Re Hunt
[2007] QMHC 15
•1 August 2007
MENTAL HEALTH COURT
CITATION:
Re Hunt [2007] QMHC 015
PARTIES:
REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF MATTHEW HUNT
PROCEEDING:
Proceeding No 0153 of 2006
DELIVERED ON:
1 August 2007
DELIVERED AT:
Brisbane
HEARING DATE:
15 June 2007, 25 July 2007
JUDGE:
Philippides J
ASSISTING
PSYCHIATRISTS:Dr Wood
Dr LawrenceFINDINGS AND ORDER:
1. That when the alleged offence was committed the defendant was suffering from unsoundness of mind as described in Schedule 2 to the Mental Health Act 2000 (Qld)
2. That the defendant be detained as a forensic patient in The Park High Security Program: Central and Southern Areas for involuntary treatment and care
3. That limited community treatment in the nature of escorted leave (on the grounds of the hospital) be approved on the following conditions:
a. That the patient remains under the escort of health service staff members nominated by the authorised psychiatrist for the duration of the limited community treatment; and
b. That, for the purposes of the escorted limited community treatment, the patient complies with the directions of the nominated staff member/s for the duration of the limited community treatment
CATCHWORDS:
MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with murder – where expert opinion that the defendant was suffering from a psychotic disorder at the time of the alleged offence – where defendant has history of heavy cannabis use – where blood tests several days after the alleged offence detected low levels of cannabis in the defendant’s blood – whether defendant suffered from cannabis-induced psychosis – whether defendant’s psychosis was to any extent a result of cannabis intoxication or independent of cannabis – whether defendant at the time of the alleged offence suffered from a disease of the mind resulting in deprivation of one of the capacities
Criminal Code 1899 (Qld), s27
Mental Health Act 2000 (Qld), Schedule 2Re LIH [2002] QMHC 014, considered
COUNSEL:
Mr J Farmer for the defendant
Mr J Tate and Mr W Isdale for the Director of Mental Health
Ms D Holliday for The Director of Public ProsecutionsSOLICITORS:
Legal Aid Queensland for the defendant
Crown Law for the Director of Mental health
The Director of Public Prosecutions (Qld)
PHILIPPIDES J: The defendant, Matthew Hunt, a 23 year old man, is charged with the murder on 11 May 2006 of his then girlfriend, Rachael Hogg. The defendant’s mental condition at the time of the alleged offence has been referred to this court.
Circumstances of the Offence
On 11 May 2006, police were called to the house where the defendant lived with Miss Hogg and her father. When they arrived, police heard the defendant “saying something about the devil and demons”. He appeared to be terrified and began “raving on with some sort of incoherent gibberish”. His clothing and hands were stained with blood. They found Rachael deceased in the bedroom. She had suffered severe mutilation to her face, torso and upper limbs, including multiple punctures of the right eye and enucleation of the entire left eye. She also had bruises on her face and neck consistent with finger prints. Manual strangulation was the cause of her death, with the wounds to her body being inflicted post mortem. The defendant was arrested and taken to Redcliffe Watchhouse, where he was assessed as being acutely psychotic. He was ultimately transferred to The Park High Security Program: Central and Southern Areas (“The Park”) on 15 May 2006, where he currently remains.
From 4 May 2006, during a trip to New Zealand for his sister’s wedding, the defendant reported engaging in heavy use of alcohol and hydroponic cannabis on three consecutive nights and being up until 6 am on the morning of 7 May 2006. He said that the cannabis was noticeably stronger than the cannabis he was used to in Australia. He denied using any other drugs on these occasions and reported that when he returned to Brisbane on 7 May 2006 he took no further cannabis or alcohol.
He reported that on 7 May 2006 he started to hear voices (an experience that he had not previously had) as he was saying goodbye to his family. His mother reports that when the defendant awoke that morning he started screaming and would not stop until she went into his room. On the plane flight back to Brisbane, he described psychotic experiences, such as visual and auditory hallucinations, delusions of reference and persecutory delusions. He said he began to hear the voices of friends that were still in New Zealand. He believed that there were terrorists on board the plane, that they had a bomb and that he had saved people on the plane from evil spirits by “looking out the window at heaven”. The defendant was picked up from the airport by Rachael. Eventually the voices seemed to subside. However, on 8 May 2006, the voices returned and he noticed a “high beam look” on the eyes of the television characters on every channel, which terrified him.
He went to work on 9 May 2006. He reported noticing strange things were happening, as though he had “the power”. He thought that spirits were coming in and moving things around him. Later, at home, he thought that people on the television were looking at him in a strange way with their eyes and giving him the evil eye. He would roar at the television to scare the evil people away and reported feeling like “the Incredible Hulk” because he was able to frighten the people away.
The defendant described a similar feeling of needing to keep “the evil” away and having special powers during the following day, 10 May 2006. At one stage he went outside to spread salt around to keep the evil away. He saw tears dropping down on him. He felt weak and was crying and was comforted by Rachael. He felt unable to go to work. That night he could not sleep because he was frightened of evil spirits. He reported that during the night he was fighting an evil spirit and at one stage he thought Rachael’s face looked like an old lady’s face and that her hands had turned into his deceased father’s hands.
The defendant reported that on 11 May 2006 he was sitting in the bedroom watching television. He felt an evil spirit in the room and thought that everyone on television had “high beam devil’s eyes”. He noticed that Rachael was also looking at him in the same way indicating that the devil had got into her. He became convinced that a number of terrorists were standing behind the bedroom door with a gun ready to kill him. He also thought Rachael was planning to kill him as she had left the bedroom and returned with a pair of pliers. He thought his girlfriend was on the terrorist side and considered himself to be “the chosen one” and that he was fighting a battle between good and evil. He reported thinking that he had to kill her “to save the world”. He stabbed his girlfriend with the pliers because he believed that “Bin Laden’s mates” were hiding behind the bedroom door and she was going to open the door to let them in. He stated that the voices were cheering him on. He said that after he stabbed her, he believed that the evil spirit inside her was still alive so he strangled her. He said that even though she was dead he thought she might come back to life so he started stabbing her with some little scissors which he took from the table. He said that he thought she was a machine and wanted to check “if she was made of metal underneath”.
The defendant denied drinking any alcohol or smoking any cannabis in the three days from 7 May to 11 May 2006. A blood test taken on 12 May 2006 revealed no alcohol in the defendant’s blood, less than 0.002 mg/kg of THC and 0.007 mg/kg of 11-nor-THC-9-carboxylic acid. These results were consistent with marijuana usage several hours prior to blood collection or residual levels of cannabis from heavier use of cannabis in days to weeks prior to blood collection. A urine drug screen analysis of a sample taken on 16 May 2006 revealed relatively low urine concentrations of THC-COOH (120 ug/L) and were consistent with elimination of marijuana from the system in a moderate to heavy marijuana user in a scenario where no cannabis was consumed in the preceding five days (consistent with the defendant being in custody/hospital between 11 and 16 May 2006).
Defendant’s Diagnosis and Psychiatric History
The defendant was assessed at the Redcliffe Watchhouse on 12 May 2006. It was not then possible to conduct a formal interview given his disturbed state. The defendant was described as “exhibiting formal thought disorder, bordering on word salad” and as “appearing to respond to internal stimuli, likely visual hallucinations”. He was described as predominantly paranoid, suspicious and threatening. The defendant was observed to be struggling with police and repeatedly stated “get the devil off my head” and was fighting to get away.
When he was subsequently admitted to The Park on 15 May 2006, it was initially difficult to obtain a coherent history from the defendant due to his marked formal thought disorder. He was responding to internal stimuli, perplexed, dysphoric and fearful, describing a number of delusions and stated that he “believed that he had changed the world by killing the evil spirits in his girlfriend”. It was not possible to manage him on the open ward, notwithstanding high doses of antipsychotic medication, because of his extremely disturbed paranoid and threatening behaviour. He was managed in seclusion until 21 June 2006 and prescribed olanzapine, chlorpromazine and diazepam.
The defendant has no past psychiatric history. His mother reported that he had never suffered from any mental health problems before the alleged offence and the defendant denied ever experiencing voices or other disturbances in the past. The defendant has a history of regular, heavy cannabis abuse. He began smoking cannabis at the age of sixteen years. Since the age of 19 he reports that he usually smoked several cones every day. He admitted to increased use for four months prior to his trip to New Zealand.
Clinical Reports
The court received reports from Drs Voita, Reddan and Beech.
Dr Voita’s evidence
Dr Voita has been the defendant’s treating psychiatrist since his admission to The Park on 15 May 2006, at which time she assessed the defendant as floridly psychotic. She provided the court with two reports, one dated 6 July 2006 and the other dated 6 July 2007 and also gave oral evidence.
In her first report, Dr Voita opined that the defendant was at the material time suffering from a psychotic illness, most likely Substance-Induced Psychotic Disorder, due to cannabis, characterised by prominent auditory and visual hallucinations and persecutory, religious and grandiose delusions. Dr Voita considered the defendant was floridly psychotic as at 7 May 2006 and that his psychotic thinking had deepened to incorporate his girlfriend, who he thought was possessed by evil spirits. However, given the severity and persistence of his symptoms, she stated that a differential diagnosis of a schizophreniform disorder would need to be considered.
Dr Voita noted that the defendant’s illness was of very sudden onset and was precipitated by heavy cannabis use for at least four months and a three day period prior to the onset of his psychosis. However, on the basis of the history obtained from the defendant, Dr Voita did not consider that intoxication played a part in his actions at the material time. Dr Voita concluded that, although long-term cannabis use and to a lesser extent alcohol abuse were likely to have precipitated the defendant’s psychosis, his mental illness was of such severity at the time he killed his girlfriend that it would in itself have been sufficient to deprive him of the capacity to understand what he was doing and also of the capacity to know that he ought not to do the act. She observed that the psychosis preceded the offence by at least three days and had continued whilst in hospital, which she considered to be inconsistent with the transient state of intoxication.
At the time of her second report, Dr Voita noted that the defendant had developed depressive symptoms which she attributed to his developing increasing insight into his illness and his offence. At about the time of the report, a number of threatening and aggressive episodes had resulted in the defendant having to be restrained and secluded and given intramuscular medication. She confirmed in her second report that the defendant’s floridly psychotic symptoms were present for several months and as of November 2006 he still thought he had been tricked into his actions by Satan. However, in her second report, Dr Voita indicated that she preferred a diagnosis of Cannabis-Induced Psychotic Disorder (with onset during cannabis intoxication) and moved away from a diagnosis of schizophrenia. She discounted schizophrenia given the absence of positive psychotic symptoms beyond four months of treatment and the absence of residual negative symptoms. In her opinion, the “affective blunting and lack of spontaneity” which Dr Beech reported observing in his report on 3 November 2006 were most likely signs of his depressive illness and borderline/low average intellect, rather than supportive of schizophrenia.
Importantly, she revised her position in relation to the question of whether intoxication had contributed to any extent to the defendant’s state of mind at the relevant time and indicated that she agreed with Dr Reddan’s opinion that it had. She explained that on reconsidering that matter, she was swayed by the difficulty in reconciling the legal concept of unsoundness with the clinical diagnosis of an onset of psychotic symptoms precipitated by acute intoxication. She was also troubled by the presence of moderate amounts of cannabis nine days after the last reported use on 7 May 2006 and was influenced by the opinions expressed by Dr Reddan relating to role and effect of chronic intoxication. However, in giving evidence Dr Voita expressed some reservations about her revised opinion. Ultimately, she conceded that, while the defendant’s psychotic state was precipitated by heavy cannabis and alcohol intoxication, by the time of the events in question the psychosis had assumed a life of its own and best explained the defendant’s state of mind at the relevant time. She also accepted that cannabis and alcohol ingestion were not necessary for the maintenance of the psychosis and accepted that the presence of cannabis or cannabinoids in the drug screen could be seen as merely incidental, given the floridly psychotic condition of the defendant, whose psychosis required him to be continuously hospitalised and on a medication regime to prevent relapse.
Dr Reddan
Dr Reddan saw the defendant for assessment on 11 December 2006. Her diagnosis was of a Cannabis-Induced Psychotic Disorder, with delusions and hallucinations, with onset during intoxication (DSM-IV-TR – codes 292.22 and 292.12). Dr Reddan indicated that from a medical point of view the defendant’s psychotic disorder was a mental disease and that she considered that at the relevant time the defendant was as a result of that mental disease deprived of the capacities to control his actions and to know that he ought not to do the acts in question.
Her clinical opinion was that the onset of the drug induced psychosis was the result of chronic intoxication with cannabis and she saw intoxication as playing a role in the genesis of the disorder. In respect of the defendant’s ongoing symptomatology in the absence of continuing cannabis use after 7 May 2006 she referred to the statements in the DSM-IV-TR that the signs of intoxication may sometimes persist for days beyond the time the substance is detectable in bodily fluids, which may be due to continuing low concentrations of the substance in certain areas of the brain or to the “hit and run effect in which the substance alters a physiological process, the recovery of which takes longer than the time for the elimination of the substance.” She noted that cannabis is an unusual drug in that it is stored in body fat and requires a lengthy period for full elimination particularly where there had been regular, frequent usage. Thus, she opined, it leads to chronic intoxication “but it is very difficult and somewhat artificial to suggest that it can be determined when the intoxication ends and the psychosis begins.” Her view was that they “blend seamlessly”, as in this case, where the defendant still had detectable levels of the metabolite of cannabis in his blood over 24 hours after killing his girlfriend.
Dr Beech
Dr Beech interviewed the defendant on 3 November 2006 for the purpose of providing his report of 10 November 2006. From a diagnostic point of view, Dr Beech identified the issues to be whether the defendant was suffering from cannabis intoxication, a cannabis-induced psychosis or a cannabis triggered schizophrenia.
Dr Beech considered that the defendant had a psychotic illness characterised by formal thought disorder, auditory and visual hallucinations and delusional thinking. The history given was consistent with an abrupt onset, most likely triggered by a three day period of heavy alcohol use, cannabis use and sleep deprivation, on the background of longer term cannabis use and alcohol abuse and in the absence of pre‑morbid psycho‑pathology. He diagnosed the defendant with paranoid schizophrenia. He observed that despite substantial antipsychotic medication, his disorder had persisted for several months and after a six month period there were continuing symptoms, including a number of negative symptoms with affective blunting and a lack of spontaneity. In Dr Beech’s opinion, the schizophrenia was precipitated by heavy cannabis use, with the onset of psychosis likely to have been on 7 May 2006, with the defendant’s symptoms rapidly escalating over the ensuing days. In his view, at the time of the alleged offence, the defendant was psychotic and as a result was deprived of the capacity to know that what he was doing was wrong; he was suffering from an acute paranoid psychosis and acted on the delusional beliefs.
Dr Beech saw the current resolution of the symptoms of schizophrenia as consistent with his being successfully treated with high doses of antipsychotic medications and consistent with available data that about one third of those experiencing their first episode of schizophrenia will fully remit. Dr Beech stated that “the resolution of sickness over a longer period of time with high dose antipsychotic medication is what you see with schizophrenia.” He questioned why, if the defendant was suffering from a cannabis-induced psychosis at the relevant time, he still needed to be treated on antipsychotic medication 12 months after the incident. He was not persuaded by Dr Voita’s explanation that it was basically a precautionary medication against potential relapse, since the concern remained even in the absence of further cannabis consumption. Unlike Dr Voita, he considered that when he saw the defendant in November 2006, there continued to be negative symptoms of schizophrenia present. Dr Beech was disinclined to see the onset of a depressive illness and the realisation of the horror of his actions as explanations for those symptoms, but even accepting that there may have been the onset of a depression which improved with anti-depressant medication, he observed that there remained a conviction that Satan had “tricked” him into doing the terrible acts in question, which he saw as evidence of a residual psychosis.
In providing his opinion and particularly in his oral evidence, Dr Beech gave detailed consideration as to whether intoxication was a factor in the defendant’s mental state at the relevant time. Dr Beech observed that cannabis as an intoxicating substance causes a disturbance in brain function with specific receptors in the brain for cannabis. He gave his understanding that cannabis in terms of intoxication did not have a long lasting effect. His evidence was that chronic intoxication can be used to have two meanings: it can be the result of either some persisting intoxicating effect on the brain, which should be able to be detected clinically; or a state of intoxication which has been maintained over a period of time. He explained that chronic intoxication may thus arise where cannabis is used continually so that it is never out of the system and there chronic intoxication may be seen as persisting intoxication. He also referred to studies which indicate that in persisting intoxication there is evidence that in respect of very regular and heavy users there may be ongoing measurable effects. But he stated that where chronic intoxication is used in that sense it is a reference to effects which are not in terms of psychosis, but in terms of subtle differences in ability to retain information, to process information, to pay attention and to be able to think clearly. He disagreed with the proposition that, other than the immediate high, there is a more subtle intoxicating effect of cannabis, which is the effect upon the brain because of the slower metabolism of the cannabinoid from the fat tissues.
As to the so called “hit and run” effect, namely that the cannabis can cause disturbance in the brain which can be persisting beyond the actual metabolism of the cannabis out of the body, Dr Beech clarified that the “hit and run” effect is a “hit and run” on the brain, stating:
“… if it were to cause a psychosis I would see that as a cannabis-induced psychosis, and ... it is a hit and run, but it's hit, it's gone, … but the psychosis continues. That I would see that as a toxic psychosis … a drug-induced psychosis that usually lasts about three days. DSM-IV says it's rare and probably lasts about one day. I would think it probably lasts usually a couple of days. It certainly doesn't go beyond five days to a week.”
Dr Beech did not see the defendant as suffering from cannabis intoxication at the relevant time, given that the effects of intoxication from cannabis ingestion generally lasted two to four hours and up to 24 hours with heavy users. Based on the available information concerning the defendant’s alcohol and drug use in the period preceding the killing, Dr Beech opined that he would have been intoxicated on 6 and 7 May 2006, but cannabis intoxication would not have persisted for more than a day or two after that and the intoxication by means of cannabis as a physiologically active agent would have passed by then.
As to the evidence of cannabis metabolites in the defendant’s body, Dr Beech considered that it was not possible on the testing that had been conducted to correlate the blood or the urine readings with intoxication. The testing only indicated the presence of cannabis and suggested that there was active cannabis in the defendant’s body, but he noted that the levels were very low and the point where it could be said that cannabis caused or was causing the psychosis had passed.
As for cannabis-induced psychosis, Dr Beech stated that about 15 per cent of very high heavy cannabis users develop a cannabis-induced psychosis; a "toxic psychosis" which can be described as a primitive psychosis and usually resolves in one to five days and can be understood as a brief resolving psychosis driven by the presence of a drug or its immediate aftermath. However, Dr Beech did not favour a diagnosis of cannabis-induced psychosis in the present case as the defendant’s psychosis, because although precipitated by cannabis use, the psychosis was not sustained by it, nor did the symptoms resolve in a couple of days or even a week, rather they worsened and continued over a period of months. In this regard, Dr Beech noted that although probably psychotic by the time he got on the plane the defendant was still able to travel on a plane, to meet up with his girlfriend, have dinner and go to work for a couple of days. Nevertheless, by the end of the week, as was apparent from the audio tapes of the Watchhouse interview, he was speaking incoherent gibberish and for the next couple of weeks required one on one nursing in a high secure mental health unit and continuing antipsychotic medication. Dr Beech therefore considered the defendant to have a psychotic disorder triggered by drugs which evolved into schizophrenia free-reigning, rather than psychotic disorder induced by cannabis which remitted quickly as the cannabis left his system.
On these matters, he disagreed with the opinions of Dr Reddan and Dr Voita, referring to studies conducted by Rothenberg, Topra, Tenant and Wang to the effect that a cannabis-induced psychosis is short lived, and where the psychosis is of a persisting nature, requiring the same treatment as schizophrenia and having the same outcome, it should probably be seen as schizophrenia.
Whether the Defendant Was of Unsound Mind at the Relevant Time
The unanimous view of the experts, was that at the time of the events the defendant was suffering from a psychosis, which deprived him at least of the capacity to know that he ought not to have done the acts the subject of the charge. They all assessed the defendant as having an ongoing psychotic illness which required long-term antipsychotic medication over several months, which was successful in controlling his serious psychotic symptoms.
There is a difference in the specific form of the psychosis diagnosed by Drs Reddan and Voita, who considered it to be a drug induced psychosis, as opposed to Dr Beech, who diagnosed a paranoid schizophrenia, considering that the cannabis was the relevant precipitant of the psychosis, or a trigger to the psychosis. However, the critical difference of opinion was as to the role played by cannabis intoxication in the defendant’s state of mind at the relevant time.
Dr Beech’s clinical opinion was that intoxication was not to any extent a factor; although triggering the schizophrenic illness in the first instance, at the time of acts in question, it was the schizophrenic illness alone that was by then “free-reigning” that accounted for his conduct. As already outlined Dr Voita initially saw no difficulty in relation to the issue of intoxication. However, in her second report, she reconsidered her opinion, revising her understanding as to the residual levels of cannabis. While she had originally disregarded those as meaningful in terms of ongoing intoxication, she came to share the view of Dr Reddan that they represented some form of ongoing chronic intoxication.
The advice of both assisting psychiatrists was that the evidence of Dr Beech ought to be preferred. Dr Wood’s recommendation was that it represented:
“… a clear understanding and the best understanding of what has happened in this situation and it shows that while a psychotic illness of a schizophrenic type and nature developed during a period of intoxication, that psychotic illness was then maintained over many months in the absence of ongoing intoxication which apparently had ceased before the material time. .”
In his advice to the court, Dr Wood noted that when the assisting psychiatrists explored with Dr Voita whether she was able to identify any clinical features of intoxication at the material time which might have contributed to his mental state at the relevant time, she was unable to do so. Having considered the varying views on the role of intoxication, Dr Wood’s clinical advice was that there was:
“…no clear indication [of] any clinical signs of continuing intoxication other than the actual precipitation of the schizophrenic psychosis itself which continued, but that having occurred as an ongoing consequence of continuing intoxication, no-one seems to be able to point to any cluster or group of symptoms and say that these are indicators of an ongoing cannabis intoxication …What we do have is indicators of the psychotic condition of a schizophreniform type that Dr Beech has no problems as identifying as a schizophrenic illness and that Dr Voita is treating as if it were a schizophrenic illness in terms of a schedule of treatment.”
Dr Lawrence in her advice to the court provided an extensive review of the definitions of intoxication and cannabis-induced psychosis as they are understood in terms of the DSM-IV-TR Manual, which accorded with Dr Beech’s evidence. She noted the DSM-IV-TR criteria for substance intoxication in the context of cannabis required a recent ingestion of cannabis associated with clinically significant maladaptive behaviour or psychological changes that develop during or shortly after cannabis use. It also may include perceptual disturbances, namely variations in visual and auditory and other sensory phenomena such as strange aberrations of taste or touch or so on, but most usual is some sort of visual disturbances. She emphasised that the DSM-IV-TR stated that the condition of intoxication should not be maintained if other phenomena, such as psychotic symptoms or a cannabis-induced disorder, become apparent and are of their own nature sufficient to warrant independent clinical attention. She remarked that the issue became confusing because of the particular metabolism of cannabis, stating:
“… after a recent use of cannabis there is the intoxicating effect, but then that the drug itself then circulates around the body and may be stored for periods of time in the fat, continues to circulate and is gradually but slowly eliminated - that is the matter which is detected by the blood and urine tests. Those tests can only reveal the presence of the metabolites in the body, they do not necessarily indicate a state of intoxication unless perhaps, as Dr Beech suggested, you have a series of tests and levels which you can then compare with a known period of ingestion. That is not available to us here.”
Referring to statements in the DSM-IV-TR that when the psychotic symptoms are judged to be in excess of those usually associated with the intoxication syndrome the diagnosis of psychosis should be made instead of intoxication, Dr Lawrence’s advice was that:
“… all the evidence supports the fact that that psychosis, as has been said, assumed a life of its own from the Sunday [7 May]. It got worse, not better. If an element of intoxication was present one would have expected any elements to have decreased and the effects to have worn off.
… the progress of the illness and its persistence with active symptomatology over a period of many months, persisting even after the use of a range of different forms of antipsychotic medication, all goes to support the presence of an independent mental illness, psychosis or schizophrenia.”
Dr Lawrence therefore also preferred the opinion of Dr Beech, stating that she believed:
“… that he has demonstrated that the psychosis, without any intervening use of cannabis, five days after return from Australia, was the reason for [the] mental illness which led to the deprivation ...
I would not accept as a clinician that intoxication was operating to any extent at the time of the tragic events of the killing. Intoxication and the use of cannabis, an intoxicating substance, may have contributed to an extent to the triggering of an illness, a mental illness, but the psychosis itself was operating at the time. There was no evidence that there was any ongoing use of that intoxicating substance such as to maintain the psychosis in the five days between the documented onset and the killing.”
Mr Campbell for the Director of Public Prosecutions sought to rely on ReLIH [2002] QMHC 014 at [13] where it was said:
“The “state of mind” referred to in the second part of the definition of “unsound mind” (beginning “but does not include …”) is a description of absence of capacity caused by mental disease. … If intentional intoxication plays any role in bringing about the deprivation, the state of mind does not amount to “unsoundness of mind”: that is what is meant by the words “resulting, to any extent, from …”.
There is no dispute that the principles set out above correctly state the law. However, the present case differs factually from Re LIH because in that case there was cannabis ingestion continuously right up to the time of the alleged offences, such that the psychosis evident there was found to be maintained by cannabis intoxication. The psychosis resolved with the elimination of the cannabis from the individual's system.
I am persuaded by the evidence of Dr Beech and am satisfied that in the present case the defendant’s state of mind did not to any extent result from intoxication. I do not consider that acute intoxication was a factor, nor in the absence of continuing use of cannabis that chronic intoxication was operative. While intoxication from cannabis played an initial precipitating role in the onset of the defendant’s psychotic illness, it ceased to play any role in that illness as at the time of the terrible events in question. By that stage the defendant’s independent psychosis alone resulted in his being deprived of at least one of the relevant capacities. I find that the defendant was of unsound mind at the relevant time. In reaching this conclusion, I found of great assistance the analysis given by the assisting psychiatrists of the varying expert evidence and the issues of intoxication and diagnosis.
All reporting doctors consider a forensic order necessary given the defendant’s considerable ongoing psychiatric treatment needs and in order to ensure his safety and the safety of the rest of the community and that he would best be treated at The Park in the High Security Programme. The assisting psychiatrists are also of this view and consider that the defendant should be permitted only escorted leave on the grounds of the hospital in accordance with the recommendations by the Director of Mental Health. I make a forensic order and approve limited community treatment in accordance with those submissions.
Orders
The orders of the court are:
1. That when the alleged offence was committed the defendant was suffering from unsoundness of mind as described in Schedule 2 to the Mental Health Act 2000 (Qld).
2. That the defendant be detained as a forensic patient in The Park High Security Program: Central and Southern Areas for involuntary treatment and care.
3. That limited community treatment in the nature of escorted leave (on the grounds of the hospital) be approved on the following conditions:
a.that the patient remains under the escort of health service staff members nominated by the authorised psychiatrist for the duration of the limited community treatment; and
b.that, for the purposes of the escorted limited community treatment, the patient complies with the directions of the nominated staff member/s for the duration of the limited community treatment.
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