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Intrauterine death at term in a cocaine user detained under the Mental Health Act. We report the case of a 31-year-old woman who presented at 23 weeks gestation following a mixed overdose of medication. She was detained under the Mental Health Act 1983/2007 for ongoing suicidal ideation and heavy cocaine use. She had a normal nuchal scan, and unremarkable anomaly and growth scans at 19, 29, 32 and 34 weeks. At 40 weeks, an ultrasound scan confirmed fetal demise. A macerated male stillborn was delivered by forceps. Women with mental health and substance misuse problems may have reduced awareness of fetal movements, and they may be poor historians or frequent attenders for non-specific symptoms. It is crucial that these factors do not influence the ability of clinicians to thoroughly investigate symptoms and promptly identify obstetric complications.