Re Gleadhill

[2012] QMHC 1

MENTAL HEALTH COURT

CITATION:	Re Gleadhill [2012] QMHC 1
PARTIES:	REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF NORMAN GLEADHILL
PROCEEDING NO:	0052/11
DELIVERED ON:	3 February 2012
DELIVERED AT:	Brisbane
HEARING DATE:	31 January 2012
JUDGE:	Ann Lyons J
ASSISTING PSYCHIATRISTS:	Dr J M Lawrence Dr F T Varghese
FINDINGS AND ORDERS:	That at the time of the alleged offence the defendant was of unsound mind as described in the Schedule to the Mental Health Act 2000 (Qld); That the defendant be detained, pursuant to a forensic order, to the Redcliffe Caboolture Authorised Mental Health Service; That limited community treatment is approved at the discretion of the authorised psychiatrist, on the conditions set on in the submission of the Director of Mental Health.
COUNSEL:	J Briggs for the defendant J Tate for the Director of Mental Health A Lossberg 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)

A LYONS J:

1. This is a reference by the Director of Mental Health dated 1 March 2011. Mr Gleadhill is charged with the attempted murder of his wife on 15 November 2010. He is currently 79 years of age.

Circumstances of the Offence

1. Mr Gleadhill is a retired engineer who has been happily married to his wife Kay for 44 years.  Throughout 2010 he had been experiencing worsening anxiety and depression. His sleep became disturbed and his mood deteriorated. In March 2010 Mr Gleadhill’s general practitioner prescribed antidepressants. Whilst he experienced an initial improvement he deteriorated markedly later in the year and had a number of contacts with the Caboolture Mental Health Service and the Acute Care Team. In October 2010 he was admitted to hospital for two weeks. He was discharged on 28 October with follow up from the Older Person’s Mental Health Service. He was diagnosed as having a Major Depressive Disorder which had developed in the context of a Generalised Anxiety Disorder and a background of significant obsessional personality traits.

1. In November 2010 he attended the Caboolture Hospital Emergency Department on four occasions and was prescribed more tablets. On Saturday 13 November he told his wife he was having “dark thoughts” and they went to the Emergency Department. After waiting until 7pm they returned home as it was clear there was no one from Mental Health able to see him that night.

1. On the morning of 15 November 2010, whilst his wife was sitting at the breakfast table, Mr Gledhill went to the pantry to get some cereal. He noticed a hammer in the pantry. He walked out of the pantry and struck his wife on the head with the hammer which he said was a glancing blow. He then struck his wife a second time whilst his wife struggled to take the hammer from her husband. She eventually was able to escape to the neighbours’ next door.

1. Mr Gleadhill followed his wife next door and apologised and said to ring the police. Mrs Gleadhill waited in the neighbour’s house for police and an ambulance to arrive. Mr Gleadhill then went to his own garage and started the motor of his vehicle. His intention was to kill himself for hurting his wife.

1. Mr Gleadhill was subsequently charged with the attempted murder of his wife.

1. A number of reports have been prepared by psychiatrists in relation to Mr Gleadhill’s mental condition at the time of the commission of the alleged offence by Dr Trevor Hollingsworth, Dr Jill Reddan and Dr Jonathan Mann. Drs Reddan and Mann also gave oral evidence at the hearing of the reference.

Dr Hollingsworth

1. In an undated medical report received on 1 March 2011, Dr Trevor Hollingsworth indicated he assessed Mr Gleadhill on the day of the offence. He confirmed that Mr Gleadhill had been admitted to the Caboolture Mental Health Unit for two weeks from mid-October and was diagnosed as suffering from a melancholic depressive disorder and generalised anxiety disorder associated with prominent obsessional personality traits. He also noted that he had, however, once again attended the Emergency Department two days before the offence complaining of anxiety symptoms. He described an intensification of his belief he would fail to have his driving licence renewed which would leave him and his wife isolated. This was complicated by the fact that their son who lived locally was planning to locate away from the vicinity. Mr Gleadhill had been ruminating about this difficulty in the days before the alleged offence.

1. Dr Hollingsworth noted that, when questioned, Mr Gleadhill indicated that he had not formed a plan prior to harming his wife. He had thought of harming himself but then he thought that he did not want to leave her on her own. Dr Hollingsworth essentially confirmed the diagnosis which had been made at the Caboolture Mental Health Service.

1. Dr Hollingsworth stated that he considered Mr Gleadhill was suffering a mental illness, namely a melancholic depressive illness with transient psychotic features, of such severity that he was of unsound mind at the time of the offence. He considered that at the time of the offence Mr Gleadhill was suffering from a severely depressed mood with morbid pessimism distorting his understanding of his predicament with associated hopelessness and helplessness and with associated severe psycomotor agitation.

1. Dr Hollingsworth considered that in this state Mr Gleadhill acted impulsively with only the most vaguely and instantaneously formulated plan to render his wife unconscious and end their lives by carbon monoxide inhalation from the car exhaust.  He considered that under those specific circumstances Mr Gleadhill did not have the opportunity to reflect on the nature of the act nor to contemplate the consequences even if he was able to momentarily apprehend the physical nature of the act he was committing.

1. Dr Hollingsworth considered that between sighting the hammer in the pantry and delivering the two blows to his wife’s head he did not have the capacity to reflect upon his thoughts and so to exercise conscious deliberate control of his actions. He considered he acted in this impulsive and unreflecting manner as a direct consequence of his morbid disorder of mood and morbid heightening of agitation. He considered the act was completely contrary to his habitual manner of reflection and deliberative action.

Dr Reddan

1. In a report dated 20 September 2011 Dr Reddan also considered that Mr Gleadhill was suffering from a major depressive disorder which was severe with melancholic features. This, she stated, was a recurrent condition but at the time of the alleged offence he was suffering the most severe episode he had ever experienced.

1. Dr Reddan agreed with Dr Hollingsworth that at the time he had developed an abnormal attachment to his wife and in the context of a severe melancholic depression his dependency manifested as an egocentric disregard for his wife’s right to life.

1. Dr Reddan considered he was suffering from a mental illness and was of unsound mind at the time of the commission of the alleged offence as he was deprived of the capacity to know that he ought not do the act of attempting to kill his wife.

Dr Mann

1. Dr Jonathan Mann, in a report dated 16 May 2011, stated that Mr Gleadhill has been diagnosed with a depressive illness on a background of co-morbid generalised anxiety disorder and obsessional personality traits. Dr Mann also noted his admission to the psychiatric inpatient unit for 14 days between 15 October 2010 and 28 October 2010 and that his medication was being changed from desvenlafaxine to nortriptyline at around that time.

1. On 4 November he was reviewed again by Dr Hollingsworth who recorded a diagnosis of major depressive episode, persisting generalised anxiety and obsessional anxiety prone personality traits. Dr Mann also noted that Mr Gleadhill attended at the Caboolture Hospital Emergency Department on 13 November, two days before the alleged offence. He stated he was having dark thoughts but denied any immediate suicidal ideation. He had been informed a few days earlier that his eyesight was too impaired to have his licence renewed, which had upset him. Recent stressors were noted at that appointment including his declining eyesight and his son’s plan to move to Ipswich.

1. He noted another entry by a social worker recorded him catastrophising and having bad thoughts about the future. He denied to Dr Mann that he had planned to hit his wife prior to the instance before he did hit her. When asked why he had attacked his wife he responded to Dr Mann “I just got down to that low, the mornings are always the hardest part of the day and I perk up throughout the day”. He stated that he and wife are making plans to sell the house and move together to a retirement village. His son has moved recently into a house which is only 4 kilometres away and he is now happy not driving and that the stressors which existed at the time of the alleged offence have largely resolved.

1. Mr Gleadhill further told Dr Mann that his main stressor at the moment is being separated from his wife. Dr Mann concluded that Mr Gleadhill does not dispute that he hit his wife with a hammer, although he only recalls hitting her once. Whilst there is some conflicting evidence about the planning behind the attack the evidence of Dr Mann was that Mr Gleadhill said he acted impulsively when he picked up the hammer and Mr Gleadhill denied he planned to kill his wife.

1. Dr Mann concluded that at the time of the commission of the alleged offence Mr Gleadhill was suffering from a depressive episode in the context of a major depressive disorder which was recurrent. He considers this constitutes mental illness as understood in the Criminal Code Act 1899 (Qld). Dr Mann does not consider Mr Gleadhill was deprived of the capacity to understand what he was doing or the capacity to control his actions.

1. He did however consider that Mr Gleadhill was depressed to such an extent that he was unable to exercise even a moderate degree of sense and composure and that this led him to become overwhelmed with stress and see no future for himself and his wife. He believed that his depression completely deprived him of the capacity to reason as to the moral rightness and wrongness of the action and he was deprived of the capacity to know that he ought not do the act. On the balance of probabilities Dr Mann considered that Mr Gleadhill was fully deprived of the capacity to understand that he ought not commit the acts due to his mental illness.

The advice of the assisting psychiatrists

1. Dr McVie advised that Mr Gleadhill clearly has a history of a severe depressive illness which is described as melancholic with psychotic features. Dr McVie stated   that there is no doubt from the evidence about the intensity of symptoms and the nature of his disturbed thinking which was described as morbid negativity and that at the time of the offence he was deprived of the capacity to know he ought not do the act.

1. Dr Varghese stated that the clinical evidence is very clear that at the time of the offence the defendant was suffering from a very severe depression of a melancholic type which, as Dr Reddan pointed out, was more than ordinary major depression, but a separate entity which he considered was a variant of bipolar disease. Dr Varghese also considered that he would also add a diagnosis of psychotic depression as he had never seen a case of melancholic depression of this depth without psychotic symptoms. He stated that an authority in melancholia, Professor Gordon Parker, suggests that any melancholic depression that requires inpatient care almost always has psychotic symptoms. Dr Varghese considered Dr Reddan's description of his morbid preoccupation was consistent with a psychotic depression. He concluded that the depression was to such as extent as to deprive him of capacity to know the wrongness of his act. He was therefore of unsound mind at the time.

1. There is no doubt that the reports of the reporting psychiatrists and the advice of the assisting psychiatrists is that Mr Gleadhill was suffering from a severe mental illness at the time of the commission of the alleged offence and was of unsound mind. 

1. I am therefore satisfied that Mr Gleadhill was of unsound mind at the time of the commission of the alleged offence of attempted murder. I am satisfied he was experiencing a recurrent major depressive disorder with melancholic features and probable psychotic features. I am satisfied that Mr Gleadhill was deprived of the capacity to know he ought not do the act.

Is a forensic order required?

1. All of the psychiatrists agree that a forensic order is required and that this is the best way of managing the risk. Dr Mann considers that there is a clear link between his mental illness and his future risk to his wife. He also considers that Mr Gleadhill continues to experience ongoing symptoms of depression, although he now has good insight into his illness and the need for treatment. Whilst stress and fear of isolation were the precipitating factors, it is clear that these stressors have been reduced with the plan to move to a retirement village.

1. Dr Mann considers that when he is well he poses no threat to his wife and that he can be managed most appropriately in the community. A forensic order allows for swift intervention by services if his mental state should decline.

1. Dr Hollingsworth in an update report to the court dated 27 January 2012 has indicated Mr Gleadhill has maintained his wellbeing throughout the last 12 months and has improved. Whilst he has a mild degree of cognitive impairment consistent with his age there is no evidence of dementia. Dr Hollingsworth noted that, should there be a recurrence of his melancholia, his wife had indicated she would insist that he be admitted to hospital. Indeed, she was disappointed that her husband was not admitted prior to the alleged assault as he presented and sought admission but there were no beds available for him.

1. Dr Hollingsworth confirmed that currently there is no morbid thought content and no catastrophic thinking; there is no expression of desperation, nor thoughts of suicide or violence to others. He does not consider there are any delusions or over valued ideas present and there is no evidence of hallucinations.

1. Dr Hollingsworth considers that he can be appropriately managed on a forensic order and that he has a clinical review every two weeks and that he be reviewed by a psychiatrist monthly and a psychologist monthly as well. There should also be arrangements put in place for emergency psychiatric assistance.

1. Ultimately Dr Hollingsworth considered that Mr Gleadhill would benefit from receiving continuing community psychiatric care under the provisions of the Mental Health Act 2000 (Qld), which would allow for prompt intervention including hospitalisation with the assistance of police should his condition deteriorate and constitute a risk of harm to himself or his family.

1. He considers that with those provisions in place Mr Gleadhill could be safely reunited with his wife on a permanent basis which is his strong wish and that of all members of his family, particularly Mrs Gleadhill.

1. Both Dr Reddan and Dr Mann as well as the assisting psychiatrists agree that Mr Gleadhill can be appropriately managed on a forensic order.  As Dr Reddan noted, this was a “low frequency event’ and was not likely to recur.  In addition Dr Reddan noted Mr Gleadhill’s increasing physical frailty.

1. I am therefore also satisfied that in the circumstances of this case a forensic order is required given the serious nature of the offence and Mr Gleadhill’s recurrent psychiatric illness. A forensic order is also required to ensure the safety of his wife. Mrs Gleadhill has indicated she does not require a no contact order and wishes to be reunited with her husband.

1. Accordingly I am satisfied that there should be a forensic order in the terms of the submission from the Director of Mental Health.