Re KMV

[2003] QMHC 5

MENTAL HEALTH COURT

CITATION:

Re KMV [2003] QMHC 005

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF KMV

PROCEEDING NO:

320 of 2002

DELIVERED ON:

5 August 2003

DELIVERED AT:

Brisbane

HEARING DATE:

22 July 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 Cairns District and Area Network Authorised Mental Health Service for involuntary treatment and care;
3. Approval of limited community treatment in the nature of more than overnight limited community treatment to commence immediately on the following conditions:

(i)         That the defendant reside at an address approved in advance in writing by the authorised psychiatrist;

(ii)       That the defendant attend all follow-up appointments and in-patient care as required by the authorised psychiatrist;

(iii)      That the defendant refrain from using alcohol and illicit drugs and cooperate fully in random medical tests for those substances as required by the treating psychiatrist;

(iv)       That the defendant comply with the requirements of the authorised psychiatrist in relation to the taking of subscribed medication and other treatment;

(v)        That the defendant not drive a motor vehicle unless permitted to do so by the authorised psychiatrist.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with murder of her infant daughter – where defendant had previously suffered from a mental illness – where defendant has limited ability to communicate her feelings when she is well and no ability when she is unwell –  where defendant suffering major depression with mood congruent delusions – where defendant deprived of the capacity to know she ought not do the act

Mental Health Act 2000 (Qld), schedule 2

COUNSEL:

J Tate for the Director of Mental Health
B G Devereaux for the defendant
C Heaton for the Director of Public Prosecutions

SOLICITORS:

The Crown Solicitor for the Director of Mental Health
Legal Aid Queensland for the defendant
The Director of Public Prosecutions

1. WILSON J:  The defendant has been charged with the murder of her baby daughter [“T”] on 29 November 2002.  The matter of her mental condition in relation to the offence was referred to this Court by the Director of Mental Health.

1. The reference was heard on 22 July 2003. At the conclusion of the hearing I found that at the time of the alleged offence the defendant was of unsound mind as described in schedule 2 of the Mental Health Act 2000 (Qld), and I made a forensic order and approved limited community treatment. The following is a statement of my reasons for so finding.

1. The defendant was born in [Europe] on 15 January 1967.  She came to Australia with her husband and two elder children in 1997, and went to live in [a small town] in north Queensland.  A third child was born soon after their arrival.  The defendant’s husband is a carpenter, who was away from home for extended periods doing contract work in places such as [ … ].

1. A daughter, T, was born on 21 November 2002 in the Cairns Base Hospital.  It had been a planned pregnancy.  Although the labour was difficult, the baby was healthy.  On 29 November 2002 the defendant killed the baby by squeezing her hard so that she would “go to heaven”.  The defendant was subsequently charged with the murder of the baby.

1. The defendant had previously suffered from mental illness.  As a teenager she had an eating disorder, probably anorexia, and some depression.  In 1990 she had an episode of going “high” followed by depression with sleeplessness.  She sought treatment in [European city].  After the birth of her third child in Australia she was depressed, and a presumptive diagnosis of post natal depression was made.  Then in 1999 she was admitted to the Cairns Base Hospital Mental Health Unit as an involuntary patient.  Her symptoms included psychomotor retardation, which alternated with periods of aggression requiring seclusion, disorganised behaviour, paucity of speech, and internal preoccupation; she was possibly responding to auditory hallucinations.  Her treating psychiatrist Dr Janet Bayley diagnosed a schizophreniform psychosis or a brief psychotic episode.  The defendant was discharged into the care of her family and followed up at [a district] Community Mental Health Service under Dr Una Stephenson, a consultant psychiatrist.  There was another depressive episode without psychotic features in 2001.  Although she was prescribed anti-depressant and anti-psychotic medication, the defendant chose not to take this during her pregnancy with T, for fear of harming the unborn child.

1. Even when she is well, the defendant has only limited ability to communicate her feelings.  She has virtually no ability to do so when she is unwell.  This is more than a function of English being her second language. 

1. Immediately after the birth of T the defendant began to worry about the baby’s health - although the baby was perfectly healthy.  She was concerned at her own parenting skills and had a fixed, delusional belief that someone was going to take her children from her.  While she was still in the Cairns Base Hospital the Obstetrics Registrar noted her odd affect and decreased interaction with the baby, and arranged for review by the Consultation Liaison Psychiatry Team.  They found no overt signs of psychosis or mood disorder, and no indication for her to be detained in hospital.  She was discharged on 22 November with arrangements in place for close follow up by the [district] Community Mental Health Service and the [local] Hospital Child Health Service. 

1. On 23 November the defendant was admitted to the [local] Hospital overnight complaining of sleeplessness, but without significant improvement.  On 25 November she had phone contact with the [district] Community Mental Health Service and she consulted her general practitioner who prescribed anti-depressant medication.  It seems that she did not take this for fear of harming the baby whom she was breast-feeding.  On 26 November she attended Dr Una Stephenson at the [district] Mental Health Service with her husband, complaining of poor sleep and low mood.  She was not suicidal but was noted to be less emphatic about infanticidal ideation.  Dr Stephenson did not consider that hospital admission was required.  On that day the defendant told her eldest daughter (who was aged 16) that she felt really low, and that she was afraid her children would be taken away from her.  The next day she attended the [local] Hospital Child Health Clinic again complaining of poor sleep, and she had telephone contact with the [district] Community Mental Health Service.

1. On 28 November the defendant’s husband left for work on […].  The defendant received a home visit from the [district] Community Mental Health Service.  Again she was troubled by the thought that her children would be taken away from her.  That evening she told her eldest daughter that she was taking T and her other small child to a café.  When she had not returned an hour and a half later, the eldest daughter became concerned.  Eventually she tracked them down at the [local] Hospital.  The defendant had gone there concerned, groundlessly, about the baby’s feeding and about her umbilicus.  They went home.  In the early hours of the next morning, the defendant was unable to sleep and began to feel overwhelmed by illness and feelings her children were going to be taken from her.  She thought life would return to normal if T went to heaven.  Feeling that she had no other choice, she squeezed the baby hard until she died.

1. The Court received reports and oral evidence from four consultant psychiatrists - Dr Keith Muir (who treated the defendant in the Cairns Base Hospital after the death of T), Dr Janet Bayley, Dr William Kingswell and Dr Peter Fama, as well as written reports from Dr Una Stephenson.  All agreed that at the time of T’s death the defendant was suffering from a mental illness.  Dr Bayley diagnosed the illness as bipolar affective disorder which was in a major depressive episode with psychotic features at the relevant time.  Dr Fama ultimately agreed that she suffered from bipolar affective disorder.  Dr Kingswell described it as a mental illness characterised by recurrent depressive episodes associated with psychotic symptoms.  Ultimately Dr Muir expressed the opinion she was suffering from major depression with psychotic features.  However the illness is best described, it was ultimately the opinion of the four psychiatrists who gave oral evidence that at the relevant time the defendant was suffering from major depression with mood congruent delusions which deprived her of the capacity to know that she ought not kill her daughter. 

1. At the conclusion of the oral evidence, it was clear that the four psychiatrists all supported a finding that at the relevant time the defendant was of unsound mind.  Counsel for the Director of Public Prosecutions did not challenge such a finding.

1. The terms of the forensic order and of the limited community treatment approved were in accordance with the recommendation of the Director of Mental Health, and were supported by the Assisting Psychiatrists.