New South Wales state coroner Teresa O'Sullivan released a 2025 coroner's court report finding 66 deaths in custody or as a result of police operations in the state, an increase of 18 from 2024. The report was sent to state Attorney General Michael Daley.

Of the 66 deaths, 39 occurred in custody and 27 were a result of police operations. Twelve of the in-custody deaths were among First Nations people, the highest number recorded to date.

"Each of these deaths represents a person whose life mattered and whose loss is felt deeply by families, loved ones and communities across the state," O'Sullivan said. In October, she had released a statement noting that New South Wales had recorded 12 Indigenous deaths in custody with three months still left in the year, a new record.

Six of the Indigenous deaths in custody were by self-harm or accidental overdose, five were from natural causes and one had an unknown cause. The report noted that deaths by natural causes inside prisons may lead to inquest findings that preventable issues such as quality of care, treatment or supervision contributed.

Nine of the 39 in-custody deaths were reported as intentional self-harm, eight of them by hanging. Hanging deaths reported as intentional self-harm accounted for 22% of the total deaths in custody or as a result of police operations.

Corrective Services NSW said it invested $16 million to remove ligature points from almost 800 cells and to replace cell doors, grills, beds, basins and tapware, with work on an additional 145 cells expected to be completed by July 2025. A government spokesperson said in a statement that work to remove ligature points under the program was ongoing as of Friday.

Fifteen of the 39 people who died in custody were on remand. She said the number of people on remand in New South Wales prisons was at a record high due to an increase in bail refusals. The number of Indigenous people on remand in the state has surged by 63% in the past five years.

Five of the in-custody deaths had unknown causes, which the report said prompted the state's chief health officer, Dr. Kerry Chant, to undertake additional toxicology testing of coronial samples. The additional screening did not reveal any new drug trends or issues of concern.

Among the 27 deaths resulting from police operations, nine were from crashes during police car pursuits, five occurred in the course of a police operation to contain or restrain someone, and three were in the context of the administration of sedation for agitation management. The report said an increasing trend in crashes during police pursuits raises the need for safeguards or qualifiers before police engage in a pursuit.