Re Horne

[2012] QMHC 23

MENTAL HEALTH COURT

CITATION:

Re Horne [2012] QMHC 23

PARTIES:

REFERENCE BY LEGAL AID QUEENSLAND IN RESPECT OF ADAM JAMES HORNE

PROCEEDING NO:

No. 0168 of 2012

DELIVERED ON:

Ex tempore reasons delivered on 5 October 2012

DELIVERED AT:

Brisbane

HEARING DATE:

5 October 2012

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr E N McVie
Dr J N Chalk

FINDINGS AND ORDERS:

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

That a Forensic Order be made detaining the defendant to the Princess Alexandra Hospital Authorised Mental Health Service; and 2.          

Limited community treatment is approved to commence immediately, subject to the discretion of the authorised psychiatrist, on the following conditions: 3.          

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 drive a motor vehicle unless permitted to do so by the authorised psychiatrist;(d)        

That the patient reside at an address or at a place approved in advance in writing by the authorised psychiatrist; and(e)        

That the patient must attend an appointment with a psychiatrist and all follow up appointments and in-patient care as required by the authorised psychiatrist. (f)        

COUNSEL:

K Prskalo 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
Office of the Director of Public Prosecutions (Qld)

ANN LYONS J:

The Charges

1. This is a reference by Legal Aid Queensland filed on 26 July 2012 in relation to Adam Horne. He is charged with nine offences, all of which occurred on 16 September 2011 at the boarding house he was residing in. He is charged with four counts of burglary and five counts of wilful damage. It would appear that he created a disturbance at his boarding house in Highgate Hill which comprises nine rooms.

1. Mr Horne is charged with entering a number of rooms in the boarding house without permission. He is also charged with kicking in a number of doors causing them to splinter and with damaging a number of the occupant’s possessions. He is also accused of walking out into the street and damaging three vehicles. He was heard to be making allegations that the neighbours were spying on him.

1. The witnesses indicated that at the time of the events Mr Horne was talking to himself, yelling, screaming and swearing and calling someone a paedophile and a cunt. Other witness statements indicate that he was being aggressive to everyone in the boarding house, pacing up and down the hallway and wanting to fight. It would appear he was rambling incoherently and telling the residents that they were all going to get on their knees and “apologise to him”.

1. Mr Horne has had a diagnosis of paranoid schizophrenia since the age of 19. When he was seen at the watch house following his arrest on 17 September he was described as agitated, talking to himself and appearing to respond to internal stimuli. He had not slept since the time of his arrest. His last contact with Mental Health Services had been one year before when he was treated under an involuntary treatment order (“ITO”) at the Princess Alexandra Hospital. The clinical impression on 17 September was that there was a relapse of psychotic illness with elevated mood in the context of likely disengagement with Mental Health Services. He was transferred from the watch house to the Princess Alexandra Hospital.

1. There are two reports before the Court, namely the report of Dr Mann dated 23 June 2012 and the report of Dr Purushothaman dated 7 December 2011. Both doctors also gave evidence during the hearing. Having considered the evidence of both the reporting doctors as well as the advice of the assisting psychiatrists I will act on the advice of the assisting psychiatrists and prefer the evidence of Dr Mann for the reasons I set out in more detail below.

Dr Purushothaman’s evidence

1. Dr Purushothaman in his evidence indicated that, in his view, Mr Horne was not of unsound mind in relation to any of the offences due to his psychotic illness alone and was concerned about the role intoxication played at the relevant time. He accepts that he would have been impaired by reason of his psychotic illness but does not consider that the deprivation of any relevant capacity existed without the interaction of intoxication with cannabis.

1. In particular, Dr Purushothaman relied on the rational explanation given to him by Mr Horne subsequently that he was angry with the residents as they were stealing his cannabis and that he retaliated as he could not complain to the manager of the boarding house or the police. Dr Purushothaman said Mr Horne told him that he would do it again. In my view, Mr Horne’s attempt at a rational explanation at a time when he was still acutely psychotic cannot overcome the clear evidence contained in the witness statement and the objective assessments at the time.

1. In particular, I am concerned that Dr Purushothaman did not consider the watch house assessment notes and the court liaison notes. Neither did he see the notes of Mr Horne’s first two weeks in the Princess Alexandra Hospital prior to him taking over his management in the hospital. It was also clear from Dr Purushothaman’s evidence that he had not considered all of the witness statements. In my view Dr Purushothaman was satisfied that there was cannabis intoxication when there was no objective evidence that that was in fact the case.

1. There was in fact no positive evidence that there had been cannabis ingestion on the day of the offences. Indeed, the evidence was that no cannabis was found by police during their search of the boarding house. Mr Horne’s own evidence was that his cannabis and other possessions were being stolen by the residents and that he was staying home to guard them. I agree with Dr Mann that Mr Horne’s opportunities to obtain cannabis had diminished and, given that smoking of cannabis was banned at the boarding house, his opportunities to ingest cannabis were limited. Whilst there was a urine drug screen on 23 September 2011 which was positive for metabolites, that merely indicates ingestion at some time in the three-to-four week period before the test and nothing more. It says nothing about actual intoxication or even use on 16 September 2011.

1. I also note that Dr Purushothaman’s evidence was that when Mr Horne was given emergency electroconvulsive therapy (“ECT”) two weeks after the date of the charges he was acutely psychotic and the ECT was only given to treat the psychosis and for no other reason. 

1. Whilst I note the argument on behalf of the Director of Public Prosecutions, in my view there is simply no objective evidence of intoxication from cannabis at the time of the alleged offences. I am not satisfied, therefore, that it contributed to his mental state given his acute symptoms on arrest and the fact that those acute symptoms continued in such a severe form for so long. I am satisfied that his psychosis alone drove his behaviour.

1. Accordingly I prefer the advice of the assisting psychiatrist in this regard and the report of Dr Mann.

Dr Mann’s Report

1. In his report dated 23 June 2012 Dr Mann indicated that he assessed Mr Horne in June 2012 and Mr Horne reported that in the days prior to the alleged offences he had noticed that food and medication had gone missing. He had been at the boarding house for approximately five months and was in receipt of a disability support pension in relation to his diagnosis of schizophrenia. He told Dr Mann that he was training regularly in the months before the alleged offences and had stopped training three weeks before the offences due to concerns about his belongings being stolen. He stated he needed to be at the boarding house to watch his stuff. He stated that he was being persecuted by the other residents of the boarding house and they were running him down and he had a mental snap. He stated that whilst he had been prescribed the antipsychotic, Zyprexa, he was not taking the medication at the time and was not subject to an ITO.

1. Mr Horne told Dr Mann that approximately four days before the offences he had been walking back to his boarding house and had experienced hearing other people’s thoughts in his head. He thought he had special powers and he saw the shadow of a man running between cars like a demon. In relation to his special powers, he said he thought he was God and started reading the Bible and preaching to people. I also note that Dr Purushothaman’s evidence was that, whilst Mr Horne did not describe special powers to him, such a belief was consistent with Mr Horne’s behaviour on the ward.

1. Mr Horne also stated to Dr Mann that he recalled hearing voices in the boarding house and one morning he heard a voice saying “you’re going to die”. He believed that his bedroom was bugged and his mood was all over the place. In relation to the offences, he stated he did not know why he did it. He believed everyone was out to get him and that they were always ganging up on him and standing over him. He stated he had not slept for four days and whilst he accepted he broke into the rooms, he disputed the details in the court brief in relation to the assaults.

1. He also indicated that after his arrest he did not sleep for a further four nights and did not eat. He said in the watch house he thought he was Captain Cook on the front of the ship going up and down. He was placed in a seclusion cell after his arrest and felt safe in the cell and did not want to leave. He believed the whole world was watching him and he said “I travelled up to see God”.

1. Dr Mann indicated after his transfer to the Princess Alexandra Hospital he was placed on depot risperidone and was placed in the high dependency unit and was treated with ECT on three occasions. He did not wish to be treated with ECT and absconded. He was then readmitted to a psychiatric hospital in Adelaide before being returned to the Princess Alexandra Hospital in Brisbane where he spent a further period of time in seclusion. He was eventually transferred to the open psychiatric ward where he spent a further four to five weeks.

1. Dr Mann indicated that he did not believe intoxication was a relevant factor:

“I do not believe he was deprived of the capacity to understand what he was doing at the time of any of the alleged offences.

I do not believe he was deprived of the capacity to control his actions at the time of any of the alleged offences.

I believe he was deprived of the capacity to know that he ought not to do the act or make the omission in relation to any of the alleged offences. I believe his psychotic symptoms which included auditory hallucinations, persecutory ideas and beliefs about having special powers deprived him of the ability to reason with a moderate degree of sense and composure about what he was doing.”[1]

[1]Report of Dr J Mann dated 23 June 2012 at 9-10.

1. Having considered all of that evidence I agree with Dr Mann that Mr Horne’s decision making was overwhelmingly overtaken by his psychosis and that there is no evidence of a link between his cannabis use and aggression. In this regard I note the advice of Dr McVie that Mr Horne’s agitation and aggression was at the “severe end of the spectrum”. I also note the advice of both assisting psychiatrists that there is no direct relationship between cannabis and psychosis and that many patients take cannabis to ameliorate the effects of psychosis and, indeed, some improve.

1. I am satisfied therefore that Mr Horne was of unsound mind at the time of the commission of all of the alleged offences and that he was deprived of the capacity to know he ought not do the act. I am also satisfied that intoxication did not play a role in the deprivation of that capacity.

1. I am also satisfied that given the seriousness of the offences and given Mr Horne’s treatment needs as well as the protection of the community, that a Forensic Order is required. Limited Community Treatment is approved to commence immediately at the discretion of the authorised psychiatrist on the conditions set out below.

ORDERS:

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

That a Forensic Order be made detaining the defendant to the Princess Alexandra Hospital Authorised Mental Health Service; and 2.          

Limited community treatment is approved to commence immediately, subject to the discretion of the authorised psychiatrist, on the following conditions: 3.          

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 drive a motor vehicle unless permitted to do so by the authorised psychiatrist;(d)        

That the patient reside at an address or at a place approved in advance in writing by the authorised psychiatrist; and(e)        

That the patient must attend an appointment with a psychiatrist and all follow up appointments and in-patient care as required by the authorised psychiatrist. (f)