A patient who was found hanging by his bedsheet was considered a 'moderate' risk, an inquest into his death heard.

The inquest is being held into the death of Shandal Richardson, 35, who was found dead in the early hours of March 5, 2008, having hanged himself using a bedsheet in his room at the Mid-Atlantic Wellness Institute (MWI).

On Friday, the ongoing hearing heard more from Michael Looby, the nurse in charge of psychiatric care in the Somers Annex at MWI, who was on duty from 7.15 a.m. to 3.30 p.m on March 4 last year.

During this time he periodically used the cameras in the nursing office to check on patients, the inquest heard.

He told Coroner Juan Wolffe that Mr. Richardson was placed in a routine observation unit and monitored on a frequent basis, and added: "In the context of Somers Annex routine observation is somewhere between very frequent and almost constant observation.

"Because of orientation, size and format of the unit, use of cameras and frequency of staff in the nursing station, patients are being observed every minute or two by one's eyes and the cameras."

Questioning him, Mr. Richardson's family lawyer Victoria Pearman suggested: "You didn't look at cameras every three minutes. You didn't look at the camera every hour. You can't say that someone else did."

Mr. Looby, a nurse at MWI for 16 years, replied: "What I can tell you is if someone wasn't looking at Shandal at the camera every three or four minutes they were looking at him with their own eyes."

According to Mr. Looby, patients are also monitored closely by camera at night. He said: "The lights go out at 10 p.m. but processes are still in place; the only difference is at night. Because all clients are bedded in their room the majority of observation is through the camera system."

He added: "When lights go out it is partial darkness, you can detect if a client is moving around, but you can't get detailed observation."

Mr. Richardson was admitted to MWI on March 4 last year after he attempted to stab himself with a knife at his Southampton home.

During questioning by Allan Doughty, lawyer for the Bermuda Hospitals Board, Mr. Looby said the deceased was considered to be at "moderate" rather than severe risk due to the way the nursing scale was set up. He also believed Mr. Richardson's condition was improving by the time he finished his shift.

Mr. Looby said: "I felt he was improving first because when he came into the ward he was not communicating, he was essentially motionless and he appeared perplexed.

"The process of improvement began when he voluntarily came out of the observation room and then asked for something to drink and although he still appeared perplexed to some degree he was walking freely around the unit in proximity to other clients and did verbalise basic requirements, such as can he have some cigarettes. Essentially he appeared a bit more orientated."

This improvement led to Mr. Richardson being moved from the observation room, where he was under constant monitoring, and had only a mattress and urinal bucket.

He was moved to a routinely supervised room with furniture and another patient. Mr. Richardson used the bed frame and bed sheets in that room to hang himself.

The inquest continues.