Re Howarth

[2009] QMHC 10

MENTAL HEALTH COURT

CITATION:

Re Howarth [2009] QMHC 10

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF GARRY BRIAN HOWARTH

PROCEEDING NO:

No 0257 of 2008

DELIVERED ON:

2 September 2009

DELIVERED AT:

Brisbane

HEARING DATES:

2 September 2009

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr F Varghese
Dr E N McVie

FINDINGS AND ORDERS

1.   That at the time of the alleged offence on 6 August 2009 the subject of the references the defendant was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000 (Qld);

2.   That defendant be detained as a forensic patient at The Townsville Network Authorised Mental Health Service;

3.   Limited community treatment for the defendant is not approved;

4.   If there is a limited community treatment order then a non-contact condition is to be part of that.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF

MENTAL ILLNESS OR INCAPACITY – where the defendant charged with one offence of grievous bodily harm – whether the defendant was of unsound mind at the time of the alleged offence.

Mr J Briggs for the Defendant
Mr J Tate for the Director of Mental Health

Ms D Holliday for the Director of Public Prosecutions

SOLICITORS:

Legal Aid Queensland for the Defendant
Crown Law for the Director of Mental Health
The Director of Public Prosecutions (Qld)

ANN LYONS J:

1. This is a referral by the legal representative for Mr Howarth.  Mr Howarth is charged with one offence of grievous bodily harm, which occurred on 6 August 2008 at the complainant’s unit in Cairns.

1. The facts in that offence as related to the three psychiatrists by Mr Howarth in October 2008, April 2009 and July 2009 have been consistent, in that Mr Howarth indicates that the complainant was persisting in wanting to buy something from him and started to push him around.  There is an account of the complainant throwing him around the room. 

1. His account to the psychiatrists includes the fact that he believed the complainant was a robot and that he saw beams of light coming out of his eyes and that a voice told him to grab a bottle and hit him.  The accounts of the complainant and a witness, however, indicate that it was Mr Howarth who stabbed the complainant with a bottle without any reason and that it was Mr Howarth who was trying to get the complainant to buy the item.

1. Mr Howarth departed the scene, but then presented himself to the Townsville Hospital on the 10th of August, some four days later.  The Hospital notes of that admission record that he was seeking admission because “he was not right”, and he stated he has left Cairns following an altercation where he stabbed a man.  He stated that he did not want to fight him.  He also said on admission that he was hearing voices that were inside his head of a derogatory nature, which were usually male but sometimes female.  When spoken to by police on that day Mr Howarth said, “The guy asked for an ambulance, I hurt him with a beer bottle.”

1. It would appear from the brief of evidence that the first occasion that a reference to robots was specifically documented was in October 2008, some four months later.  There is clear evidence that Mr Howarth was psychotic on the 6th of August 2008 and that he had been becoming progressively unwell in the two days immediately prior to this attack on 6 August.  This is documented in the notes of the Lakeside Clinic. 

1. The report of Dr Woolridge of 22 October 2008, following an examination on the previous day, which I note is the closest examination in time to the events in question, indicates a diagnosis of chronic paranoid schizophrenia, antisocial personality disorder and polysubstance abuse.  Dr Van Meer and Dr Kingswell agree that Mr Howarth has chronic paranoid schizophrenia.

1. Dr Woolridge considers that Mr Howarth was seeking help for his psychotic symptoms prior to the assault.  He also states that he had previously obeyed command hallucinations and in fact had previously cut off his own finger in response to these commands.  Dr Woolridge considered that Mr Howarth, importantly, had given a consistent account of what had happened prior to the stabbing and that whilst Mr Howarth did have some alcohol on the day, probably one beer at the most, that was the extent of his alcohol consumption.  Dr Woolridge considers there was no intoxication involved.  This is endorsed by the other psychiatrists and I am therefore satisfied there is no issue about intoxication. 

1. Dr Woolridge’s opinion is that at the time of the attack Mr Howarth was deprived of the capacity to understand what he was doing and the capacity to control his actions and of the capacity to know that he ought not do what he had done.  In particular, Dr Woolridge considers Mr Howarth had psychotic symptoms prior to the offence and it was clear he was experiencing psychosis immediately preceding the attack.

1. Furthermore, Dr Woolridge notes, and he considers it significant, that Mr Howarth’s psychiatric and psychotic symptoms have continued since his incarcerations.  He states, “He remains psychotic despite treatment”.  In relation to his mental state he considered Mr Howarth was deluded at the time of committing the offence as his belief that the man he attacked was a robot was false and he was out of touch with reality at the time.  He believed he was clearly acting on a psychotic belief, which was a product of his schizophrenia. 

1. Dr Kingswell, in his evidence and in his report, diagnosed chronic paranoid schizophrenia with persistent auditory hallucinations and persecutory delusions which were complicated by a polysubstance dependence together with poor compliance and problems in employment, accommodation and relationships.

1. Dr Kingswell, however, considers that Mr Howarth’s account that the victim was a robot was contrived and he does not accept his account of the stabbing.  It would appear that the difference between Dr Woolridge and Dr Kingswell is that Dr Kingswell did not believe that Mr Howarth was acting on his delusion that the victim was a robot.  Dr Kingswell, however, concludes that if Mr Howarth’s account is believed then he would be considered to be of unsound mind at the time. 

1. Dr Kingswell considers that if Mr Howarth’s account is accepted Mr Howarth would have been deprived of the capacity to know he ought not do the act.  Dr Kingswell concedes that Mr Howarth was unwell on 6 August, the day of the offence, and that he was clearly unwell on 10 August, as he was hearing voices on that day which were of a psychotic nature. 

1. So, clearly Dr Kingswell considers that Mr Howarth was suffering from chronic paranoid schizophrenia on the day and that he had a mental state where there were auditory commands and he was in a delusional state.  Dr Kingswell’s concern is that on 10 August, four days after the offence, Mr Howarth does not mention the robot at all and the robot is not mentioned until October.  Dr Kingswell considers that Mr Howarth’s story as to the robot should not be accepted as Mr Howarth has a history of being untruthful and dishonest. 

1. Dr Van Meer, in his report dated 25 July 2009, initially indicated that Mr Howarth clearly had chronic paranoid schizophrenia and that he was deprived of the capacity to know he ought not do the act.

1. However, his view changed at the hearing when it was indicated that Mr Howarth did not mention robots at all until October and he tended to the view of Dr Kingswell in his oral evidence.  He considered that Mr Howarth was chronically unwell and that he had reports of derogatory and command voices.  He essentially considered that if there was a late reference to robots it was more likely that it was contrived. 

1. Turning to the resolution of the issues it would seem clear there is no reasonable doubt that the offences occurred.  Therefore the provisions of s 268 are not brought into consideration.  It also seemed clear that a defence does not arise on the facts.  Clearly provocation is not available.  Furthermore, given Mr Howarth responded to a pushing or punching with an attack with a beer bottle and a stabbing, self-defence is not available given the disproportionate response. 

1. The real question therefore, is whether Mr Howarth has the defence of unsoundness of mind.  The resolution of that question essentially depends on whether I consider, on the balance of probabilities, that Mr Howarth was operating under a delusional construct and that he had the belief the victim was a robot. 

1. Of the three psychiatrists I am most inclined towards the view of Dr Woolridge as I consider he has made the most complete examination of the issues.  He considered the factual matters put to him by counsel in relation to the police statements and he stated he did not consider that that made a difference.  I consider he made the most in depth analysis of the issues in an independent way and he was not influenced at all by the criminal history. 

1. Having considered the evidence and the advice of the assisting psychiatrists I consider, on the balance of probabilities, that Mr Howarth did have such a belief that the victim was a robot and that he was justified in attacking him on that basis.  I make this finding on the following grounds:

1. I consider he has a clear history of chronic paranoid schizophrenia and he has responded to auditory commands before, in that he has chopped off his own finger previously.  Clearly his illness is at the severe end of the spectrum of schizophrenia.  He was clearly unwell in the days preceding the attack and was on medication.  He was clearly experiencing psychotic symptoms on admission to the Townsville Hospital on 10 August 2008.  He was also scared that people were out to get him on that admission.  He was hearing auditory commands and he was angry and defensive.  He was also very clearly unwell on 15 August in prison where he was hearing voices.

1. I also consider that Mr Howarth gave a consistent account of the incident to the psychiatrists on different days months apart when he was asked for his account of what had happened.  Given the fact that he is such an unreliable historian I consider it unlikely he would have given such a version so consistently if it were not part of his belief system.  I do not consider his failure to mention robots prior to October is definitive, particularly as it would appear he was told by police at some stage that robots were not involved.  It is also unlikely he would give a full account on admission to hospital when he was specifically observed to be defensive and guarded, and that is set out in the notes. 

1. There is also evidence in the history of his bizarre belief system in relation to robots.  This belief system involves Arnold Schwarzenegger and the Terminator movies, which would appear to involve robots which are quite human at times.  The robot was clearly part of his delusional system.  In May 2009 it is clear that Mr Howarth is still referring to robots.  It is clear that Mr Howarth’s beliefs about robots form part of an elaborate system.  It is also clear he continues to show signs of psychosis and that he is treatment resistant. 

1. On the balance of probabilities I accept the truth of his statement about the belief that the victim was a robot.  I also consider that the perception as to who started the fight could also be a result of his delusional state.  I am satisfied intoxication is not an issue.

1. I therefore consider that Mr Howarth was of unsound mind at the time of the offence in that he was deprived of the capacity to know he ought not do the act.

1. I consider a forensic order is required given that he remains psychotic, despite treatment, and given his persistent history of psychotic symptoms.

1. I consider that the order should be that he be detained in the Townsville District Authorised Mental Health Service.  It seemed clear that he is not yet ready for a limited community treatment order, but it also seemed clear that I cannot at this point make a non-contact condition.  There is not a limited community treatment order.  All I can indicate is if there is a limited community treatment order then a non-contact condition be part of that. 

1. I make an order then that the transcript of yesterday and today go to the treating team together with a copy of the reasons for the Court’s decision.