Re HMF
[2003] QMHC 7
•13 November 2003
MENTAL HEALTH COURT
CITATION: | Re HMF [2003] QMHC 007 |
PARTIES: | REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF HMF |
PROCEEDING NO: | 0055 of 2003 |
DELIVERED ON: | 13 November 2003 |
DELIVERED AT: | Brisbane |
HEARING DATE: | 13 November 2003 |
JUDGE: | Wilson J |
ASSISTING PSYCHIATRISTS: | Dr J M Lawrence Dr J F Wood |
FINDINGS AND ORDERS: | 1. At the time of the alleged offence, the defendant was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000 (Qld); 2. Order that the defendant be detained as a forensic patient in The Park High Security Program Authorised Mental Health Service for involuntary treatment and care; 3. Approval of limited community treatment at the discretion of the authorised psychiatrist in the nature of escorted leave on the grounds of the hospital, and closed bus trips. The escorts should be Health Service staff members nominated by the authorised psychiatrist. The number of escorts should be determined by the authorised psychiatrist having regard to the defendant’s treatment needs. The leave should be subject to the following conditions: (1) That the defendant remain under the escort of the Health Service staff members nominated by the authorised psychiatrist for the duration of the leave and; (2) That for the purposes of the leave, the defendant comply with the directions of those staff members for its duration. |
CATCHWORDS: | MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant is charged with one count of murder – where defendant has suffered from positive and negative symptoms of schizophrenia for thirty years – where defendant’s symptoms of schizophrenia have been largely treatment resistant – where defendant experienced a homicidal ideation concerning her mother – whether defendant was suffering from unsoundness of mind at the time of the alleged offence MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where forensic order made – where conflicting expert opinions as to approval of limited community treatment |
COUNSEL: | B G Devereaux for the defendant |
SOLICITORS: | Legal Aid Queensland for the defendant |
WILSON J: HMF has been charged with the murder of her mother on 17 December 2002. At the time of the alleged offence, her mother was an elderly woman living in a nursing home. The defendant stabbed her.
The defendant was born on 31 January 1945. She has suffered from schizophrenia for more than 30 years. As Dr van de Hoef described her condition, she has suffered severe positive symptoms (hallucinations, delusions and thought disorder) and negative symptoms (withdrawal and some decline in self care) almost relentlessly over that time, and many of the symptoms appear to have been largely treatment resistant.
The course of the illness has also featured a strong history of suicidal ideation and a range of serious attempts, as well as homicidal ideation toward her mother in response to persecutory delusions, delusions of control and auditory hallucinations including command hallucinations.
More specifically, for many years she has suffered from delusions of life-long mistreatment by her mother including control by her mother. She has also suffered from delusions about a man named [B]. He is a real person living in Sydney and someone with whom at one time she thought she was in love. The delusions about the two people became wrapped up together as Dr Reddan has reported.
She was particularly vulnerable to the influence of Mr [B] because, “My mother had broken me,” and she said that Mr [B], “forced” her to murder her mother. She said that Mr [B], “told” her that her mother would murder her and that her mother wanted to “will me to death”. She said she would also frequently hear her mother’s voice when her mother was not in proximity and her mother would urge her to suicide or would make statements such as, “I’ll get you now.” However, she also told Dr Reddan that, more recently, she had become uncertain as to whether it was her mother or Mr [B] who wanted her to die or to commit suicide.
At the time of the alleged offence, the defendant was acutely psychotic. Her mother’s condition was deteriorating. She had had some disagreement with another friend, [K], and believed he had abandoned her. In her mind, matters had reached the point where, if she did not kill her mother, her mother would cause her death.
It was agreed by both Dr van de Hoef and Dr Reddan that the mental illness deprived her of the capacity of control at the relevant time. In Dr Reddan’s view, it also deprived her of the capacity to know that she ought not do the act. Dr van de Hoef seemed unwilling to agree with the latter, largely because of the defendant’s conduct immediately after the killing in going to the police and reporting what she had done.
It should be observed that the defendant had been under the continuous care of the Valley Mental Health Service for many years. She received depot medication. But as Dr Lawrence brought out in questioning, schizophrenia is a disease with a capacity to remit or relapse even when the patient is compliant with medication.
In all the circumstances, I am satisfied that at the time of the alleged offence, the defendant was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000 (Qld).
Having regard to the seriousness of the offence, her treatment needs and the protection of the community, it is appropriate that a forensic order be made. I order that she be detained as a forensic patient for involuntary treatment and care in The Park High Security Program Authorised Mental Health Service.
There is then the question of whether any limited community treatment ought to be ordered or approved. Dr Reddan saw the defendant about six months ago. At that stage, she did not consider that there was reason for denying her limited community treatment and, further, she considered that detention in a high-security unit was not warranted from the clinical perspective.
However, the Court has heard evidence this morning from Dr Ness McVie, who is the treating psychiatrist. She has said that the defendant remains unwell with prominent auditory hallucinations and delusions often involving death and homicidal themes. Her condition has been unstable. It has been a case of a failure to improve rather than an overall worsening in her condition.
Medication has been changed in the last six months to Clozapine, but according to Dr McVie the defendant has not shown any clear evidence of improvement on that. Her management is complicated by chronic obstructive airways disease.
Dr McVie referred to homicidal and suicidal ideation. She considered that detention in the high security unit was necessary on clinical grounds. She further observed that if she were not placed in the high secure unit at The Park she would be under the Royal Brisbane Hospital District Authorised Mental Health Service and probably placed in a medium secure unit at Prince Charles Hospital. Dr McVie observed that the facilities there are not as well-suited to female patients as those in the high secure unit at The Park. As I have already said, I think it is appropriate that she be detained in The Park high security unit.
There is the question, however, of whether there ought to be any limited community treatment and, if so, the terms of it. She has not had any to date. In oral evidence, Dr McVie supported limited community treatment in the nature of escorted leave on the grounds of the hospital and enclosed bus trips at the discretion of the treating psychiatrist. She said there ought to be two nurses escorting her.
The advice of Dr Wood, one of the assisting psychiatrists, was that the leave might be more extensive than that; that it might be staff-escorted trips on and off the grounds of the hospital. This would, for example, allow her to attend a shop to purchase new clothes. He also advised that the number of escorts should be determined by the treating psychiatrist, having regard to her current treatment needs, and that there was no need for the escorts to be nurses.
Dr Lawrence took a slightly more conservative approach. She felt that the escorted leave should be limited at this time to leave on the grounds of the hospital and closed bus trips.
There is obviously a slight difference in the advice that I have been given by the assisting psychiatrists. I intend to act upon the advice of Dr Lawrence in this particular case, because it accords more closely with the evidence of the treating psychiatrist, Dr McVie. I am conscious that forensic orders and orders for limited community treatment are reviewed regularly by the Mental Health Review Tribunal. This seems to be a case where, having regard to the fact that there has been no limited community treatment to date, one should proceed cautiously. If the defendant’s condition improves to the point where she can take advantage of the limited community treatment I am presently approving, then it may be that when the matter comes for review before the Mental Health Review Tribunal, the nature of the leave and the conditions attaching to it can be liberalised somewhat.
I approve a limited community treatment at the discretion of the authorised psychiatrist in the nature of escorted leave on the grounds of the hospital, and closed bus trips. The escorts should be Health Service staff members nominated by the authorised psychiatrist. The number of escorts should be determined by the authorised psychiatrist having regard to the defendant’s treatment needs. The leave should be subject to conditions that the defendant remain under the escort of the Health Service staff members nominated by the authorised psychiatrist for the duration of the leave and, secondly, that for the purposes of the leave, the defendant comply with the directions of those staff members for its duration.
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