29th April 2016

St Pancras Coroner's Court, Camley Street, London.
Before HMC Mary Hassell

A jury at St Pancras Coroner’s Court has today returned its conclusion in the inquest into the death of Jack Susianta.

Jack, a 17 year old A-Level student, drowned in the River Lea, East London after jumping into the water whilst being chased by TSG[1] officers on the afternoon of Wednesday 29 July 2015. Jack’s family had telephoned the Metropolitan Police for help after he had jumped out of their living room window an hour previously following a mental health crisis. His crisis had been triggered by taking MDMA at a music festival during the preceding weekend. When Jack returned home from the festival on Monday 27 July he was extremely anxious and emotional. His family sought to calm and comfort him; however, he became delusional and ran out of their home in Hackney. His family searched the local area all night and asked the police for help.

In the early hours of Tuesday 28 July, Jack was found by local police officers cold, wet and mentally unwell sitting on a traffic island in Hackney. He was removed by local officers to Homerton Hospital as a place of safety under the Mental Health Act 1983. It has only recently come to light that at the hospital Jack was subjected to a high level restraint by numerous local police officers, including one male officer kneeling on his neck. He was admitted to A&E at 3am and discharged just four hours later at 7am after being seen by a Consultant Psychiatrist employed by East London Foundation NHS Trust (‘ELFT’). The Consultant did not provide Jack or his family with any advice on what to do if his crisis re-emerged.

After returning home with his family, Jack’s crisis re-emerged over the course of 28 -29 July. His family, not having been provided with any advice by ELFT on how to manage that situation, did their best to comfort Jack; however, he deteriorated and eventually jumped out of a ground floor window around 3pm on Wednesday 29 July.

His family sought help from the police, making clear that his mental health crisis had re-emerged. TSG officers found Jack soon after running on Hackney marshes. They gave chase and Jack jumped into the River Lea. Jack managed to keep his head above water for approximately five minutes, during which time the TSG officers declined to enter the water and discouraged members of the public from so doing. Jack eventually could not keep his head above water any longer and submerged. After three to four minutes a local police officer waded in but could not find Jack beneath the water by that stage.  TSG officers did not call the London Fire Brigade’s Water Rescue Service (LFB) as soon as Jack entered the water, delaying two – three minutes. The first LFB unit arrived nine minutes after Jack jumped in the water and four minutes after he submerged. A police diver entered the water an hour later and recovered Jack’s lifeless body. Jack’s was declared deceased at 5.33pm. Before this incident Jack had never been ill and never been in contact with the police. He was an ambitious student, a keen sportsman and looking forward to going to University. Jack was much loved by a large group of friends  and fellow pupils who have built a shrine and fund-raised for a bench in his memory by the River Lea.                                               

The jury concluded that Jack died by drowning as a result of a drug related accident.

Jack’s mother, Ms Anna Susianta said:

Jack was a wonderful son, a brilliant brother, a great friend and a bright student. He loved life and had everything to live for. When he became ill we sought help from professionals because we had never been in this situation before. We believe that Jack did not get the help he needed from East London Foundation NHS Trust or from TSG officers by the River Lea. If he had received that help we believe Jack would be alive today. He will never be forgotten.

We are relieved that the Jury has not sought to blame Jack for his own death as the police and East London Foundation NHS Trust have sought to do. We hope that this process will result in other vulnerable young people and their families receiving better support from the authorities and we welcome the Coroner’s decision to make a preventing future deaths report to that end. We look to the IPCC to now do its job.”

The family’s solicitor, Tony Murphy of Bhatt Murphy said:

“The conclusion of the IPCC’s investigation into these events is awaited. This includes the physical restraint to which Jack was subjected by a number of local police officers at Homerton Hospital on the day before he died. The restraint, captured on CCTV, included a male officer kneeling on Jack’s neck at a time when was a highly vulnerable mental-health patient. ”   


Victoria McNally of the charity INQUEST said:
It is disturbing to witness yet another death of a mixed-race young person who sought help from the authorities during a mental health crisis but ended up being restrained and ultimately drowning. Police and health authorities must help those who are unable to help themselves due to mental-illness. It is also important that public authorities are not allowed to blame the victim as they appeared to try to do in this inquest.”        

INQUEST has been supporting the family of Jack Susianta since his death. The family is represented by INQUEST Lawyers Group member Tony Murphy, Bhatt Murphy Solicitors.


Note to the Editor

  • The family are grieving and ask not to be contacted directly by the media. All requests for information should please be communicated via their solicitor [email protected].  For INQUEST contact Victoria McNally, Tel 020 7263 1111).
  •  The majority of INQUEST’s police related cases over the past five years have involved the death of vulnerable individuals in some form of mental health crisis, many in circumstances involving the use of restraint.  Following an eleven year low of 11 police custody deaths in 2013/14, the number of deaths in or following police custody rose sharply to 17 in 2014/15.  8 out of those 17 deaths were of people identified as having mental health concerns.  5 were restrained. This marks the continuation of a trend in mental health related deaths where in 2012/13 of the 15 people who died in or following police custody, almost half (7 individuals) were identified as having mental health concerns.  In 2013/14 of the 11 people who died, 4 were identified as having mental health concerns.   See IPCC annual statistical report:
  •  In February 2016 the Home Secretary announced an independent review, conducted by Dame Elish Angiolini QC, into Deaths in Police Custody.  Jack Susianta’s family have had input into the review, attending a ‘Family Listening Day’ organised by INQUEST.  INQUEST Director Deborah Coles is special advisor to the review