Content warning: This story contains reference to suicide. Please refer to the services at the bottom of this article for support.

Please note: This story contains reference to someone who has died.


A coronial inquest into a 2019 New South Wales death in custody has heard the 20-year-old inmate begged for help days before his death.

Wiradjuri man Bailey Mackander died in November 2019 after escaping custody at Gosford Hospital whilst being returned to Kariong Correctional Centre.

While under the supervision of two prison guards, Mackander climbed over a concrete barrier at the hospital and fell 10 metres. He died the following day.

He was on remand for drug and driving offences.

The inquest, which began on Monday, heard that the man’s death was “avoidable”.

Gosford Detective Senior Constable Jesse Mears said the unfenced wall, the gaps corrective officers left whilst escorting Mackander, and the hospital response were contributing factors to the death in custody.

Sr. Constable Mears showed the Coroner photographs of the concrete barrier which had a large black grill fence that “wasn’t there” at the time of Mackander’s death.

On Tuesday, the inquest heard that Mackander was taken to hospital after he had reportedly swallowed batteries and razor blades.

On November 3, three days before his death, Mackander had disclosed in a consultation with a psychologist he had “daily thoughts of suicide”.

A support plan was established and the following day a Risk Intervention Team assessed Mackander’s risk of self-harm and suicide.

He was placed in an isolated cell due to staff concerns for his mental health.

A former cell mate told the inquiry that prisoners were routinely sent to the observation cell.

“[I’ve] seen people make one comment [about their mental health] and end up in an observation cell,” said the inmate.

He also said he believed Mackander was “being punished for his honesty” after disclosing his mental health to correctional officers.

The inquest heard audio evidence from the prison’s “knock up” system which is an intercom between inmates and staff for medical emergencies.

Mackander used the system multiple times before he died, alerting staff to symptoms of stress and anxiety, and telling them he couldn’t breathe.

“Somebody help me, please … it’s making me stressed, I’m about to have a f**king anxiety attack,” Mackander said to prison guards.

“I’m stressed and I’m panicking, it’s making me sick — I can’t cope.”

“I’m f**king sick, I can’t breathe.”

“You can’t breathe because you’re winding yourself up,” a prison guard replied through the intercom.

Mackander made multiple other calls about chest aches, gagging, vomiting and uncontrollable crying.

“There nothing wrong with you at all, other than your attitude,” he was told by another prison guard.

One guard told Mackander, who was gagging at the time, he was having a panic attack and needed to slow his breathing.

I can’t breathe,” Mackander replied.

“Mate, as I said, you’re probably having a panic attack, you need to slow your breathing down,” said the guard.

The inquest viewed CCTV footage of Mackander in the isolation cell, where he was regularly curled up on the ground and pacing back and forth.

Counsel assisting Tracey Steven told the inquest that Mackander’s parents had separated when he was 10-years-old. He would often call his mother whilst in custody to tell her he wasn’t coping and having a “really hard time in jail”.

Steven noted that Justice Health clinical notes recorded Mackander was struggling throughout 2019 and was reportedly taking ice, marijuana and prescribed antidepressants in custody.

Mackander’s family was present in court. Outside of the court, Mackander’s father David described hearing the audio recordings as “gut-wrenching”.

“I just don’t know how anyone could do that to anyone, let alone a young man just crying and begging for help.”

Mackander’s mother Tracy did not listen to the recordings, leaving the room before they were played.

“I couldn’t bear to hear my son being treated in such a way. What they did to him is absolutely heartbreaking and soul-destroying,” she said.

“They should not be treating our inmates or people they are paid to look after that way,” David Mackander said.

“They should be doing the right thing by our loved ones who are in there to try and get help.”

The inquiry continues until Friday and will resume in July.

If you or anyone you know is struggling with mental ill-health, call or visit the online resources below:


By Rachael Knowles