Re MJT
[2005] QMHC 16
•7 June 2005
MENTAL HEALTH COURT
CITATION:
Re MJT [2005] QMHC 016
PARTIES:
APPEAL BY MJT AGAINST DECISION OF MENTAL HEALTH REVIEW TRIBUNAL
PROCEEDING NO:
0011 of 2005
DELIVERED ON:
7 June 2005
DELIVERED AT:
Brisbane
HEARING DATE:
7 June 2005
JUDGE:
ASSISTING PSYCHIATRISTS:
Holmes J
Dr J F Wood
Dr J M LawrenceFINDINGS AND ORDER:
Appeal dismissed
CATCHWORDS:
MENTAL HEALTH – CONFINEMENT AND RESTRAINT OF MENTALLY ILL PERSONS AND SIMILAR ORDERS – GENERALLY – where patient detained pursuant to a forensic order on 11 June 1993 – where MJT appeals decision of Mental Health Review Tribunal to confirm forensic order – where psychiatric opinion is that appellant suffers from treatment resistant chronic paranoid schizophrenia and has no insight into his illness – where history of non-compliance with forensic order – where psychiatric opinion evidences a likely deterioration in mental state without ongoing treatment – whether the defendant represents an unacceptable risk to the safety of himself or others having regard to his mental illness
Mental Health Act 2000 (Qld), s 203(6)
COUNSEL:
Ms S Ryan for the appellant
Mr W Isdale for the Director of Mental Health
SOLICITORS:
Ms S Ryan for the appellant
Mr W Isdale for the Director of Mental Health
HOLMES J: This is an appeal against a decision of the Mental Health Review Tribunal, made on 22 December 2004, to confirm a forensic order made in respect of MJT on 11 June 1993. That order was made in respect of one charge of break enter and steal and one charge of unlicensed possession of a firearm. MJT was said to have broken into a house and stolen a .45 semi-automatic pistol and bullets.
The Mental Health Tribunal, as it then was in 1993, was provided with a report of Dr A. She set out, as at that time, a long history of MJT: of grandiose and paranoid delusions which had led to a number of psychiatric admissions.
She gave the diagnosis of paranoid schizophrenia. Significantly, she received from MJT a history of the pistol being taken for protection. The theft was a planned one. He had obtained the pistol because he perceived himself as in danger from an Irish gang. This was part of his delusional system.
The forensic order made in 1993 detained MJT in the Mackay Hospital but permitted immediate leave which required that he reside at a particular address and comply with medication and attend appointments. Within a month, he had decamped from Mackay. The treating team report provided to the Mental Health Review Tribunal gives a history of later admissions to hospital. (It is signed by Drs B and C and is dated 21 December 2004.) MJT had three admissions on the Sunshine Coast in 1996, 1997 and 1998 and is recorded as being psychotic and non-compliant on those occasions. He was admitted in March 1999 to the Royal Brisbane Hospital threatening self harm and presenting himself as homeless and destitute; again in July 1999, refusing depot medication. In November 1999 he presented with a psychotic exacerbation; and in June 2000 he was admitted with a diagnosis of a situational crisis.
In December 2000, MJT was admitted to the Gold Coast Hospital after revocation of his leave due to worsening psychotic symptoms following non-compliance with his depot. He had at that time, it is said, threatened community staff with violence if they attempted to administer his depot medication. He was admitted to Lismore Hospital in February 2001. This was a brief admission due to suicidal ideation. It is said that, following his discharge, he threw a rock through a hospital window in anger at not being kept for longer. He was admitted to the Gold Coast Hospital in July 2001.
Dr D was MJT’s treating psychiatrist in February 2003 when he first recommended a discharge of the forensic order and substitution of an involuntary treatment order. That did not occur. Dr D repeated that proposal on a further review by the Tribunal in August. At that time, MJT was in the Robina Hospital. He was discharged on 28 August. He failed to keep an appointment with Dr D on 16 October 2003. He rang his case manager in November 2003 and advised he was in Newcastle, New South Wales and had no intention of returning to Queensland or receiving treatment from any Mental Health Service. He ended up in Casino where he did come in contact with the local Mental Health Service. As the result of his non-compliance with medication, he was hospitalised again, and it seems that it was at that point that he was finally returned to the Gold Coast in December 2004.
MJT was admitted to the Gold Coast Hospital, on 19 December 2004, where it is said that he made a couple of attempts at absconding. He is described in the treating team report as having fixed delusions about being spied on by satellites, a belief that a mob and the Chinese mafia are after him. These are delusions very similar to those which are said to have inspired the offence which was the subject of the forensic order in the first place. He is described as having poor insight into his illness and seeing no need to take his medication. The treating team recommended the confirmation of the forensic order, and the Mental Health Review Tribunal confirmed the forensic order and approved limited community treatment.
Dr E has reported to this Court on 25 May 2005. He describes
MJT's delusional system which includes that he is under satellite observation and has the mafia persecuting him. He says MJT believes that if he were not on a forensic order, he could stop his medications and he would feel better. He describes MJT as completely insightless and considers that, without the compulsion of a forensic order, he would cease his medications. Dr E says that MJT requires ongoing treatment of his paranoid schizophrenia and, without that treatment, the worsening of his mental state and disorganised behaviour including self neglect is a likely outcome. There is also a possibility of socially inappropriate behaviour.
Dr D has provided a further report. He says that the continuation of the forensic order's status is excessive, offering, he says, "no discernible advantages in terms of risk mitigation". It is hard to understand why he would say that except perhaps that he has a misconception about how an involuntary treatment order might operate in this case. The point was made by Dr E, it seems to me correctly, that if MJT were to absent himself from treatment for six months, any involuntary treatment order would thus lapse under the Act.
Dr D has provided a schedule of risk assessment. I note that he describes the mental illness as "mild paranoid schizophrenia" which seems not really to fit with Dr E's view and as to active symptoms of major mental illness, he says "not currently"; but it does seem, as recently as a couple of weeks ago, Dr E was able to observe them. Interestingly, Dr D omits to put anything in the column against "prior supervision failure" which seems to me rather to disregard a major aspect of this case.
In short, it is apparent that MJT still labours under the same delusional system which was the cause of the original offending. He does require treatment with which he is liable to be non-compliant without some level of compulsion.
He has been responding reasonably well to the treatment he has been receiving.
He is largely without social support and, if discharged without further monitoring, is liable to find himself floating and seeking the attention of mental health authorities if for nothing more than accommodation.
Taking into account each of the factors set out in s 203(6) of the Mental Health Act 2000, it seems to me that the Mental Health Review Tribunal was perfectly correct in concluding that the forensic order should be confirmed with the provision for limited community treatment as representing the least restrictive way of managing MJT's circumstances.
I am satisfied that the forensic order ought to be confirmed on all the information before me. I dismiss the appeal against the Tribunal's decision to confirm it.
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