Coroners Court Preparation

Preparation for the Coroner's Court

For clinicians, coroners’ inquests raise complex personal, professional, and systemic issues. This page brings together resources to help you understand what to expect, how to prepare, and how to navigate the process with care and confidence. Whether you are giving evidence, supporting others, or reflecting on your role, these materials are here to guide you through the journey with clarity and compassion.

Research Article

Grief, participation, and partial resolution: an autoethnographic study of inquests after a suspected suicide

A paper based on three case-studies of coroner inquests involving suspected suicides of people who have been under the care of mental health services.

The paper tries to articulate the experience of being a participant in the inquest which often felt emotionally charged and relationally, very complex.

Key findings are:

Grief as the most central stakeholder at the inquest
Inquests are participatory processes where one task is for grief to be witnessed and validated by those present
The coroner must contain the emotion in the courtroom, attend to adversarial dynamics and make it ‘safe-enough’ for witnesses to participate in a way that enables grief to be validated.

Review

Millie Tamworth's Review

The following resources are taken from Millie Tamworth’s review critiquing the publicly available guidance for mental health practitioners called to a coroner’s inquest and offering a list of her own guidance.

Tamworth, M., Billings, J., Tekin, S., Pitman, A., Jacobson, J., & Killaspy, H. (2025). A systematic review and critique of publicly available guidance for mental health practitioners called to a coroner’s inquest. Psychiatry, Psychology and Law, 1–36.

Videos and recorded webinars

Familiarise yourself with the process

Here you’ll find a list of videos and recorded webinars which are a good way to familiarise yourself with the whole process.

Giving evidence

Giving evidence remotely at a coroners inquest for clinical witnesses

Browne Jacobson (2023) law firm

Inquests: Top tips and advice for the medical witness

University of Plymouth et al., (2020) multiple stakeholders

Avoiding criticisms at the coroner's inquest

MDU (2022) Third party indemnity

Understanding investigations

Understanding coroners' investigations

MDU (2022) Third party indemnity

Derek Tracy's Book

A clear, accessible introduction to the coroner’s court for clinicians and mental health professionals. This guide explains what to expect, how to prepare, and how to give evidence with confidence and clarity:

“Practical and straightforward, this book aims to make the unfamiliar territory of the coroner’s court transparent, enabling clinicians to negotiate all eventualities. It will provide clinicians with the confidence to turn what can feel like an adversarial situation into an opportunity to engage with an important part of the healthcare system, preventing future deaths and providing understanding to relatives. It also explores the underlying necessity of complying with requirements and suggests ways to cope with the emotional impact. With chapters covering expert witnesses, legal perspectives and managing outcomes, this book is essential for any healthcare professional called to an inquest.”

Project

The Voicing Loss Website

A powerful project exploring how bereaved families experience inquests after state-related deaths. This resource gives voice to those often unheard in the process and offers vital insights for professionals seeking to understand the emotional and social impact of inquests.