Warning: This story deals with suspected suicide and may be upsetting.
The psychiatrist in charge of Nicky Stevens' care would have "absolutely" revisited his unescorted leave if informed he went Awol from a mental health facility just one day before he disappeared, an inquest has heard.
Stevens left the medium-security ward at the Henry Rongomai Bennett Centre, where he was being treated under a compulsory care order for paranoid schizophrenia, on March 8, 2015 and did not return for 45 minutes.
Stevens was allowed only two 15 minute cigarette breaks per day at that stage.
The next morning the Waikato District Health Board psychiatrist, whose identity is suppressed, was not informed about the breach.
The psychiatrist said during questioning from Richard Fowler, QC, the lawyer acting for the family, the failure to be notified of the March 8 breach of leave was concerning.
"Given that it is your view that you ought to have been told and you were concerned about that, if you had been told you would have revisited Nicky's unescorted leave arrangements wouldn't you?" Fowler said.
"Absolutely," the psychiatrist said.
The March 8 Awol preceded an incident of continuous leave by Stevens the next morning which when later reviewed on CCTV footage showed him frequently coming in and out of the Henry Rongomai Bennett Centre at Waikato Hospital.
At 12.30pm on March 9 Stevens took another unsupervised break outside, leaving the centre at 1.08pm. He never returned.
His body was found in the Waikato River three days later.
The inquest, before coroner Wallace Bain at the High Court in Hamilton, heard the psychiatrist was not aware of either situation.
Under questioning from the lawyer assisting Bain, David Dowthwaite, the psychiatrist admitted it was possible Stevens may have tried to disguise his true thoughts to achieve what he wanted.
The inquest earlier heard Stevens should not have been relied on to tell the truth because of his illness as he suffered delusions.
The psychiatrist said that was possible but it was not their clinical observation.
"I don't think I would be a very good psychiatrist if I take the option of not believing what patients told me. But it is possible."
The inquest heard on Monday that Stevens' parents implored HRBC staff not to give their son unescorted leave because of his two recent suicide attempts.
But the psychiatrist's brief of evidence contradicts that, stating that neither parents or a close friend of Stevens raised concerns over him having unescorted leave.
The psychiatrist earlier extended condolences to the family before breaking down on the witness stand at an inquest today.
The psychiatrist, whose identity is suppressed, said Stevens' death had been distressing and resulted in post-traumatic stress disorder and anxiety.
"As a result of Nick's death I've found it incredibly hard to keep working in a place where I love working and with people I love working with."
The inquest heard the psychiatrist had treated more than 2000 patients during their career and Stevens was the only one who died.
Stevens' parents Jane Stevens and Dave Macpherson, a Waikato District Health Board member and Hamilton city councillor, acknowledged the condolences and accepted the situation was hard for the psychiatrist.
Earlier in the day the inquest heard Stevens could not be relied on to tell the truth about his suicidal thoughts.
Stevens told his mother he tried to drown himself 10 days before he disappeared from the HRBC.
But he denied suicidal thoughts to the DHB psychiatrist in charge of his care.
The inquest heard from independent psychiatrist Dr Margaret Honeyman, who said Stevens' death was avoidable after she reviewed the case.
"Despite what Mr Stevens may have said when he denied any thoughts of suicide, there is compelling evidence that he was reporting things to his mother which he concealed from staff.
"It was therefore unwise to rely on his assurances."
Fowler said the DHB psychiatrist did rely on Stevens' accounts.
He pointed to the psychiatrist's brief of evidence where it was indicated Stevens' leave was made more restrictive and cautious than it had been in the weeks before under a different psychiatrist.
Fowler said this was based on Jane Stevens' concerns for her son after he told her he went to Waikato River on February 27 and tried to drown himself.
"I based this (restrictive leave) on the concerns that had been expressed by Mr Stevens' parents to the after-hours nurse coordinator, weighed against his own adamant denial of suicidal/self-harming thoughts and intentions," the psychiatrist's evidence said.
Fowler asked another expert psychiatrist Dr Marcus Patton whether the appropriate weight was given to Jane Stevens' concerns versus her son's denials.
"There is a credibility stand-off between Nicky and his parents," Fowler said.
"That's not an uncommon position for clinicians to find themselves in," Patton answered.
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633 ,free text 234 or email firstname.lastname@example.org or online chat.
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
• SAMARITANS – 0800 726 666.