Re JMT

[2010] QMHC 11

MENTAL HEALTH COURT

CITATION:

Re JMT [2010] QMHC 11

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF JMT

PROCEEDING:

No 136 of 2009

DELIVERED ON:

25 May 2010

DELIVERED AT:

Brisbane

HEARING DATE:

25 May 2010

JUDGE:

Philippides J

ASSISTING
 PSYCHIATRISTS:

Dr J M Lawrence
Dr E N McVie

FINDINGS AND ORDER:

1. That at the time of the alleged offences the defendant was of unsound mind as described in Schedule 2 of the Mental Health Act 2000 (Qld);

2.    That the defendant be detained as a forensic patient at the Logan Beaudesert Authorised Mental Health Service;

3.    Approval of limited community treatment at the discretion of the authorised psychiatrist on the conditions set out by the Director of Mental Health.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with two counts of attempted murder and two counts of stupefying in order to commit indictable offence – where defendant had been suffering depression prior to commission of alleged offences – where defendant previously diagnosed with Major Depressive Disorder

Mental Health Act 2000 (Qld), Schedule 2

COUNSEL:

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

Mr A Lossberg for the Director of Public Prosecutions (Qld)

SOLICITORS:

Legal Aid Queensland for the Defendant
Crown Law for the Director of Mental Health

The Director of Public Prosecutions (Qld)

PHILIPPIDES J:

1. The defendant is charged with the attempted murder of her then nine year old daughter and seven year old son on 30 March 2009.  She's further charged with two counts of stupefying in order to commit an indictable offence on the same date.

1. At the relevant time the defendant was 33 years of age and had been separated from her husband for some 17 months.  She was living with her two children and until a couple of weeks prior to the events in question had been working as a receptionist at a medical centre.

1. She had been suffering depression since her marital separation in October 2007.  The evidence indicates that about nine months prior to the events of 30 March 2009, the defendant suffered a significant deterioration in her mood and mental condition, with marked and persistent depressed mood, a preoccupation with worthlessness, a preoccupation with deliberate self-harm and suicide, sleep disturbance, appetite disturbance with marked weight loss and a considerable loss of social occupational functioning.  During this period, there were three attempts at suicide/self‑harm, with the two episodes of overdose occurring in June and August 2008 and an episode of self-harm in December 2008.

1. Additionally, there was a further worsening of the defendant's condition in the fortnight proceeding the events in question.  That was characterised by features of persistent low mood, frequent weeping, deepening feelings of hopelessness, worthlessness, irritability, low concentration or memory, low energy levels, insomnia and, as I mentioned insomnia and suicidal ideation.

1. The defendant's situation was such that her employer was indicating that she was not performing to the level required at work and because she believed she was at risk of imminent sacking the defendant left her position at work essentially because she was unable to cope.

1. The defendant asked for assistance during this period both from her estranged husband, indicating she was unable to cope, and also from her employer.

1. On the day in question, the defendant took a call from the children's school and was advised that her daughter was ill.

1. She collected the children from school.  She bought a gas cylinder from a service station on the way home.  When she arrived at her home the children complained of sore stomachs.  The defendant gave the children something to eat and also gave them Phenergan, an antihistamine, which she had previously purchased for one of the children's allergies.

1. The children had taken the medication, which the defendant was aware had a sedative effect, and were lying on the bed together.  The children fell asleep and the defendant then swallowed the contents of a bottle of Temazepam tablets and had a glass of wine.  She indicated that she did not think that the Temazepam would kill her so she took the gas bottle and turned it on in the bedroom.

1. The defendant’s husband (the father of the children) attended the house at about 7.00 pm to find the house in darkness and the defendant and the children unconscious in the bedroom.  He could smell the strong odour of gas.  He called 000.  The defendant and children were taken by ambulance to the hospital.

1. The defendant indicated her reasoning at the time to police, and also to the psychiatrists who examined her.  She told Dr Sundin that at the time she thought, "We'd all go to sleep and not wake up again.  The kids and I would be together.  I was like on auto-pilot."  She also said, "I just thought we'd all be in a better place and be happy."

1. Dr Gill saw the defendant upon her admission to hospital the following day, on 1 April 2009.  The defendant's depressive condition was so severe that the clinical decision was made that she required electric convulsive therapy (ECT).  A total of eight ECT treatments were administered over a two week period.  That, combined with anti-depressant medication, resulted in a slow but gradual improvement in the defendant's condition.  The defendant was managed in the Acute Obsevation Area for five weeks.  She remained an involuntary patient at the Logan Mental Health Unit until 5 November 2009.

1. Dr Gill, both in his report of 12 May 2009 and in oral evidence, opined that at the relevant time the defendant was suffering from a Major Depressive Disorder and had done so for some two years.  The condition escalated in intensity to one of such severe depression that, in Dr Gill's opinion, at the relevant time, the defendant was, as a result of her condition, deprived of the capacity to know she ought not do the acts in question.

1. Dr Kingswell provided a report dated 15 November 2009 after interviewing the defendant on 17 October 2009, at which time she had been in hospital for six and a-half months.  He also gave oral evidence.  Dr Kingswell diagnosed major depressive disorder with melancholic features.  He considered that there was also a possibility of there being a delusional intensity to the defendant's thinking but was content to rest with a diagnosis of Major Depressive Disorder with melancholic features.  He also considered the defendant’s mental illness to be of such a severity as to deprive her of the capacity to know she ought not do the acts in question.

1. Dr Kingswell opined that in her disordered and depressed frame of mind the defendant thought that she was doing everybody a favour and that her conduct would result in a merciful end to her and her children's lives.  Dr Kingswell opined that the defendant appeared to be particularly prone to depressive illness, noting a strong family history of depression and the defendant’s personal background of some adversity together with a personal history of previous depressive illness and post natal depression.

1. Dr Sundin, who provided a report dated 25 January 2010 and also gave evidence, reached the same conclusion as Dr Kingswell in terms of diagnosis.  She also gave evidence, as did Dr Kingswell, that the defendant's condition had previously been misdiagnosed as an Adjustment Disorder.

1. Dr Sundin stated that the defendant's longitudinal history of previous episodes of major depression, the recurrent nature of the illness and particularly the severe nature of the episode in question led her to conclude that the condition suffered by the defendant was not one of Adjustment Disorder, but Major Depressive Disorder.

1. She noted also that the defendant had severe symptoms of the disorder with pervasive depressed mood, prominent sleep disturbance, psychomotoretardation, substantial weight loss and profound feelings of guilt, and that the defendant had persistently been ruminating in respect of suicidal and homicidal thoughts, that she was overwhelmed with feelings of incapacity to cope independently and that she inappropriately perceived that her children would be abandoned, or suffer if she left them alone.  Dr Sundin described the symptomology as a classic case of extended suicide.  The conclusion which Dr Sundin reached in relation to the capacities affected were also in line with the other reporters, that the defendant was deprived of the capacity to know she ought not do the acts in question.

1. The clinical evidence therefore is all to the effect that the defendant suffered from a mental illness at the relevant time, namely a major depressive disorder with two reporters finding it to be associated with melancholic features.  All the clinicians agreed that as a result of her mental illness the defendant suffered from a deprivation of one of the relevant capacities.

1. The three expert witneses are thus unanimous in the view that the defendant was of unsound mind at the relevant time and that clinical position was supported by the advice from the assisting psychiatrists.

1. In the circumstances, I find that the defendant was of unsound mind at the time of the alleged offences.  Given the serious nature of the conduct in question, the significant and ongoing treatment needs of the defendant, and that the defendant will require ongoing treatment with potentially serious consequences if she were to disengage from treatment, it is clear that a forensic order is required.

1. A submission has been provided by the Director of Mental Health as to the terms of the forensic order and limited community treatment appropriate in this case.  There is no dispute in relation to the terms of that submission.  In the circumstances, I order that the defendant be detained in the Logan Beaudesert Authorised Mental Health Service. 

1. I approve limited community treatment to commence immediately at the discretion of the treating psychiatrist on the five conditions contained in the submission.  I note the amendment to condition 1.

1. I direct that a copy of the transcript of today's hearing be provided to the treating team and to the Mental Health Tribunal on any review of the orders made today.