Re DGM

[2012] QMHC 22

SUPREME COURT OF QUEENSLAND

CITATION:

Re DGM [2012] QMHC 22

PARTIES:

REFERENCE BY THE LEGAL REPRESENTATIVES IN RESPECT OF DGM

PROCEEDING NO:

0205 of 2010

DELIVERED ON:

3 October 2012

DELIVERED AT:

Brisbane

HEARING DATE:

25, 26 and 27 September 2012

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr E N McVie
Dr J M Lawrence

FINDINGS AND ORDERS:

1. The patient was of unsound mind at the time of the 12 offences between 30 June 2004 and 25 September 2009.

2. A Forensic Order is required.

3. I will hear submissions as to the conditions of his Forensic Order and Limited Community Treatment.

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

Office of the Director of Public Prosecutions (Qld)

ANN LYONS J: 

Background

1. This is a reference by the legal representatives for DGM. He is charged with 12 offences between June 2004 and September 2009. The offences include seven counts of indecent treatment of a child under 16, two counts of attempted indecent treatment of a child under 16 and three counts of common assault.

1. It is alleged that during those years he inappropriately kissed, cuddled and touched young children on the outside of their clothes during group sports coaching classes.

1. He is 77 years of age and has no criminal history.

1. It is clear that DGM has worked as a sports coach in rural Queensland for more than 45 years. He had previously worked in a managerial position for a long period of time until he retired in his mid-fifties to concentrate on tennis coaching. He was held in high regard until these charges were laid.

1. The evidence from his wife and family is that over the last decade DGM has become progressively more disinhibited and that his behaviour in social settings is inappropriate. They also indicate that there has been a gradual coarsening of his manners and he exhibits an inability to control his eating. They have observed that he lacks insight and does not appreciate the feelings of others.  The family were able to relate that there had been several incidents where it was considered that he had kissed his daughter-in-law and a close male friend inappropriately on a number of occasions in social settings even after being told he was not to do so.

1. Whilst there was some initial indication that DGM was disputing the charges it seems that he now essentially agrees with the substance of the allegations against him.

1. The greatest difficulty in this case is the fact that the earliest offences occurred some nine years ago. There is also a difference of opinion not only between the three reporting psychiatrists but also between the assisting psychiatrists. All the psychiatrists agreed that the factual background to this case and the nature of the mental disease, namely frontotemporal lobe dementia, combined to make this a particularly difficult case.

Report of Dr Reddan

1. In a report dated 17 July 2012, which is an update to an earlier report dated 24 April 2011, Dr Reddan considered that DGM has developed a frontotemporal dementia which has had a slow progression and is mainly a behavioural variant as there seems to be little evidence of marked cognitive deterioration.

1. Whilst Dr Reddan conceded that frontotemporal dementia could be regarded as a mental disease within the meaning of s 27 of the Criminal Code 1899 (Qld) (“Criminal Code”), she does not consider there is any evidence that between 2004 and 2009 DGM was deprived of any of the three capacities specified in s 27 of the Criminal Code and she could not therefore recommend the defence of unsoundness of mind.

1. Dr Reddan placed considerable emphasis on the witness statements gathered by police as she considered they are a more contemporaneous account of his actions. Dr Reddan considered that DGM was able to modify his behaviour when confronted by the principal in 2004 and that the statements indicate that, during one incident, he moved a child out of view. Whilst she considers his judgment might have been impaired she does not consider he was deprived of any of the capacities, particularly of control.

1. Dr Reddan noted that his criminal behaviour was at the mild end of the spectrum and in that regard had been able to moderate his behaviour. She noted that in 2010 when she saw him he was still paying the bills and using his computer.

1. Dr Reddan observed that whilst DGM disputed some elements of the offences, when she interviewed him it would seem that he no longer disputes the allegations and there is not a dispute of facts.

1. Dr Reddan indicated that when Professor Byrne saw DGM he had deteriorated and that raises a question as to whether DGM is now fit for trial. Her opinion was that when she examined him in December 2010 he was fit for trial but that a considerable period of time has gone by. Dr Reddan is concerned that she would have doubts whether DGM can adequately instruct counsel, challenge witnesses or follow events at his trial.

1. Dr Reddan therefore considered that on the balance of probabilities it is unlikely that he is fit for trial.

1. Dr Reddan could see no benefit in a Forensic Order if he was found to be of unsound mind.

Report of Dr Douglas

1. Dr Douglas is a neuropsychologist and she conducted a number of assessments on DGM in February 2011. She noted a weakness in his capacity to alternate movements on a motor based task and also concluded that there was an abnormal decline in his word finding and verbal fluency abilities. Her conclusion, however, was that there was nothing on the testing that would support a finding that he suffered from a dementing illness. Dr Douglas indicated that she could find no evidence of any decline in his intellectual, attentional memory or executive functioning skills. She considered that despite isolated deficits, those deficits would not support a diagnosis of dementia and that the deficits would not be responsible for the alleged offences.

1. Dr Douglas considered that the lack of progression and, in some respects, apparent improvement between her report and the earlier report of Ms Tanya Withers, psychologist, would not support a progressive dementing illness.

Report of Dr O'Sullivan

1. Dr John O’Sullivan provided a number of reports dated 4 November 2009, 23 August 2011 and 16 September 2011. He also gave oral evidence to the Court. Dr O’Sullivan noted that the report of Dr Lucille Douglas indicates that, at the time of her assessment in February 2011, his cognitive assessment was largely consistent with other men of his age and educational ability whilst acknowledging that there were some isolated deficits in verbal fluency and in assessment of initiation and perseveration.

1. Dr O'Sullivan considered that DGM has developed behavioural symptoms, supported by the collateral history from his family, representing a change in his behaviour in recent years. Dr O'Sullivan considers that those changes are consistent with behavioural changes that are seen in dementia, particularly frontotemporal dementia. However, he considers that Dr Douglas’ more detailed neuropsychological assessment is more accurate than the earlier report of Ms Withers and that the findings of Dr Douglas do not support a diagnosis of dementia.

1. Dr O'Sullivan considered that, if DGM had frontotemporal dementia of sufficient severity to explain the abnormal behaviour associated with numerous criminal charges between seven and five years ago, the progression of his dementia would be expected to result in more definite and significant cognitive and neuropsychological changes. Dr O'Sullivan concluded that the findings of the assessment of Dr Douglas and the lack of any progressive atrophy on neuroimaging would not support frontotemporal dementia.

1. Dr O'Sullivan also indicated that his symptoms may support a neurodegenerative condition, however, the subsequent neuroimaging compared with the earlier neuroimaging and the more recent neuropsychological assessment led him to form the view that a neurodegenerative condition is much less likely, although it remains difficult to exclude the possibility.

1. Dr O'Sullivan concluded that, whilst the alleged offences may have occurred in a setting of other behavioural changes, any behavioural changes could not be readily explained on the basis of frontotemporal dementia.

Report of Dr Phillipson

1. Dr Phillipson, in a report dated 18 August 2010 and in his evidence to the Court, indicated that DGM has evidence of a dementing illness, most likely frontotemporal dementia. He considered he was deprived of the capacity to control his actions due to his dementia and, therefore, was of unsound mind at the time of all of the offences. Whilst he considered that the 2004 offences were more marginal, he was none the less satisfied that he was deprived of capacity in relation to all of the offences.

1. He considered that, given the likely progressive nature of the psychiatric condition, a Forensic Order would be appropriate.

1. He did, however, consider that DGM understood the charges against him and that, if he was found not to be of unsound mind, he considered that DGM was fit for trial.

Report of Professor Byrne

1. Professor Gerard Byrne is a psychogeriatrician with extensive experience in dementia and particularly in behavioural changes associated with dementia. In a report dated 8 May 2012 and in his evidence to the Court, he noted that DGM’s wife and children reported the onset of personality and behavioural changes 12 years ago, before the first of the alleged offences. He gave evidence that those changes included decreased empathy and reduced concern about others. He had also lost social graces and was tactless. Professor Byrne noted that DGM exhibited increased verbal aggression and a lower threshold for anger and frustration. Professor Byrne also noted coarse eating habits and increased preference for sweet foods. He noted a ritualistic checking and arranging behaviours.

1. Professor Byrne indicated that the history suggested progressive worsening of symptoms over time. He also has anosmia (loss of smell) as well as erectile impotence of some 25 years’ duration. Professor Byrne noted that DGM had little insight into the nature of his difficulties and the impact they had on others. There was no past forensic history of paedophilic sexual preferences.

1. Professor Byrne stated that the clinical cognitive testing had in fact disclosed minor abnormalities which suggested a decline from his pre-morbid level of function. He stated that neuropsychological testing had revealed impaired verbal fluency and impaired initiation and perseveration. He stated that the structural neuroimaging findings exclude moderate or severe ischaemic changes.

1. Professor Byrne considers that, despite those findings on imaging, DGM is suffering from a frontal lobe syndrome which has progressed over the years. He considers in the absence of evidence for alternative causes, it is likely to be occurring on the basis of frontotemporal dementia. He stated that the white matter ischaemic change evident on the MRI scan does not seem of sufficient severity to account for his behavioural symptoms.

1. In particular, Professor Byrne stated that a negative FDG-PET scan would not exclude frontotemporal dementia and that a definitive diagnosis could only be made following a brain biopsy. He also stated that the behavioural variant of frontotemporal dementia is a well-established neuropsychiatric syndrome. He considered that DGM’s mental state and behaviour is likely to continue to deteriorate until his death. He considers that there is no effective disease-modifying treatment for frontotemporal dementia but that antidepressant and antipsychotic mediations are sometimes used to ameliorate symptoms. He also indicated that frontotemporal dementia has been described in the context of late-onset paedophilic behaviour.

1. Professor Byrne noted that the main clinical caveat is that the diagnosis of the behavioural variant of frontotemporal dementia is made on the basis of informant’s report rather than on neuropsychological testing or neuroimaging. He considered that DGM is fit for trial and he does not dispute the broad facts of the prosecution case, although he does dispute certain details.

1. In terms of unsoundness of mind, Professor Byrne considers that it is more probable than not that DGM was of unsound mind at the time of the alleged offences due to a mental disease that deprived him of the capacity to know that he ought not do the act. He considers it is likely that this mental disease is the behavioural variant of frontotemporal dementia, a progressive neurological condition.

1. He considers that DGM had a reduced capacity to control his actions at the time of the alleged offences, although he was not deprived of the capacity. He considers that DGM had the capacity to understand what he was doing. Professor Byrne considers it important that his risk of offending against children be minimised. He should be supervised when in the presence of children and he should not coach children’s tennis or be involved in any activities involving children. Professor Byrne stated that DGM does not presently require an institutional setting but it may become necessary in the future as his dementia progresses. He considers that DGM needs a Forensic Order but with limited community treatment which would allow him to reside at his current address.

Advice of the Assisting Psychiatrists

Dr McVie’s Advice

1. Dr McVie stated that was clear that DGM does suffer with some type of organic brain disorder, probably a dementia. She believed there is clearly deterioration in his cognitive testing, at least between Dr Douglas’s testing in February 2011 and the clinical assessment of Dr Byrne in December 2011.  Dr McVie stated that the issue of frontotemporal lobe dementia arises clinically because the earlier signs of his disorder were in the behavioural spectrum. Her advice was that frontal dementias classically present with behaviour disturbance prior to the onset of cognitive disturbance.  She considered that what was occurring from 2004 to 2009 were the behavioural symptoms of a frontotemporal dementia.

1. Dr McVie noted that even Professor Byrne, in his evidence, revised his diagnosis to a frontotemporal dementia or a frontal lobe syndrome. He described a cluster of symptoms rather than the illness and agreed his symptoms could be due to frontotemporal dementia or possibly early onset or prolonged onset of Alzheimer's.

1. Dr McVie also considered that DGM could have suffered a cerebrovascular incident due his past history of hypertension and noted that Dr Byrne offered the potential of a small stroke which would not be detected by neuroimaging. Dr McVie considered that such a diagnosis could be consistent with the symptoms and would also add some weight to the fact that there did not appear to be significant deterioration in symptoms through that period from 2004 to 2009. 

1. Dr McVie noted that assuming there was some cognitive impairment or organic brain process present through that period, the real issue is whether this was of sufficient intensity at the critical time to deprive him of capacity.

1. Dr McVie considered that it is possible that there are some subtle connections between deterioration in social awareness and social graces and the nature of the offences, particularly the excessive hugging and kissing of young girls. Dr McVie’s concern was that the 12 offences occurred over a wide period of time.  She also observed that none of the offences were actually seen by others, even though the witness statements indicate that some of the kissing occurred while the girls were sitting next to other girls.

1. Dr McVie indicated that if there was such a coarsening of his social awareness as a result of an illness, then the offences would have been more widespread or detected earlier than they were.

1. Dr McVie noted that the school principal spoke to DGM on several occasions and he was certainly able to modify his behaviour after this.  She also considered that he was able to respond to the school principal with a very good social awareness and very good social interactive skills.  Indeed, he convinced the principal that he was capable of continuing his job as a tennis coach.  Dr McVie considered the facts that he was able to continue coaching 35 hours a week in 2004 and that he was able to continue coaching a large number of children over that time period suggest that his social functioning must have been relatively preserved throughout that time period.

1. Dr McVie noted that Dr Phillipson considered he was deprived of the capacity to control, which “to my mind would be the capacity, if you're looking at a behavioural variant, of a dementing illness, and Dr Reddan also considered that it would have been controlled capacity to consider.”[1] 

   [1]Transcript 3-26 at 8-12.

1. Dr McVie stated that DGM was able to modify his behaviour after being approached by the principal and he was obviously able to change when he knew he was being observed.  At least one of the offences occurred when he was in the clubhouse and Dr McVie recalled one of the girls’ statements that she was very pleased when another person entered the room because he stopped hugging her.  She considered that the external control stopped him behaving in that manner, indicating that he did have capacity to control his behaviour.

1. In terms of the capacity to know he ought not do the act, Dr McVie advised that she considered that he did have awareness of the moral wrongness of his actions as he apologised to one complainant and he offered her free tennis lessons for the next term. In her view that indicates he knew what he had done was wrong and that he was attempting to almost bribe her so that she would come back and not tell others. He specifically told some other children not to let others see what they were doing and told others not to tell what had happened, indicating a clear concept of moral awareness. 

1. Dr McVie advised that overall DGM probably does have a dementing process which may well be a frontotemporal lobe dementia. However, she found it very difficult to believe that his illness was severe enough to deprive him of capacity over such a broad period of time; although, if he does have that illness, it probably did lead to some impairment of his capacities from time to time.

1. Even though Dr Byrne assessed him in December 2011 and considered he was fit for trial, Dr McVie found it difficult to equate that somebody could have a dementing illness and be deprived of capacity, yet remain fit for trial. She stated that:

“even if his deprivation of capacity is behavioural, one would've expected to see evidence of disinhibition or inability to maintain social control, which certainly hasn't been evident over the last couple of days.  So I would advise your Honour that [DGM] was not deprived of any capacity in relation to all of the offences and is fit for trial.”[2]

[2]Transcript 3-26 at 51-57.

Dr Lawrence’s Advice

1. Dr Lawrence preferred the opinion of Dr Byrne with respect to diagnosis as she thought he was the most experienced clinician. Dr Lawrence noted in particular that he was a psychogeriatrician, specialising in behavioural disturbances, memory problems and issues to do with dementia.  Of the two psychometric evaluations she preferred the opinion of the more experienced Dr Lucille Douglas. 

1. Dr Lawrence stated that all three of the reporting psychiatrists came to the conclusion that he did display evidence of a frontal lobe syndrome.  Dr Phillipson certainly expressed that opinion when he first assessed DGM in August 2010.  Dr Reddan initially did not, but after she took into consideration Dr Byrne's later assessment she accepted that a frontal lobe syndrome was present.

1. Dr Lawrence stated that Dr Byrne had made that diagnosis and was able to provide considered reasons for his opinion. She noted in particular that he had pointed to the clinical findings and the collateral information that he had obtained from the family, leading to such a diagnosis. Dr Lawrence stated that Professor Byrne recognised the potential for possible bias in such information but she noted that when examining cases of dementia collateral information from those closest to the individual is taken into consideration. She also considered that the information was detailed and specific enough to be able to be used validly.

1. Dr Lawrence also considered that DGM’s counsel, Mr Briggs, had highlighted in his submissions many of the points in that collateral information that corroborated behaviours which are relevant in terms of his sexual offending. Dr Lawrence considered that the information confirmed the coarsening and the loss of social graces and social cognition. She considered that Dr Byrne was able to highlight from his report the objective evidence and found that the evidence was all consistent with frontal lobe syndrome. Dr Lawrence also noted that many of Dr Douglas’ findings, particularly those affecting verbal fluency and the Stroop test, were indicative of a frontal lobe syndrome.

1. Dr Lawrence noted that the x-ray imaging in this case has not been particularly helpful and stated that, whilst positive findings on imaging can be helpful, if one gets negative findings that does not exclude the diagnosis. She considered that this is particularly the case when one is considering frontotemporal dementia, which is a very specific form of dementia and one with behavioural variants. She considered that frontal lobe syndrome indicates the presence of some damage to the frontal lobe.  Dr Lawrence further considered that, in this case, whilst it has not been conclusively shown to be a frontotemporal dementia behavioural variant, there was clear evidence to support such a diagnosis.

1. Dr Lawrence considered that in this case there is clear evidence of an organic condition which is a disease of the mind. Dr Lawrence’s advice was that if this disease of the mind is a variation of frontotemporal dementia, then the rate of progression of this illness does not seem to have been very rapid given the collateral information indicates that there were manifestations of this as early as the late 1990s. She considered, however, that there seems to be some evidence of progression in recent times and that the progression is probably reflected in the increased number of charges that were laid in 2009. She also noted the emergence of the further symptoms, indicated by Dr Byrne, some 12 months later.

1. Dr Lawrence relied in particular on Dr Byrne’s advice that the progress of an illness, in particular frontotemporal dementia, can be variable. She considered that, usually, the younger a patient is at the age of onset, the quicker the rate of deterioration.  Dr Lawrence continued that the older the patient is at the age of onset, then the deterioration is slower.  She noted that DGM was in his seventies or late sixties when the illness presented.  

1. Dr Lawrence stated:

“whilst I think there is very valid argument that this man's illness may have impaired his judgment and his ability to control his behaviour and wasn’t totally deprived, I have come to the point where I believe that it - as a result of the illness, he was totally deprived of the capacities to know that he ought not do the act, and to control his behaviour and there is an interaction there, I believe, that is important to understand both of those factors are - well, the capacity to know and to control are the result of the influence of these particular factors derived from the damage to his frontal lobe.”[3]

[3]Transcript 3-30 at 16-26.

Was DGM suffering from a Mental Disease within s 27 of the Criminal Code?

1. It is clear from all of the reports that DGM has experienced the debilitating affects of a frontal lobe syndrome over the last decade. There is a clear consensus of opinion amongst the reporting psychiatrists and the assisting psychiatrists that such a syndrome is a mental disease for the purposes of s 27 of the Criminal Code.

1. I am accordingly satisfied that DGM was suffering from a disease of the mind at the time all of the offences were committed in the period from June 2004 to September 2009.

Was DGM deprived of any of the relevant capacities?

1. I note Dr Reddan’s concern that there was not sufficient evidence of a deprivation of one of the relevant capacities, given the lack of evidence of cognitive impairment on testing and the period of time since the deficits commenced. Those concerns were mirrored by Dr Sullivan and Dr McVie.

1. Ultimately, however, I accept the advice of Dr Lawrence, together with the evidence of Professor Byrne and Dr Phillipson, that there was a deprivation of his capacity to know he ought not do the act, which was impacted on by his impaired capacity to control his actions. In particular, I note the coarsening of social awareness: the impaired judgment, a lack of sensitivity, a lack of empathy and awareness.

1. I rely, in particular, on the evidence of Professor Byrne who is the pre-eminent expert in this area of brain disease which is associated with mood and behaviour. Whilst I note Dr O’Sullivan’s expertise as a neurologist, I accept that DGM’s presentation is more appropriately within Professor Byrne’s area of expertise. Professor Byrne clearly indicated that the diagnosis in DGM’s case had been a challenge for all of the experts. Professor Byrne’s clear view, having considered all the reports as well as the radiology and the neuropsychological testing, was that the overall preponderance of the evidence was in support of a frontal lobe syndrome, which he stated is a medical condition affecting the brain, which can have a variety of causes. Professor Byrne stated that most of the identifiable causes have been excluded in DGM's case.

1. Professor Byrne considered that the scans show some evidence of cerebrovascular disease, but not to the extent that one would normally expect to see to produce the symptoms that have been reported and the findings on the neuropsychological testing. He stated that there was an uncertainty about what might be going on but that one alternative, which cannot be excluded by the tests that have been done and cannot reasonably be excluded in clinical practice without a brain biopsy, is frontotemporal dementia. His evidence was that this can be a very slow moving, insidious condition which does not produce much in the way of cognitive change, but produces a lot in the way of behavioural change and change in personality function.

1. Professor Byrne continued:

“And those things are integral to - to what people do and say and how they view themselves and their own behaviour.  And it seems to me that [DGM] has had a syndrome over a very extended period of time characterised by loss of social graces, poor judgment, inability to forecast the future - in other words, reduced foresight - a stimulus-bound sort of phenomenon where what's in front of him produces a response from him - the - the – [DGM’s wife] reported her husband's behaviour in relation to food as it is laid out on a table in a group setting where one would normally, you know, exhibit some judgment in relation to how much one would eat when there are other people who need to eat as well, and [he has] been reported to not exercise that judgment.  In other words, he sees food, he eats the food.  So stimulus-bound.

Mmm?‑‑ Stimulus reaction.  And that's typical of what you see in people with frontal lobe syndromes.

Mmm?‑‑ And it's entirely typical of what you see in people with frontotemporal dementia, which is a common cause of frontal lobe syndromes.  Notoriously difficult to diagnose though.

Mmm?‑ Often presents in way - it's a chameleon clinically‑‑‑‑‑

Mmm?‑‑ ‑‑‑‑‑often presents in ways which don't seem like ‘dementia of the Alzheimer's sort’.

Yes?‑‑ Now, it is possible though for Alzheimer's disease itself to present with a frontal lobe syndrome, and it does.”[4]

[4]Transcript 2-3 at 28-58.

1. I note in particular Professor Byrne’s evidence in relation to DGM’s stimulus-bound behaviour. His evidence was that people with an intact frontal lobe act so as to check their behaviour and assess whether their behaviour would be socially appropriate, but in someone with frontal lobe dysfunction that does not happen and that, rather, you get “a stimulus and then a reaction”[5] with no cognition between the impulse and the action. The evidence and the advice indicates that the tests show an impairment of auditory learning and that such an impairment is a sign of the early cognitive changes. 

   [5]Transcript 2-13 at 55.

1. I note the Crown’s submission that DGM was not deprived of any of the capacities because he was able to conceal his behaviour, however I place particular reliance in this regard on Professor Byrne’s evidence that DGM’s behaviours were disinhibited and stereotypical and that “the disinhibited stereotypical nature of it suggests to me frontal impairment.”[6] In terms of the argument that he was concealing his behaviour, Professor Byrne noted that there was no real artifice with DGM’s behaviour and noted that with paedophilic behaviours “concealment is an art form”.[7]

   [6]Transcript 2-6 at 52-54.

   [7]Transcript 2-6 at 47.

1. I also note the Crown’s submission that DGM must have been aware of the moral wrongness of his actions as he apologised to some of the children and asked them not to say anything. In this regard I note Dr Lawrence’s advice that, whilst DGM was obviously aware of what he had done at some point because he remembered and later apologised, he nonetheless later reverted to the same sort of behaviour. Dr Lawrence considered that this indicates a difficulty in remembering that he must not do something he desired to do at a particular time. 

1. In my view, there is clear evidence that there are several symptoms of frontal lobe syndrome present, including difficulties with abstract thinking. As Dr Byrne pointed out, this condition is likely to provoke stimulus-bound responses. That is, in certain situations, behaviours may emerge which are difficult or impossible for the person to control. Dr Byrne and Dr Phillipson considered that these deficits amounted to a loss of capacity to know that he ought not do the act and also some impairment at least of failure to control the impulses; that is, defects in his moral reasoning and his ability to control his behaviour at specific times. 

1. I accept that DGM’s organic brain condition impedes his ability to control his behaviour and to know that he should not do certain things at certain times, but not others.  It is clear that this is not a sort of permanent loss of control or loss of moral reasoning which pervades the whole of his life but only some aspects of it.  I accept that such deprivation is precipitated or triggered by certain situations that he finds himself in. I do not find any evidence that DGM was responding to paedophilic or paraphilic influences and that if he was just doing what he was impelled to do as a result of a particular sexual inclination there would have been evidence of that in some way in the preceding 60 years.

1. I am therefore satisfied on the balance of probabilities that DGM was of unsound mind at the time of the commission of all of the offences between 2004 and 2009.

1. I consider that a Forensic Order is required and he should be granted Limited Community Treatment.  Most importantly, he should not have unsupervised access to children, which has already been implemented in any case.  I accept the advice that DGM would also need some assessment, both neurologically and psychogeriatrically, over time and may well need some other sorts of treatment.

1. I will hear submissions as to the conditions of his Forensic Order.