MGH
[2014] QCAT 250
| CITATION: | MGH [2014] QCAT 250 |
| PARTIES: | MGH |
| APPLICATION NUMBER: | GAA686-14; GAA687-14 |
| MATTER TYPE: | Guardianship and administration matters for adults |
| HEARING DATE: | 9 April 2014 |
| HEARD AT: | Cairns |
| DECISION OF: | Member Johnston |
| DELIVERED ON: | 6 June 2014 |
| DELIVERED AT: | Brisbane |
| ORDERS MADE: | 1. The Adult Guardian is appointed as MGH’s Guardian for the following matters: (a) Accommodation; (b) Provision of services; (c) Health care; and (d) Education and training. 2. Unless the Tribunal orders otherwise, this appointment remains current for two (2) years. 3. The Public Trustee of Queensland is appointed as MGH’s Administrator for all financial matters. 4. The Tribunal dispenses with the requirement for the administrator to provide a financial management plan. 5. The Tribunal directs the administrator to provide accounts to the Tribunal when requested. 6. This appointment remains current until further order of the Tribunal. |
| CATCHWORDS: | APPOINTMENT OF GUARDIAN AND ADMINISTRATOR – with a need for appointments. Guardianship and Administration Act 2000, ss 12, 14, 15, 31 |
APPEARANCES and REPRESENTATION (if any):
| MGH ME MF QD BV KA HT AK | The adult Adult’s mother Adult’s father carer SL friend Office of the Adult Guardian official Public Trustee of Queensland official Public Trustee of Queensland official |
REASONS FOR DECISION
Background
MGH is a 26-year-old woman who has a diagnosis of a mental illness which is described as paranoid schizophrenia. She currently resides in a co-tenancy arrangement which is supported by SL in Town I. MGH has a strong connection with her mother ME and resides with her for up to four days each fortnight in W Vale.
ME has requested that the Tribunal review the appointment of the Guardian and the appointment of the Administrator and asked to be considered to undertake these roles herself.
Does MGH have capacity to make her own decisions?
MGH acknowledged that she needed others to help her with the important decisions. She felt strongly however that she should be able to make her own decisions and believed that she had the capacity to do so. The Tribunal told her that she could get a Health Professional Report from her Doctor and if he or she thought that MGH had capacity she could bring an application for a declaration that she had capacity.
QD told the Tribunal that since her medication had been changed in November of 2013 she had seen a big improvement in MGH. She was however of the view that MGH still needed support in a number of areas as MGH didn't understand the consequences of making some decisions and was easily influenced as well.
ME told the Tribunal that her daughter was able to make some of the right choices but still needed guidance in some areas.
Dr FM a general practitioner had provided a Health Professional Report dated 19 December 2013 in which he reported that MGH thought that she could make her own decisions. The Doctor reports that MGH has been diagnosed with a form of autism along with the mental illness schizophrenia. He states at paragraph 5.1 that MGH: ‘has difficulty understanding [the] need for medication or her [medical] condition’. He states that MGH: ‘does not have [the] ability to fully understand accommodation choices and [the] impact on her’. In relation to financial affairs he says that MGH: ‘does understand budgeting of her allowance [that she receives] from the Public Trustee’. The doctor says that MGH is easily influenced by whoever she is with at the time. He gives as an example of this, her accommodation choices. When she is with her mother she states that she does not like living where she is now. When with her carer she states that she is happy where she is now. He concludes his report in paragraph 9 by stating that MGH is unable to make any complex decisions.
The Tribunal accepts the evidence of Dr FM it is consistent with the evidence provided by ME, MGH’s mother and by QD, her support worker.
The Tribunal makes the findings: MGH has a serious mental illness coupled with an intellectual disability described as autism; these conditions impact on her cognitive functioning in relation to decision making. The Tribunal also finds that MGH is easily influenced by those around her. The presumption of capacity is rebutted.
Does MGH need a Guardian?
KA told the Tribunal that she saw a need for decisions in relation to: accommodation; provision of services; health care; and education and training.
MGH continues to reside in co-tenancy accommodation supported by SL. She also resides with her mother, ME. The current accommodation arrangements enable MGH to reside safely with ME for four nights a fortnight and maintain a positive relationship. Both ME and MGH often request to extend these periods at short notice but conform to the arrangements when reminded of the accommodation plan. In line with MGH's wishes there have been trials to increase her stays with her mother with monitoring and contingency plans in place.
KA stated that both MGH and ME have also expressed the desire for MGH to live with her mother in W Vale. ME has historically demonstrated misconceptions about MGH's capacity; a lack of understanding of her complex needs and been unable to provide adequate support to MGH to ensure her well-being and safety. ME would require extensive respite and community supports to care adequately for MGH which are limited in her location at W Vale. It is not clear if ME would access them. It is anticipated that future decisions will be needed to maintain a safe and stable accommodation arrangements for MGH.
KA stated to the Tribunal that MGH's co-tenancy accommodation was supported by SL and this has contributed to consistent review and monitoring of her mental and physiological health needs, and the development of her life skills. Challenging behaviours that MGH has historically exhibited including property destruction and physical aggression have been reduced. When MGH's visible psychotic symptoms emerged last year, SL immediately sought support which resulted in successful management of MGH's symptoms. QD has an open communication style which ME responds to. This has contributed to ME gaining some insight into her daughter’s needs and has limited her strong negative influence on MGH. MGH will continue to require supports to meet her mental health needs, manage her challenging behaviours and increase her life skills.
KA stated that MGH had a diagnosis of schizophrenia. Historically, ME who is a strong influence on MGH has disagreed with her prescribed medications and treatment. There have been concerns that MGH was not compliant with her medication while staying with her mother. Dr FM a GP in Town I monitors MGH's mental health and general health care needs. SL support MGH to access health services, including dental, and monitor her medication administration. KA believes that future healthcare decisions will need to be made to ensure that MGH's health and well-being are looked after adequately.
KA indicated that SL continue to encourage MGH to participate in community activities including exploring volunteer opportunities to gain vocational skills. MGH will continue to require assistance to gain skills in preparation for community living and vocational opportunities.
ME told the Tribunal that she agrees that MGH needs support in these areas. She told the Tribunal that she now understands how important it is for MGH to stay on her medication.
QD told the Tribunal that she sees a need for decisions around accommodation and service provision. She believes that MGH needs support 24 hours a day seven days a week. She also sees a need around health care and education and training. QD told the Tribunal that Dr W had spent time with ME explaining that daughter’s mental illness and the need for MGH to take medication on a consistent basis.
The Tribunal finds that there is a need to decide where adult lives and the supporting services that she receives where she is living. The Tribunal finds that MGH needs intensive support and that any decision about accommodation needs to provide appropriate supporting services.
Who should be appointed as MGH's Guardian?
MGH supports her mother acting in the role.
QD told the Tribunal that things were good at the moment with ME’s involvement but that there had been issues in the past. She was of the view that there were benefits in keeping an independent professional Guardian place for the present time. Whilst MGH spent time with her mother and time with the carer this situation needed to be monitored. Her hope is that with a gradual reintegration with her family that she might be able to live with them permanently. However the family would have to show that they had insight into her needs for support services and put in place those supports.
MF told the Tribunal that it would be better for ME to be MGH’s Guardian.
KA has expressed reservations about the appropriateness of ME which is reported in paragraph 11 of these Reasons.
The Tribunal shares the concerns of the Adult Guardian's representative about ME’s lack of understanding of her daughter’s complex needs and the fact that she has been unable in the past to ensure her well-being and safety. The Tribunal notes that the service provider's shares the same concerns.
The Tribunal is of the view that if steps are going to be taken to reintegrate MGH with her family that this should be on a gradual basis undertaken over a period of time. ME must be able to show there are appropriate services in place to meet her daughter’s needs. The Tribunal was not satisfied that there were adequate plans for that transition to occur at this time.
The Tribunal also notes that the circumstances around the appointment of the Guardian on 25 May 2009 were that MGH had been admitted into the Cairns Base Hospital weighing only 34 kg. She had been grossly under socialised and was extremely vulnerable. The Tribunal was told at that time that ME had no insight into MGH’s condition and that MGH had experienced a history of neglect whilst living with her mother. The Tribunal was also told that ME had been unable to support her daughter in 2009 as she had to spend several months in jail for growing marijuana. The Tribunal is not satisfied in the circumstances that ME is more appropriate than an independent professional Guardian at this point in time.
The Tribunal notes that the certificate of appropriateness in the application makes no reference to any past offences and the Tribunal would expect from ME a criminal history check to be attached to any further application which she might make so this can be clarified. The Tribunal has also set out in these reasons what other material the Tribunal would expect if ME is to be considered for appointment the future.
The Tribunal accepts that ME has now developed an understanding of the need for treatment for her daughter’s mental illness. The Tribunal notes that it has taken an extremely long period of time for ME to develop this understanding. The Tribunal accepts that the current shared accommodation arrangements are working smoothly. The Tribunal believes however that the continued involvement of the Office of the Adult Guardian over the next two years should be helpful overseeing any transition from the existing care arrangements. The Tribunal is satisfied that the Adult Guardian is more appropriate in the circumstances.
The Tribunal will appoint the Adult Guardian for a period of two years in relation to these matters: accommodation; service provision; health care; and education and training.
Does MGH need an administrator?
HT told the Tribunal that MGH receives $902.50 a fortnight made up of a Disability Support Pension of $842.80 plus rental assistance of the $59. She has a term deposit of $15,506 and $7393 in the Trustees’ cash account. The rent is paid to SL; she contributes to utilities; pays for groceries; and has a chemist account. She is also given $120 a week as a living allowance.
The Public Trustee hears from QD and the Guardian regarding MGH's needs. The Trustee is also prepared to contribute to the expenses of MGH travelling to W Vale. She recently requested funds to purchase a fish tank which were provided.
ME told me Tribunal that MGH did need help to put money aside to pay bills. She told the Tribunal that if MGH lived with her family she would not have to pay rent and she would have more savings. She believes that MGH can manage her finance with some guidance.
QD told the Tribunal that she was working with MGH to prove her financial skills. MGH has opened up a second account and she is trying to teach MGH about saving. She is of the view that the Public Trustee of Queensland have done a wonderful job with MGH’s finances and supported the continued involvement of the Public Trustee.
There were no other submissions about the need for an administrator or who should be most appropriate.
The evidence of Dr JA the Psychiatric Registrar at the Tribunal on 25 May 2009 was that MGH had been taken advantage of financially by another family member and had no assets at the time that the Public Trustee was appointed.
Who should be appointed as MGH's administrator?
The Tribunal notes that the Public Trustee of Queensland has done an excellent job since appointed by the Tribunal and that MGH's current needs are being met and she has savings in place to assist her with her future needs. The Tribunal believes that this highlights benefits of having an independent professional administrator in place.
The Tribunal has not been satisfied that there is any evidence that supports the contention that ME is more appropriate than the Public Trustee of Queensland.
The Tribunal finds that: MGH is receiving a disability support and rent assistance; her support worker is trying to increase her financial skills; she has savings that need to be managed; the Public Trustee of Queensland have put in place a budget which meets her needs and allows savings for her future needs; and MGH has a past history of being taken advantage of.
The Tribunal appoints the Public Trustee of Queensland as administrator for MGH; the Tribunal dispenses with the need for a financial management plan; directs the administrator to provide accounts when directed by the Tribunal.
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