeatedly refused to admit him because of his young age.
Master W's family was told he was "too young" for treatment three times in six weeks.
Sarah Gobbert, then-operations manager for alcohol and other drugs on behalf of NT Health, said the staff flagged concerns that the child's health was "deteriorating" but there was "nowhere that we could actually place this child".
Christine Kelly, who at the time was a clinical nurse manager with NT Health, said the team "couldn't make a recommendation for mandated treatment because there was nowhere to make it to".
In the months that followed, the court heard Master W grew violent, continued to skip school and kept sniffing petrol.
He was accepted into BushMob when he turned 12 but was kicked out after three months for fighting and property damage.
The court heard Master W's expulsion from the program was never flagged with the CHO.
Three months later, Master W died.
Three children 'denied treatment plans'
Top End Mental Health and Alcohol and Other Drugs Service general manager Richard Campion said although assessors knew Master W was at "risk of severe harm", the child's case was not accelerated to the CHO with a treatment plan following his expulsion — a breach of NT Health guidelines.
"It appears there was some unfortunate human error," Mr Campion said.
Mr Currie told the court all three kids were "denied treatment plans".
"All of these children were seen by assessors but none of them, despite the assessors providing referrals to other agencies and the like … none of them were provided with treatment plans which were referred up to the CHO," he said.
Master JK died a few weeks before his 14th birthday after sniffing deodorant from an aerosol can on November 3, 2019.
The court heard Master JK was first found sniffing solvents at the age of eight and 11 when his grandparents first asked for Master JK to be assessed after finding the boy passed out from sniffing.
The court heard three further applications were made between February 2018 and April 2019 after Master JK was seen accessing fuel from bowsers in the dark of night.
Seventeen-year-old Ms B took her life on August 9, 2018. Mr Curry described her death as "the final act of a young girl who had a very traumatic and troubled life".
Ms B went to BushMob twice, and was expelled both times for unruly behaviour.
During her second stint with the program, Ms B's doctor said returning home would "not be helpful" for the child, but the following day the decision was made to discharge her for "non-compliance, behaviour issues and wanting to return home".
Four months later, she took her life.