The death of a 26-year-old musician in Bury St Edmunds was an accident, an inquest has concluded.
At Suffolk Coroner's Court in Ipswich, area coroner Jacqueline Devonish told the hearing that Colin Christopher Currie fell while walking in Bury St Edmunds, sustaining a fatal head injury.
Mr Currie fell backwards in an area known as The Dip on August 22, 2017. He died at West Suffolk Hospital on August 25.
The police officer that found him, PC Daniel Witter, told the hearing how Mr Currie was "barely breathing" when he arrived at the scene.
In her conclusion, area coroner Jaqueline Devonish said: "Colin was buying amphetamines from the age of 14 and spiralled into drug use. He spent five months in hospital with a diagnosis of schizophrenia in late 2012 and early 2013.
"This diagnosis was later rescinded and after this his admissions to hospital became shorter and shorter.
"When he was not using drugs he was eloquent and had capacity of his functions.
"It is my conclusion that this death was the result of an accident."
A toxicology report confirmed that Mr Currie had a blood alcohol level four times the drink-driving limit when tested soon after his fall, which indicated it could have been even higher prior to testing. There was also evidence of a historic use of cannabis and amphetamines.
The inquest heard Mr Currie had been admitted to psychiatric wards in Bury St Edmunds and Ipswich 26 times before he died.
Over a four-year period, mental health services had given and rescinded different diagnoses for Mr Currie, including paranoid schizophrenia, drug-induced psychosis and ADHD.
On Tuesday, his mother Bernadine Scott-Currie said: "Colin was gregarious, he loved singing, writing, and he was a champion for the underdog.
"As he became older he found living life very difficult, he told me it felt like his brain was running at 100mph."
The court heard also the last evidence in the case from Dr Oliver Jenkins, was a consultant psychiatrist on the NSFT's Poppy Ward when Mr Currie was sectioned in August 2017.
Dr Jenkins believed his aggression and delusions were a result of drug-induced psychosis and saw a gradual change in Mr Currie's behaviour during his seven days on the ward.
When asked if Mr Currie was discharged without a care plan, no mental health diagnosis, no medication and nowhere to live, he answered: "yes."
Mr Jenkins also said that a patient with an illicit drug habit such as Mr Currie would be at very high risk of relapsing.
Mr Jenkins said: "Mr Currie's situation was not unique, and as clinicians the decision to discharge someone in Mr Currie's position is not taken lightly."
Ms Devonish noted in her conclusion that the NSFT were not able to keep Mr Currie as an inpatient after he was no longer being detained under the Mental Health Act.
Ms Devonish said that staff at Poppy Ward, the NSFT facility in Ipswich, did tell Suffolk Constabulary and St Edmundsbury Council Mr Currie was discharged, as well as providing him with the information to find temporary housing in Ipswich.
Mr Currie admitted to mental health staff that he was taking amphetamines to self-medicate for his anxiety and he did not intend to stop using them despite knowing they caused a drug-induced psychosis. A follow up call 48 hours after Mr Currie was discharged was missed, but a call seven days later was made.
After his death a Serious Incident Requiring Investigation (SIRI) report was carried out by the NSFT into his treatment on Poppy Ward.
Changes recommended by the report were made to ensure no follow-up calls are missed in the future.
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