Warning: this article includes the name and image of an Aboriginal person who has died. It also discusses distressing themes, including suicide.
A Yamatji teen's death after he harmed himself in detention was a preventable tragedy, the corrections officer who found him in his cell has told an inquest.
Cleveland Dodd was found unresponsive in the early hours of October 12, 2023, inside his cell in Unit 18 in Perth's Casuarina Prison.
The 16-year-old was agitated and had made eight threats to self-harm in the hours before he was discovered by youth custodial officer Daniel Torrijos and transported to hospital, where he died eight days later.
Mr Torrijos told a coroner in Perth on Monday Cleveland was more upset than usual on the night of the incident that led to his death.
"Cleveland was very volatile and would act out and do crazy things but I never felt he was that down and out or depressed," he said.
"He was angry, more angry than usual ... he looked stressed and angry."
The veteran officer, who was well-liked by the detainees, described Cleveland's death as a tragedy.
"Obviously it could have been avoided, it's been a build-up of a few things that happened over the years, it didn't happen overnight and I just don't want to see anything like that happen again," he said.
Youth custodial officer Nina Priestly said she had a "soft spot" for Cleveland and his death had "a huge impact on me".
"He was a funny kid and we enjoyed having a chat and making jokes," she said in a statement read to the court by Counsel Assisting the Coroner Sarah Tyler.
Ms Priestly said she was an Aboriginal woman and joined the department to "help my people".
"I wanted to make a difference. I wanted to show the detainees compassion despite their circumstances," she said.
"His death is the exact opposite of why I joined."
Coroner Phil Urquhart heard Unit 18 detainees were constantly making threats to self-harm and it was often difficult to determine if they were serious.
"It's rolled like that for three or four years, a lot of self-harm attempts," Mr Torrijos said.
"It's spiralled out of control ... it's something that's like an epidemic, plague proportion."
The court heard Cleveland's threats to self-harm on October 12 started after staff working on the night shift ignored his requests for water five times because the day shift told them he'd been given six cups earlier.
He had spent most of the day in his cell, which had no running water, and was facing the prospect of having to wait until morning before he was given any more.
The United Nations stipulates "drinking water shall be available to every prisoner whenever he or she needs it".
Mr Torrijos said if he had been allowed to unlock Cleveland's cell door and give him water he would have but he was directed not to.
In the 86 days leading up to October 12, Cleveland spent 22 hours or more in his cell per day on 75 of them and had only three hours of schooling in four weeks.
The inquest heard Mr Torrijos had been investigated and disciplined about two years earlier for failing to properly do cell checks on seven occasions and reporting that he had.
Asked about the finding, Mr Torrijos said he was overworked and it was unrealistic to expect him to be able to complete the amount of tasks assigned to him.
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