A man from Bristol was found dead just days after he was released from prison. An investigation into the death of Julian Woollon, 47, found that he died from hanging ten days after he was released from HMP Channings Wood, in Devon.
Mr Woollon, from Station Road, Portbury, east of Portishead in Somerset, had been sentenced to 16 months in prison after he pleaded guilty to strangulation and obstructing police. He was released on September 11 and was found dead on September 21 of last year.
The Prisons and Probation Ombudsman (PPO) investigates deaths that occur within 14 days of an person’s release from prison. HM Coroner for Plymouth was informed of the investigation and post-mortem examination results were provided.
On March 9, 2023, Mr Julian Woollon was charged with intentional strangulation and was remanded to HMP Bristol. It was found that Mr Woollon had a history of anxiety, depression and substance misuse.
At his initial health screen on March 9, Mr Woollon said that he had not previously used drugs, he said he had no thoughts of suicide or self harm, but mentally he felt ‘mixed up’ and needed his medication. He denied using heroin but said he would drink alcohol four times a week. Nevertheless, he tested positive for opiates and benzodiazepines.
Mr Woollon was being prescribed pregabalin and diazepam on a weekly basis before he was jailed. A nurse informed the on-call GP at the prison to make them aware of the risk of Mr Woollon detoxing from his prescribed medication.
A GP at the prison placed Mr Woollon on a diazepam detoxification programme. He was also prescribed 30mg of mirtazapine, an antidepressant.
Mr Woollon was given a short prescription of zopiclone sleeping pills on April 18, 2023, to help him during his court hearing, after he asked for pregabalin and was denied.
On April 27, Mr Woollon pleaded guilty of intentional strangulation and sentenced to 16 months in prison, remaining at Bristol. Upon his return from court, Mr Woollon refused to see the nurse and asked to return to the wing instead.
In the following weeks, staff recorded no significant concerns about him, although he reported feeling extremely anxious and experiencing poor sleep. Mr Woollon was transferred to Channings Wood on May 25.
Mr Woollon said that he was struggling with anxiety and depression. During a second health screening on May 26, Mr Woollon requested to meet with the mental health team to discuss his low mood, anxiety, and panic attacks. A member of the substance misuse team met with Mr Woollon for the recovery service induction on the same day, but he declined to engage with their service.
A nurse carried out a mental health assessment on Mr Woollon on June 6. He confessed that he had been feeling down when he was in the community and used to self-medicate with vallium and pregabalin. However, he said he wanted to learn skills to manage his anxiety without resorting to drugs. It was agreed that Mr Woollon would benefit from joining an anxiety management group and he received a self-help booklet on anxiety for him to read in his cell.
On June 26, due to growing anxiety about a painful growth on his knuckle, Mr Woollon saw a GP at the prison. After examining his hand, the GP requested an X-ray.
During this consultation, Mr Woollon voiced concerns that his current dosage of mirtazapine, 30mg, was insufficient in managing his low mood and anxiety. The GP agreed to increase his mirtazapine dosage to 45mg and also prescribed naproxen to ease the pain in his hand.
A 12-week pre-release screening assessment was completed by the co-ordinator on June 28. Mr Woollon reported constant anxiety, due to issues with his hand, and felt his medication was not helping. He was keen to work with a community GP to improve his symptoms and avoid using pregabalin as a painkiller. He was referred to the local community drug and alcohol service, We Are with You (WAWY).
On July 7, the Community Offender Manager (COM) received information that indicated that Mr Woollon did not require a referral to community mental health services. It was noted that he appeared anxious and stressed about his hand condition but did not share any suicidal thoughts.
Mr Woollon was removed from the waiting list for the anxiety management group on July 17, as it was deemed there was not enough time for him to complete the course before his scheduled release on September 11.
On July 28, a prison GP confirmed Mr Woollon had osteoarthritis, a chronic disease that affects the joints and bones. The GP prescribed 10mg amitriptyline, which was increased to 20mg on 1 September to help manage the pain.
Mr Woollon met with he co-ordinator had a harm minimisation discussion on September 7, where safer drinking habits, drug use and understanding tolerance levels was discussed. He also discussed naloxone, a medication used to counteract an opiate overdose, and its availability in the community if he felt it was necessary.
Mr Woollon was released from Channings Wood on September 11, with a two-week supply of prescribed medication, including amitriptyline, naproxen and mirtazapine. Although he wasn’t given naloxone upon release, he was informed that he could find it from the community substance misuse team if required.
After his release, Mr Woollon visited the probation office in Weston-Super Mare. Mr Woollon signed his licence, acknowledging that he understood the conditions while he was temporarily living at his mother’s home.
On September 13, a representative from WAWY contacted the probation office to inform them that Mr Woollon had visited their office on September 12. He seemed extremely stressed and anxious about missing his appointment.
Mr Woollon revealed that he hadn’t used opiates for nine months but requested a prescription of subutex, an opioid used to treat opioid use disorder, acute and chronic pain, due to fears of relapsing into drug misuse. However, he was not provided one as he didn’t meet the treatment threshold at that time.
He was scheduled to visit the probation office on 20 September. But his mother called his Community Offender Manager, requesting a rescheduling of the appointment as a community GP was due to make a home visit over concerns about his mental health.
Mr Woollon’s hand-related symptoms were worsening, causing him distress. The community GP prescribed medication for Mr Woollon’s low mood, but Mr Woollon passed away before he could begin this medication.
On September 21, Avon and Somerset Police informed HMPPS of Mr Woollon’s death. Mr Woollon’s mother’s partner discovered him in the utility room at their residence. The post-mortem report stated the cause of death as hanging.
The investigation found that the COM said Mr Woollon “appeared desperate” for the issues with his hand to be addressed properly and this caused him continued concern. No one working with him in the community considered that Mr Woollon was at risk of suicide.
The Prisons and Probation Ombudsman was satisfied that both the prison and probation staff did all they could, to manage the risks of Mr Woollon’s anxiety.