Re MJP
[2002] QMHC 1
•23 May 2002
MENTAL HEALTH COURT
CITATION: | Re MJP [2002] QMHC 001 |
PARTIES: | REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF MJP |
PROCEEDING NO: | 0002/02 |
DELIVERED ON: | 23 May 2002 |
DELIVERED AT: | Brisbane |
HEARING DATE: | 22 May 2002 |
JUDGE: | Wilson J |
ASSISTING PSYCHIATRISTS: | Dr J M Lawrence |
| Dr J F Wood | |
| 1. Finding that when the alleged offence was committed on 20 May 2001, the patient was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000. 2. Order that the patient be detained as a forensic patient at Townsville 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” leave on the following conditions: (1) that he reside at a place approved in advance in writing by the authorised psychiatrist; (2) that he attend all follow-up appointments and inpatient care as required by the authorised psychiatrist; (3) that he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medications and other treatment; (4) that he refrain from using alcohol and illicit drugs, and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist; (5) that he not drive a motor vehicle unless permitted to do so by the authorised psychiatrist. 4. Further order that the limited community treatment continue until he is next reviewed by the authorised doctor or it is sooner revoked by the Mental Health Review Tribunal. |
CATCHWORDS: | MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where patient charged with entering his stepfather’s house and committing an indictable offence – where patient suffered from severe form of bi-polar affective disorder – whether patient of unsound mind at the time the alleged offence was committed – where evidence showed that at the time of the alleged offence the patient understood what he was doing and had some control over his actions – whether patient was in such a manic state that he was deprived of the capacity to know what he was doing – relevance of previous references made to the Mental Health Tribunal in respect of the patient Criminal Code (Qld), s 27 |
COUNSEL: | J Thompson for the patient |
SOLICITORS: | Legal Aid Queensland for the patient |
WILSON J: MJP was born on 7 October 1967. He has been charged with entering a dwelling house and committing an indictable offence on 20 May 2001.
The Director of Mental Health referred the matter of his mental condition to the Mental Health Tribunal on 27 July 2001. That matter was heard by the Mental Health Court yesterday.
I come first to the facts of the offence. The dwelling house was that of the patient’s stepfather. The patient contacted the police and the ambulance claiming that his stepfather was in the house and either that he had taken his own life or that he was dying from an overdose. At the time the patient knew that his stepfather was in fact away on a fishing trip.
Police and ambulance arrived and broke into the house. Finding no one inside, they left. The patient then re-entered the house and removed a television, a stereo, two speakers and a suitcase. He returned to his own house where police later recovered the stepfather’s property.
From the police brief it would appear that at least most of the property was recovered, although the patient told Dr Stones, a psychiatrist who examined him two months later, that some of the goods were disposed of to a drug dealer.
Since about the age of 16, the patient has suffered bi-polar affective disorder. It is a relapsing disorder of a chronic kind. He has a severe form of the disorder in that he has frequent cycles of alternating severe depression and mania. He has been hospitalised many times and been prescribed high doses of medication. Indeed, in the 12 months since the alleged offence, he has been hospitalised seven times.
The Court must determine whether at the time of the alleged offence the patient was deprived, other than by intentional intoxication by alcohol or drugs, of one of the following capacities: the capacity to understand what he was doing; the capacity to control his actions; the capacity to know that he ought not to do what he did. See Mental Health Act 2000 section 267(1), the definition of “unsound mind” in the dictionary in schedule 2 to that Act, and the Criminal Code section 27.
The Court received evidence from two psychiatrists, Dr C M Stones and Dr Basil James, and from Ms C Carmichael, a registered nurse who is the coordinator of the daycare centre the patient attends.
Dr Stones examined the patient on 19 July 2001 and wrote a report of the same date. He saw him again on one subsequent occasion in August when his treating psychiatrist was unavailable. Dr Stones’ report was before the Court and he gave oral evidence.
Dr James examined the patient on 21 January 2002 and wrote a report dated 1 February 2002. His report was before the Court and he gave oral evidence.
I accept the evidence of Dr James that the keynote of a manic phase of the disorder is grandiosity, an inflated sense of self. This gives rise to hypomania, a sense of powerfulness, of ability to defy natural laws. There can be an inflated sense of entitlement and rights, of delusional intensity. The disorder can give rise to self-deception, to a loss of judgment, and an inability on the part of the sufferer to know that what he is doing is wrong.
On the evidence, at the time of the alleged offence the patient understood what he was doing and had at least some control of his actions.
The real issue for the Court is whether he was in such a manic state that he was deprived of the capacity to know that what he was doing was wrong. In Dr James’ opinion he was so deprived, while Dr Stones considered that he was not.
The only witness to give evidence of the patient’s condition at about the time of the alleged office was Ms Carmichael. She had been his case manager at the daycare centre he attended. She had ceased to be such at the time of the alleged offence but she had become the coordinator of the centre and still had the opportunity to observe him.
Moreover she discussed him with his new case manager. Subsequently she became his case manager again.
In her experience the manic phases were characterised by elevated mood, hyperactivity, grandiosity, non-compliance with medication, and an inability to be located. They could build up in intensity over two or three weeks.
According to Ms Carmichael, his mood was elevated and he was becoming grandiose. He was behaving in a way similar to the way he behaved when he was non-compliant with his medication, although she had not seen any test results to establish whether or not he was compliant. His case manager reported difficulty in locating him. After the offence he was hospitalised from 22 to 27 June 2001.
The patient told Dr James that at the time he had been “extremely high, manic”. That he had been “racing around and confused”. He described “everything happening so quick [he] did not know what [he] was doing”. He said he had been up all hours of the night. He could not explain his motivation. He said that at the time of the offence he had lost the notion of ownership and believed that “everything belonged to everyone else”.
Dr Stones had no specific recollection of what the patient had told him about how he felt at the time, but he said he would have remembered had the patient said he had lost the notion of ownership.
Dr James did not examine the patient until seven months after the alleged offence and there is the possibility that what the patient said about losing the notion of ownership was a fabrication.
Dr Stones considered that the purposeful way in which he gained entry into the house, knowing that his stepfather was away, and the fact that he disposed of some of the goods very quickly indicated a conscious approach to the problem; that he knew what he was doing and understood that it was wrong.
In Dr Stones’ view there was no indication that any delusions or other facets of his mental illness played any part in his decision to commit those acts.
It must be noted that when Dr Stones wrote his report he did not have the benefit of Ms Carmichael’s observations, which were consistent with a manic state or at least a developing manic state. Dr James considered that the bizarre facts of the offence, enlisting the ambulance and the police to break into the house, spoke for themselves. The patient clearly lacked the judgment to know what he was doing was wrong. The deliberate nature of his conduct did not take away from the fact that he did not know that what he was doing was wrong.
I have had the assistance of Dr Wood and Dr Lawrence with respect to the significance of the evidence from a clinical perspective. Their advice was given in open Court at the conclusion of counsel’s submissions. Counsel were given the opportunity to make further submissions in the light of that advice but declined to do so. I understood their advice to be that the opinion of Dr James was consistent with the evidence of Ms Carmichael and with the facts of the alleged offence. I have taken that into account in reaching my decision.
The Court can conclude that the patient was suffering from unsoundness of mind only if satisfied on the balance of probabilities that that is the proper inference to be drawn from the evidence – see Mental Health Act, s 405(2). The most telling evidence is that of the patient’s conduct in the commission of the offence. His conduct in calling the police and the ambulance, who could be expected to take full particulars of his presence, his identity, his complaint, the absence of his stepfather from the house and their observations of his behaviour, was indeed bizarre, and consistent with a lack of understanding that what he was doing was wrong. That, combined with Ms Carmichael’s evidence of his behaviour at about the time, and the clinical evidence as to the nature of his disorder, have led me to prefer the opinion of Dr James.
Thus, I make a formal finding that, at the time of the alleged offence on 20 May 2001, the patient was deprived of the capacity to know that he ought not to do what he was doing and so was of unsound mind.
For completeness, I record one other matter. The patient’s mental condition was twice previously referred to the Mental Health Tribunal when findings of unsoundness of mind were made. Those findings were in the context of alleged offences of dishonesty in 1985 and alleged possession of a dangerous drug in 2000. I have treated those findings simply as further evidence that he suffered from bipolar affective disorder. Having regard to the rapidly cycling nature of the disorder, those findings did not assist me in determining whether on 20 May 2001 he was deprived of the capacity to know that what he was doing was wrong. However, they may well be relevant to his ongoing treatment needs.
I am satisfied that when the alleged offence was committed MJP was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000.
I order that he be detained as a forensic patient at Townsville District and Area Network Authorised Mental Health Service for involuntary treatment and care.
I approve limited community treatment in the nature of “more than overnight” leave on the following conditions:
(1) that he reside at a place approved in advance in writing by the authorised psychiatrist;
(2) that he attend all follow-up appointments and inpatient care as required by the authorised psychiatrist;
(3) that he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medications and other treatment;
(4) that he refrain from using alcohol and illicit drugs, and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist;
(5) that he not drive a motor vehicle unless permitted to do so by the authorised psychiatrist.
I further order that the limited community treatment continue until he is next reviewed by the authorised doctor or it is sooner revoked by the Mental Health Review Tribunal.
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