Re AEM

[2012] QMHC 16

MENTAL HEALTH COURT

CITATION:

Re AEM [2012] QMHC 16

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF AEM

PROCEEDING NO:

No. 0208 of 11

DELIVERED ON:

Ex tempore reasons delivered on 6 June 2012
Written reasons delivered on 19 June 2012

DELIVERED AT:

Brisbane

HEARING DATE:

6 June 2012

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr E N McVie
Dr F T Varghese

FINDINGS AND ORDERS:

That the patient was of unsound mind at the time of the commission of the offences;1.      

Pursuant to s 288 of the Mental Health Act 2000 (Qld) a Forensic Order be made and the patient be detained at The Park Centre for Mental Health Authorised Mental Health Service; and2.      

Pursuant to s 281 of the Mental Health Act 2000 (Qld) the proceedings against the patient are discontinued and further proceedings must not be taken against him for the acts or omissions constituting these offences; 3.      

ursuant to s 289 of the Mental Health Act 2000 (Qld), subject to the discretion of the authorised psychiatrist, and on the following conditions:Community Treatment to commence immediately, LimitedP4.      

That the patient comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;(a)    

That the patient must not use alcohol unless permitted to do so by the authorised psychiatrist;(b)    

That the patient abstain from all illicit drugs and must cooperate fully in random medical tests for those substances as required by the authorised psychiatrist;(c)   

That the patient not, at this stage, initiate contact with her children without the permission of her treating psychiatrist and when there are appropriate consents in place;(d)    

That the patient is to remain under the escort of health service staff member/s nominated by the authorised psychiatrist for the duration of the limited community treatment;(e)   

For the purposes of escorted Limited Community Treatment, the patient comply with the directions of the nominated staff member/s for the duration of the limited community treatment. (f)   

COUNSEL:

J Briggs for the defendant
J Tate for the Director of Mental Health

S Vasta for the Director of Public Prosecutions

SOLICITORS:

Legal Aid Queensland for the defendant
Crown Law for the Director of Mental Health

Director of Public Prosecutions (Qld)

ANN LYONS J:

This Reference

1. This is a reference by the Director of Mental Health filed on 24 July 2011 in relation to AEM. She is charged with the murder of her husband on 14 March 2011, with three counts of endangering children by exposure on 15 March 2011 and one charge of leaving a child under 12 unattended on 15 March 2011.

1. On 5 June 2012 the matter was heard before the Mental Health Court. Findings and orders were made and short ex tempore reasons were given. I indicated that I would publish more detailed reasons in due course. These are those reasons.

The factual background to the offences

1. AEM and her husband had recently separated at the time he was killed. They had four children aged between seven years old and one year old who were living with AEM at the family home in rural Queensland. On the morning of 14 March 2011, whilst the two older children were at school, her husband came to babysit the two younger children so she could go shopping.

1. Whilst AEM was out shopping she purchased some poison. When she got home, she mixed the poison with Coca Cola and intended to give it to give it to her husband but when she tasted it she realised it tasted awful and did not give it to him. She did, however, give him a sandwich into which she had crushed a number of Tramal tablets. Whilst her husband ate the sandwich, he did not finish it. AEM then asked her husband to stay for a barbeque dinner. She asked him to sharpen a knife for her and whilst he was sitting at the table she massaged his shoulders and, in that process, got the knife and cut his throat from left to right. He began to bleed onto the floor and, although he struggled and grabbed the knife, she managed to further cut into his neck on the right side. The two youngest children were sitting in their chairs at the dining table during this period.

1. After he died, AEM had a shower, removed all her clothes and scrubbed herself clean. After the shower, she dragged his body into the car and dumped his body at a nearby property. She then returned home.

1. The next day she returned to the nearby property, taking all the children with her. She left the children beside a dam, which was adjacent to where she had dumped her husband’s body.

1. When she returned home, she was spoken to by police who had been alerted to her husband’s disappearance by his parents. She accompanied police to the property and showed them where she had dumped the body. She also showed police where she had gone to a rubbish tip to dump the towels and clothing she had worn when she killed her husband.

1. During an interview, AEM made admissions in relation to the attempted poisoning, getting her husband to sharpen the knife and then placing the knife on the table prior to slitting his throat from left to right.

1. She also indicated that at about 1.00pm a real estate agent had attended the house to do an appraisal on the house for sale and he observed blood and drag marks on the ground. She told him she had hit a sheep and killed it and dragged it inside.  There was a urine drug screen done on 18 April, which was negative for all drugs.

History prior to the alleged offences

1. The collateral material indicates that AEM had been coming increasingly unwell in the months prior to the alleged offences. In particular, she had withdrawn from her friends, she was obsessed with vaccinations and food tampering and talked about Muslims joining the Pope. She had also purchased a lot of tinned food. After her arrest her family found that she had been on a shopping frenzy, which was very uncharacteristic for her.

1. AEM’s father reported that a week prior to the offences she had spoken to him about home schooling the children and about the degeneration of mankind. Her mother also noted some odd ideas and behaviour in the weeks leading up to the offences. She had got rid of all of her chickens claiming they had too many hormones. She also got rid of her favourite horses, saddles and bridles.

The assessments by the Prison Mental Health Service

1. Dr Eve Timmins first saw AEM on 17 March 2011, three days after the alleged offences, at the Prison Mental Health Service. She reported that AEM was perplexed with a fatuous affect at times. She also stated that there was evidence of possible elevation in mood and she noted the reported buying of many things in case her true love, D, was to come to her. She considered that there was evidence of formal thought disorder with tangentiality and loosening of association. Dr Timmins considered there was also some thought blocking.

1. Dr Timmins noted AEM was exhibiting a range of religious, spiritual, and persecutory delusional beliefs. She believed she had killed D rather than her husband and she had felt D’s spirit go into her body. She was asking for a bible and asked odd questions of a religious nature. She also believed that D was talking to her. He apparently had told her to do various things including asking her to kill her husband. On admission to the Mental Health Service she refused medication on the basis “it will open up my mind to demons”.

1. AEM was also seen by Dr Aboud on 23 March 2011 and she continued to describe her relationship with D, telling Dr Aboud that D communicated with her in her head:

“I hear him, I think, in my head. Is that possible? Do you think that’s possible? I hear him say I need to relax, to trust him and not to trust him. I’ve tried to control this voice, well it sounds like his voice.”

Dr Aboud considered that she was perplexed with a fatuous affect with mild blunting and incongruent laughter. There were delayed responses and he thought she was possibly thought blocking. He considered that she:

“Presented as a little muddled. Struggling to explain herself. Occasionally distracted. Over sensitive to background noises…  Impaired insight.”

The reporting psychiatrists

1. A number of reports were prepared by psychiatrists Dr Donald Grant, Dr Jill Reddan and Dr Angela Voita.

Dr Grant

1. Dr Grant considered that, in the period leading up to the murder of her husband, AEM was suffering from a severe mental illness characterised by paranoid and religious delusions, prominent ideas of reference and auditory hallucinations, including command hallucinations from a man called D whom she identified as a religious pastor and counsellor she had known a few years earlier and to whom she had become attracted.

1. In the weeks leading up to the offence, Dr Grant considered that AEM had become increasingly preoccupied on the internet with paranoid conspiracy theories and had become convinced that Luciferians, who were devil worshippers and people involved in a ‘new world order’, were trying to eliminate people through vaccinations and they were representing a serious threat to herself and her family.

1. Two weeks before the offence, the hallucinations of D’s voice started and she began to do what he instructed her to do. This came to a climax when she was instructed to kill her husband, which she agreed to do. She then carried out that murder in a bizarre fashion with her two youngest children either present or close by. She then cleaned up the scene, disposed of the body and took all four children out to the site where she had dumped the body and left them by a dam, believing that D would decide their fate.

1. Dr Grant considered she was suffering from schizophrenia, alternatively a schizo affective psychosis. He considers there were prominent manic affect elements to her symtomotology. Dr Grant considered that the illness had been present in a florid form for at least two or three weeks, although there was some evidence of the illness developing over the previous nine months and a possibility of two brief episodes of psychotic symptoms in the previous 10 years.

1. Dr Grant noted the strong family history of schizophrenia. Her mother’s illness commenced at the age of 37. Dr Grant indicates that the onset of AEM’s illness occurred at a similar age and is also marked by prominent religious ideas and delusions.

1. Dr Grant considered that at the time of the offences she was in a state of mental disease such as to deprive her of the capacity to know she ought not do the act, given she was suffering from extensive delusions and was being instructed by auditory hallucinations to carry out the acts. In his view, AEM had lost touch with reality and was acting in a way consistent with her psychotic beliefs. She was deprived of the capacity for moral understanding of her behaviour. She was not, however, deprived of the knowledge that her behaviour might be seen as illegal. In the days following the offence she accepted that she had committed the offence but gave a range of delusional reasons as to why she had done so.

1. Dr Grant stated that AEM’s psychotic state was confirmed by repeated examinations in the days following her arrest. He considers she was of unsound mind at the time. Dr Grant considers that she has responded well to medication and has developed good insight.

Dr Redden

1. Dr Redden also completed a report and considered that at the time of the offences AEM was psychotic and was out of contact with reality. She was suffering from persecutory delusions, including the delusion that she would be going to live with D and that they would be forming a long term relationship. She was also suffering from auditory hallucinations.

1. Dr Redden considers she was also suffering from a neuro-vegetative disturbance of  a quite significant degree. She considers it is quite likely that this episode of psychosis was due to schizophrenia, although there are aspects of her condition which might lead to a diagnosis of mania. She notes AEM’s mother suffers from schizophrenia. Dr Redden also notes there is no evidence of any intoxication.

1. Dr Redden considers AEM was suffering from a mental disease, specifically a psychotic state due to schizophrenia and she was deprived of the capacity to know that she ought not do the act. She does, however, consider she was able to control her actions and she understood what she was doing when she killed her husband and endangered the lives of her children. She had multiple motivations but the predominant and overriding motivation was a psychotic one and her motivation in leaving the children to die in the dam or near the dam was due to psychotic beliefs. She considers that AEM was of unsound mind and that a Forensic Order is appropriate, but that she is not a risk to the children and a non-contact order is not required.

Dr Voita

1. Dr Voita has also prepared a report dated 15 July 2011. Dr Voita has been AEM’s treating psychiatrist since her admission to The Park in March 2011. Dr Voita has seen AEM on many occasions in that role. She had seen her at least 20 times prior to the preparation of her report in July 2011. I note a further report has been provided by Dr Voita dated 30 May 2012. Dr Voita considers AEM was suffering from a mental disease. She was suffering from a psychotic disorder, namely schizophrenia of the paranoid type.

1. There are, however, other differential diagnoses which have to be considered, namely schizophreniform psychosis or a schizo-affective disorder. Dr Voita considers that the last two diagnoses are less likely, given the relatively rapid resolution of the symptoms with medication and evidence of some symptoms consistent with mood elevation at the time of the alleged offences.

1. Dr Voita considers that, at the time of the killing, AEM was floridly psychotic and experiencing auditory hallucinations and experiencing religious bizarre persecutory grandiose and erotomanic delusions. Dr Voita stated that some of the grandiose and religious delusions appear to have been present for a number of years but became more acute in the months and, in particular, the few days prior to the alleged offences. Dr Voita states that in the weeks prior to the killing the symptoms intensified and she developed delusional beliefs pertaining to D, a man with whom she had previously been infatuated.

1. Dr Voita considers the diagnosis of a psychotic disorder is supported by the psychiatric assessments following AEM’s arrest together with the police material and the collateral information obtained from family members. Dr Voita also referred to the assessment by Dr Eve Timmins on 17 March 2011, where AEM described psychotic motivation for the killing of her husband.

1. Dr Voita also notes that subsequent behaviour and mental state assessments in custody and following her admission to the High Secure Unit support a diagnosis of a psychotic illness with evidence of formal thought disorder, a fatuous and inappropriate affect and provide evidence of multiple of psychotic symptoms. In terms of the capacities, Dr Voita considers AEM was aware of the nature of the act. She was aware that she was cutting her husband’s throat and that doing so would kill him. It is clear that she intended to kill him and she reported that she had also tried to poison him on the same day.

1. In relation to the four charges pertaining to her children, Dr Voita considers AEM was aware that leaving the children unattended would mean they could come to harm.

1. Dr Voita states, however, that AEM’s actions were driven by persecutory and religious beliefs including beliefs that a ‘new world order’ was coming. Her delusional beliefs intensified. She believed she and her family were targets. In the week prior the alleged offences, AEM believed that the ‘illuminates’ had bugged the house and were watching her through the webcam and her computer. She also indicated she received messages from the television.

1. At the time of the killing, Dr Voita considers AEM was driven by her delusional beliefs and command auditory hallucinations from the voice of D. She believed, at the time, that D loved her and that they were going to be together. She reported hearing his voice for about two weeks prior to the alleged offences and believed at the time they had a special communication. She appears to have separated from her husband so she could be with D and in the days prior to the killings she spent $7000 on clothes for herself and gifts and clothes for D, as well as clothes and toys for the children. She also spent money on household items in order to start a new life with D. She also believed she had won a holiday for two adults and two children to Orlando and had purchased travel insurance for the trip. She reports that she planned to take two of the children with her on the holiday, believing she would meet D on a cruise ship and they would be married. She believed that they were going on a holiday on a specific date, namely 9 April, which was delusionally driven. She also was planning to home school the children due to communication from D to protect them from the new world order.

1. Dr Voita indicated that AEM stated that on the day of the killing, D said to her, “will you kill [your husband] for me? Would you do that for me?” This appears to have been interpreted by AEM to mean that she should kill her husband to show her love for D and as a means to facilitate their being together. She stated that at the time it was the right thing to do because D asked her to do it. She believed D was a man of God and that it was God’s will that she and D be together. She also believed that her husband was evil and he was keeping them from being together. She indicated that she killed her husband for love and that at the time she did not believe it was the wrong thing to do. She believed D would sort things out so she “would not get pinned with the murder”. Dr Voita considers that after the killing she became aware she might get charged with the murder and began to clean up the scene.

1. When interviewed, AEM reported to Dr Voita that she knew it was against the law but believed that it was right and that it was for love. Dr Voita considers that this indicates that she was not able to reason with a degree of composure at the time of the killing.

1. Dr Voita states that AEM’s actions in disposing of the body also appear to be delusionally driven. She states she took him to a property on the outskirts of town where she believed she would live with D. She had gone to that property a week prior to the murder looking for D. She stated that she trusted D to guide her to a place he had bought for them. She believed that the man living there was involved in the plan for her to be with D. It would appear that the following day, when her husband’s family came to the property looking for him, she told them she had killed him in response to auditory hallucinations and that D had told her to do so. She then left with the children and returned to where she had left her husband’s body.

1. Dr Voita considers that, again, she was acting on her delusional beliefs and in response to auditory hallucinations. She reports that D told her that something was not right and that she was not feeling as she should and was spiritually burdened. She stated she had to give up the children because it was God’s will and because they were the spawn of Satan. She stated that whilst D was talking to her she took them to the dam and told them they could have a swim and then left them there. When asked why she left them there, she stated that she could not get rid of them and left them for D to do what he wanted. She stated that she believed this was some sort of test and she believed they would be fine.

1. Dr Voita considers that her actions were delusionally driven and secondary to command hallucinations and delusional beliefs. Dr Voita considers that AEM was able to resist the command to kill the children but was not able to do so in relation to killing her husband. This would indicate, in her opinion, that AEM was deprived of the capacity of control in relation to the killing of her husband but not in relation to the charges of abandoning her children. Accordingly, Dr Voita believes AEM was deprived of the capacity to know she ought not do the act and the capacity of control in relation to the killing of her husband but was only deprived of the capacity to know she ought not do the act in relation to the abandonment of the children.

The assisting psychiatrists’ advice

Dr McVie

1. Dr McVie considered that it was clear from the material provided that AEM developed a relatively late onset paranoid schizophrenic illness, characterised by religious grandiose persecuted delusions and probably referential delusions and also auditory hallucinations on which she has acted from time to time.  Dr McVie stated that it is interesting that her mother shared similar symptoms and a similar age of onset.  The collateral information indicates that AEM's onset of illness was at least some months prior to the events of March 2011. 

1. Dr McVie stated that the three reporting doctors, Drs Voita, Grant and Redden, have all done a comprehensive review of all the materials and have all concluded that AEM was floridly psychotic at the time of the offences. Dr McVie accepts their clear opinions that she was of unsound mind and at least deprived of the capacity to know she ought not do the acts in relation to all the offences. Dr McVie believes a Forensic Order is clearly indicated in this case and the Forensic Order should be to the High Secure service at The Park Centre for Mental Health. 

1. Dr McVie considered that as AEM has been charged with serious violent offences she needs to remain under the care of the current treating team in the Forensic Service for a lengthy period of time.  Dr McVie stated: “A clear rehabilitation plan as to a long-term management into the next five to ten years needs to be made.  As Dr Grant said in his evidence, [AEM’s] going to need to be on anti-psychotic medication for the rest of her life and she's going to need close psychiatric follow-up for the rest of her life.”

1. Dr McVie indicated that one of the issues that is concerning in this case is the issue of what to be done with the children and relationships with the children. Dr McVie stated that it is very clear, from the limited information that the resolution of that issue is not going to be a simple matter.  In particular she noted that there are no reports that indicate the effects on the children or what might be in their best interests.  Dr McVie noted however that in general terms, it is always best that parents and children are reunited but this needs to be done extremely carefully. 

1. Dr McVie also noted that those matters would be dealt with in a different environment. Her advice however was that, prior to any contact with the children AEM’s treating psychiatrist, Dr Voita, should have some contact with the legal guardians of the children and find out what their concerns are, what is happening with the children, what they believe the psychological effects of contact will be and whether the children need psychological services themselves.

1. Dr McVie considered that such contact needs to be done very gradually, slowly and carefully with the interests of the children and AEM in consideration.  Her advice was that a clause should not be added to the Limited Community Treatment (LCT) to restrict any initiation of contact with the children.  Dr McVie’s view was that as the children have legal guardians, any contact should go through them.

1. In terms of the LCT conditions, Dr McVie’s advice is that the current conditions are appropriate and should be continued and should not be extended at this point in time. 

Dr Varghese

1. Dr Varghese advice was that the patient has suffered from a psychotic illness of schizophrenia and that she was quite grossly psychotic at the time of the offences with delusions, hallucinations and other psychotic symptoms typical of schizophrenia despite the fact that there were some manic symptoms.  He considers that the evidence indicates that she was of unsound mind at the time as she was deprived of the capacity to know the wrongness of the act and arguably the capacity for the mental component of control and this unsoundness of mind would apply to the charge of murder and the offences with respect to the children. 

1. Dr Varghese considered that at the present time, AEM has largely recovered from the psychosis but that a Forensic Order is clearly indicated given the seriousness of the offence. He also indicated that there are long-term risk issues if there is a recurrence of psychosis. She will require, essentially, lifelong treatment to prevent a recurrence of the psychosis. 

1. With respect to the conditions of the Forensic Order, Dr Varghese agreed with Dr McVie, that the orders as proposed by the DMH are appropriate at this stage and that they not be extended to unescorted leave and that question can be decided by the Mental Health Review Tribunal. 

1. With respect to the question of initiation of contact, Dr Varghese disagreed with Dr McVie and thought it appropriate to have a clause where the patient not initiate direct or indirect contact with the children or their temporary guardians, except with the consent of the treating psychiatrist and then through legal or other official channels.  This would reinforce to the patient that contact with the children should not come from her, that she was not to ring them or the guardians and that any contact be done through appropriate channels. 

Was AEM of unsound mind at the time of the commission of the alleged offences?

1. Pursuant to s 257 of Mental Health Act 2000 (the Act), the question of AEM’s mental condition at the time of the commission of all of the alleged offences has been referred to this Court by her legal representatives.

1. Section 267 then provides that, on the hearing of the reference, the Court must decide whether the person the subject of the reference was of unsound mind when the alleged offence was committed.

1. The term ‘unsound mind’ is defined in the Schedule of the Act as follows:

“unsound mind means the state of mental disease or natural mental infirmity described in the Criminal Code, section 27, but does not include a state of mind resulting, to any extent, from intentional intoxication or stupefaction alone or in combination with some other agent at or about the time of the alleged offence.

Editor’s note—

Criminal Code, section 27—

27 Insanity

(1) A person is not criminally responsible for an act or omission if at the time of doing the act or making the omission the person is in such a state of mental disease or natural mental infirmity as to deprive the person of capacity to understand what the person is doing, or of capacity to control the person’s actions, or of capacity to know that the person ought not to do the act or make the omission.

(2) A person whose mind, at the time of the person’s doing or omitting to do an act, is affected by delusions on some specific matter or matters, but who is not otherwise entitled to the benefit of subsection (1), is criminally responsible for the act or omission to the same extent as if the real state of things had been such as the person was induced by the delusions to believe to exist.”

1. The evidence of all the reporting psychiatrists as well as the advice of the assisting psychiatrists is that AEM was clearly experiencing command hallucinations and persecutory delusions at the time of the offences. I consider that she was being instructed by auditory hallucinations to carry out the acts. She had lost touch with reality and was acting in a way consistent with her psychotic beliefs. The evidence from all the psychiatrists is that she was deprived of the capacity for moral understanding of her behaviour.

1. I am therefore satisfied that there is overwhelming evidence that AEM was suffering from a mental disease, specifically a psychotic state due to schizophrenia. I am satisfied that she was deprived of the capacity to know that she ought not do the acts in relation to all of the offences.

1. I am therefore satisfied that AEM was of unsound mind as defined in the Schedule of the Act at the time of the commission of all of the offences.

Is a Forensic Order required?

1. Section 288(4) provides the criteria for the making of a Forensic Order. I am satisfied that the criteria have been satisfied in this case given the very serious charge of murder, the protection of the community and AEM’s clear treatment needs.

1. Section 289 then provides that the Court may, under the Forensic Order, approve LCT. Section 289(4) provides that the Court must not order or approve LCT unless it is satisfied the patient does not represent an unacceptable risk to the safety of the patient or other, having regard to the patient’s mental illness or intellectual disability.

1. In response to Mr Tate’s question in relation to LCT, dangerousness and how these issues ought to be dealt with in the short, medium and long terms, Dr Grant stated he believed a Forensic Order to be the appropriate legal framework to ensure that AEM can be followed up long-term; he stated that she can receive the appropriate treatment; and that the public safety can also be addressed through that legal framework. 

1. Dr Grant stated that AEM responded well to antipsychotic treatment in terms of the psychotic symptoms settling down and disappearing; that she does not have a personality disorder; and that she does not abuse drugs. However, if she was ever to become floridly psychotic again, he stated that one cannot predict what her behaviour might be, as with anyone with an illness that has acted on psychotic beliefs. 

1. Dr Grant indicated that it was important that her illness be kept under control and that she take antipsychotic medication probably for the rest of her life. He considers that she needs the appropriate structure to be put in place to enable that to happen.

1. Dr Grant believed that AEM will require a further period as an inpatient in hospital to be sure that her illness is well-controlled; that the mood elements and other elements of her illness are controlled and that she is quite stable.  He considered that there should be a very graduated process of LCT with escorted leaves followed by more freedom to do things in the community, all aimed at rehabilitating her and ensuring that this can never happen again. 

1. Dr Grant believed that, from the clinical point of view, the risk now is very low because the psychosis is well controlled and there is no reason why LCT could not progress on a graduated basis.  He said: “Clearly, when there's been such a serious offence, then a degree of extra caution is indicated and - so this tends to be quite a slow process.”

1. Regarding contact with her children, in Dr Grant’s view it was important that they are assisted in re-establishing a relationship with their mother but did not indicate over what period of time that should occur. 

1. In my view a Forensic Order is clearly required.

1. I note the concerns of Dr Varghese in relation to the initiation of contact and Dr McVie’s concern that any contact should proceed slowly. In this regard I consider that a non-contact order is not appropriate but that no contact should be initiated unless such contact is approved by her treating psychiatrist.  I also note that the children are currently in the care of her late husband’s family and they have the day-to-day custody and care of them.  It would seem that the legal guardianship of the children is yet to be determined by another body and AEM will be able to make representations to that body about custody and contact with the children. It would seem to me that before AEM initiates contact with the children, appropriate consent arrangements should be in place with those who have that decision making authority.

1. Accordingly there should be a Forensic Order on the following conditions:

ORDERS:

1.          That the patient was of unsound mind at the time of the commission of the offences;

2. Pursuant to s 288 of the Mental Health Act 2000 (Qld) a Forensic Order be made and the patient be detained at The Park Centre for Mental Health Authorised Mental Health Service; and

3. Pursuant to s 281 of the Mental Health Act 2000 (Qld) the proceedings against the patient are discontinued and further proceedings must not be taken against him for the acts or omissions constituting these offences;

4. Pursuant to s 289 of the Mental Health Act 2000 (Qld), Limited Community Treatment to commence immediately, subject to the discretion of the authorised psychiatrist, and on the following conditions:

(a)        That the patient comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;

(b)        That the patient must not use alcohol unless permitted to do so by the authorised psychiatrist;

(c)        That the patient abstain from all illicit drugs and must cooperate fully in random medical tests for those substances as required by the authorised psychiatrist;

(d)        That the patient not, at this stage, initiate contact with her children without the permission of her treating psychiatrist and when there are appropriate consents in place;

(e)        That the patient is to remain under the escort of health service staff member/s nominated by the authorised psychiatrist for the duration of the limited community treatment;

(f)        For the purposes of escorted Limited Community Treatment, the patient comply with the directions of the nominated staff member/s for the duration of the limited community treatment.