PRP
[2003] QMHC 10
•10 November 2003
MENTAL HEALTH COURT
CITATION: | PRP [2003] QMHC 010 |
PARTIES: | REFERENCES BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF PRP |
PROCEEDING NO: | 0304 of 2002 |
DELIVERED ON: | 10 November 2003 |
DELIVERED AT: | Brisbane |
HEARING DATE: | 15 September 2003, 10 November 2003 |
JUDGE: | Wilson J |
ASSISTING PSYCHIATRISTS: | Dr D A Grant Dr J F Wood |
FINDINGS AND ORDERS: | Reference relating to two counts of assault occasioning bodily harm on 27 October 2001: (1) The defendant is fit for trial; (2) Order that the proceedings for these alleged offences be continued according to law. Reference relating to one count of assault occasioning bodily harm and one count of wilful damage on 13 October 2002: (1) The defendant was not suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000 (Qld); (2) The defendant is fit for trial; (3) Order that the proceedings for these alleged offences be continued according to law. Order pursuant to section 273 of the Mental Health Act 2000 for the defendant’s detention in The Park Centre for Mental Health, Authorised Mental Health Service, until he is granted bail under the Bail Act 1980 (Qld) or is brought before a Court for continuing the proceedings. Limited Community Treatment is approved in the form of escorted limited community treatment on the grounds of the hospital on the following conditions: a) That the defendant remain under the escort of a health service staff member or members nominated by the authorised psychiatrist for the duration of the limited community treatment; and b) That for the purposes of the limited community treatment the defendant comply with the directions of the nominated staff members for the duration of that treatment. |
CATCHWORDS: | MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant is charged with two counts of assault occasioning bodily harm on 27 October 2001, one count of assault occasioning bodily harm on 13 October 2002 and one count of wilful damage on 13 October 2002 – where defendant suffers from chronic paranoid schizophrenia – where defendant had been non-compliant with treatment leading up to alleged offences – where there is a paucity of collateral information – where conflicting expert psychiatric opinions – whether defendant’s illness resulted in impairment or deprivation of capacity to know he ought not engage in particular conduct Mental Health Act 2000 (Qld), schedule 2 |
COUNSEL: | J D Farmer (15 September 2003) and B G Devereaux (10 November 2003) for the defendant |
SOLICITORS: | Legal Aid Queensland for the defendant |
WILSON J: There are two references before the Court. The first relates to two counts of assault occasioning bodily harm on 27 October 2001. This Court has already made a finding that the defendant was not of unsound mind at the time of those offences. That finding was made on 27 May 2002. Accordingly, the reference in relation to those offences is one only with respect to current fitness for trial. With respect to that reference I find that the defendant is fit for trial and I order that the proceedings against him continue according to law.
The other reference relates to one count of assault occasioning bodily harm and one count of wilful damage, both on 13 October 2002. The issues on that reference are whether he was of unsound mind at the time and current fitness for trial.
The defendant was born on 25 January 1973. He is a large, solidly built Maori man. He suffers from chronic paranoid schizophrenia. The issue before this Court is whether he was deprived of any of the relevant capacities at the time of the offences.
Briefly, the offences involved these circumstances. He went to a store wanting to purchase a chicken leg to eat. He was given a chicken wing. He became annoyed. He left, went home and spoke to his mother and then returned to the store. He told police his sole reason for returning was “to beat the guy up.” He used his right fist to punch the complainant to the head twice, the second time being after he had fallen to the ground. He also told Dr Griffin, one of the examining psychiatrists, that his mother offered to get the chicken leg for him and that that made him angrier.
The defendant has had several admissions to hospital when psychotic. The first was in 1998 in New Zealand. Subsequently he has been admitted to the Barrett Centre, the Logan Hospital and the John Oxley Memorial Hospital. These admissions have usually been in the context of non-compliance with antipsychotic medication and substance abuse.
His illness has been characterised by persecutory delusions, intermittent auditory hallucinations, irritability, assaultiveness and insightlessness. He also has significant negative schizophrenic symptoms. He improves with antipsychotic treatment but has significant residual symptoms much of the time.
With respect to the question of his soundness of mind at the time of the alleged offences in October 2002, reports were received from Dr Pamela Van de Hoef, Dr Peter Fama and Dr Cassandra Griffin.
It is common ground that he suffers from chronic paranoid schizophrenia, that he had been noncompliant with treatment for some time leading up to the offences and that he was probably actively psychotic at the time. However, there was a difference of opinion whether the illness led to a deprivation of any of the capacities, in particular, the capacity to know that he ought not engage in the conduct he did, or whether it led merely to an impairment, albeit a substantial impairment, of that capacity. Dr Van de Hoef considered that it led to a deprivation while the others considered that it led merely to an impairment.
As Dr Wood, one of the assisting psychiatrists advised the Court, secretiveness and guardedness are features of the illness. That, coupled with the fact that he has very little, if any, insight into his illness, leads to his own accounts of how he felt and why he acted as he did being not very helpful, indeed unreliable.
It is usual in cases such as this to have recourse to collateral material. Unfortunately, there is very little collateral material in this case. There is the police summary in the QP9 but there is no tape of the interview or a transcript of it. There are no witness statements. There is no evidence, for example, of how the storekeeper treated him.
Dr Van de Hoef had seen the defendant after the offences in 2001 which involved assaults on nurses at the Logan Hospital. He was unwell at the time of those offences although found not to have been deprived of any of the capacities. She saw him when he got better. Then she interviewed him after the October 2002 offences at the Arthur Gorrie Correctional Centre. She conducted two interviews on 17 and 24 October 2002, that is, only a few days after the offences. He had been off treatment for seven weeks. There was no specific delusion or any delusion relating to the complainant which he could point to. Dr Van de Hoef could identify no more than general persecutory delusions. She said he had a feeling of entitlement but he denied hallucinations or “paranoia” on the day of the offences. Of course, for the reasons I have already stated, his self reports need to be treated with reserve.
In Dr Van de Hoef’s opinion the delusions of a persecutory type prevented him from considering in a rational way the rightness or wrongfulness of what he did. In other words, it deprived him of one of the capacities.
She wrote her report shortly after her interviews. In her oral evidence she indicated that she was strengthened in her views by the subsequent course of his illness and treatment. On 23rd December 2002 he was transferred from prison to the High Security Unit at The Park after a deterioration in his mental state and non-compliance with medication. She saw him about three weeks after his admission to The Park, that is, after he had been placed on medication, but he was still floridly psychotic.
The next specialist to give evidence was Dr Peter Fama. He considered that there was no evidence the defendant suffered an acute delusion as opposed to a belief that he had been badly treated and that the appropriate response was retaliation in some form. Dr Fama acknowledged that the defendant’s mental disorder led to his being sensitive to rebuff or rejection or disappointment. He considered that the defendant had overvalued ideas. This was a borderline case but ultimately he considered it was not a case of deprivation of capacity.
Dr Cassandra Griffin identified both negative and positive symptomatology but she said that the nature of the psychotic symptoms he was probably exhibiting was speculative. As the event was recounted by the defendant to her there were two aspects to the injustice he felt: the behaviour of the storekeeper and his mother’s offer to go and get the chicken leg for him. Dr Griffin relied on the police material which indicated that he assaulted the complainant because he was annoyed at not getting what he wanted. Of course, I have already referred to the paucity of that police material. As I understood Dr Griffin’s evidence, it was a combination of his psychotic illness and normal human emotions that led him to act as he did. She described the case as “a close call” but was not satisfied of deprivation.
There was a brief report before the Court from Dr Kumar, a psychiatric registrar, and he gave brief oral evidence by telephone. He had been asked for an update report on fitness for trial but in the course of that report he had expressed the opinion that the defendant was not deprived of any of the capacities at the relevant time. It became clear during his oral evidence he had relied on the defendant’s own account of how he had felt at the time and, as I have already explained, because of the secretiveness and lack of insight which characterised the defendant’s illness, his own account is not helpful. In all the circumstances I did not gain any assistance from Dr Kumar’s report on the question of soundness of mind.
Dr Wood, one of the assisting psychiatrists, explained the features of the illness as I have described. He advised the Court to look to the behaviour itself.
Dr Grant, the other assisting psychiatrist, advised the Court to consider the motivation for the defendant’s behaviour. It was to do with his illness, both directly and indirectly. While there was no evidence of delusions or hallucinations, the illness did produce emotional arousal. In the indirect sense there was the psycho-social effect of the illness in the sense of discrimination which the defendant felt. As I understood Dr Grant’s advice, the direct effects of the illness were not so marked as to enable the Court to find a clear deprivation of capacity.
This Court needs to be satisfied on the balance of probabilities that the defendant was suffering from unsoundness of mind before making a finding to that effect. His own statements are of little help. The evidence of the conduct itself is very scant. The preponderance of psychiatric evidence is that he was suffering a substantial impairment but not a deprivation of capacity.
I am not satisfied that there is an adequate proven factual foundation for the opinion of Dr Van de Hoef to allow me to accept that opinion in preference to the others. In short, I am not satisfied on the balance of probabilities that he was suffering from unsoundness of mind at the time.
All of the evidence is to the effect that he is fit for trial.
The formal findings will be that he was not suffering from unsoundness of mind at the time of the alleged offences; that he is fit for trial. I order that the proceedings against him be continued according to law.
The remaining issue is that of his placement. All of the evidence from the psychiatrists supports the need for him to continue to be looked after in hospital. I make an order under section 273 of the Mental Health Act 2000 for his detention in The Park Centre for Mental Health, Authorised Mental Health Service, until he is granted bail under the Bail Act 1980 (Qld) or is brought before a Court for continuing the proceedings.
I approve escorted limited community treatment on the grounds of the hospital on the following conditions:
That he remain under the escort of a health service staff member or members nominated by the authorised psychiatrist for the duration of the limited community treatment; and
That for the purposes of the limited community treatment he comply with the directions of the nominated staff members for the duration of that treatment.
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