Re Mju
[2003] QMHC 2
•22 April 2003
MENTAL HEALTH COURT
CITATION: | Re MJU [2003] QMHC 002 |
PARTIES: | REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF MJU |
PROCEEDING NO: | 0261 of 2002 |
DELIVERED ON: | 22 April 2003 |
DELIVERED AT: | Brisbane |
HEARING DATE: | 31 March, 1, 3 April 2003 |
JUDGE: | Wilson J |
ASSISTING PSYCHIATRISTS: | Dr J M Lawrence |
FINDINGS AND ORDERS: | 1. That at the time that each of the alleged offences was committed, 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 in the Prince Charles Hospital and District Authorised Mental Health Service for involuntary treatment and care. 3. Approval of limited community treatment to commence after a period of inpatient care sufficient in the opinion of the treating psychiatrist to allow a proper assessment of the defendant’s condition and treatment needs, at the discretion of the treating psychiatrist, on the following conditions: (1) that the defendant reside at a place approved in advance in writing by the treating psychiatrist; (2) that the defendant attend all follow up appointments and inpatient care as required by the treating psychiatrist; (3) that the defendant comply with the requirements of the treating psychiatrist in relation to the taking of prescribed medication and other treatment; (4) that the defendant refrain from using alcohol and illicit drugs and co-operate fully in random medical tests for those substances as required by the treating psychiatrist; (5) that the defendant be prohibited from possessing a firearm or other offensive weapon and that if he be in possession of same, he surrender it to the proper authorities. |
CATCHWORDS: | MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with offences including wilful damage, assault occasioning bodily harm, common assault, stealing, possession of a dangerous drug, obstructing police, serious assault of a police officer, robbery with actual violence, attempted robbery and threatening violence – where conflicting expert evidence whether defendant suffers from a head injury related problem or from schizophrenia where symptoms are similar – where defendant deprived of capacity to know what he was doing was wrong and of capacity to control actions – where defendant appeared intoxicated at the time of commission of certain alleged offences – where psychosis was so acute that intoxication would not have played any part in deprivation of capacities. Mental Health Act 2000 (Qld), schedule 2 |
COUNSEL: | S Ryan for the defendant |
SOLICITORS: | Legal Aid Queensland for the defendant |
WILSON J: MJU (“the defendant”) has been charged with five groups of offences:
(i)on 6 March 2001 - wilful damage, assault occasioning bodily harm and common assault;
(ii)on 8 March 2001 - stealing;
(iii)on 5 April 2001 - possession of a dangerous drug (cannabis sativa) and two counts of obstructing police;
(iv)on 11 May 2001 - serious assault of a police officer and two counts of obstructing police;
(v)on 11 May 2002 - robbery with actual violence, common assault, stealing, attempted robbery and threatening violence.
By a reference dated 29 August 2002 Legal Aid Queensland referred the matter of the defendant’s mental condition relating to the alleged offences to the Mental Health Court. The reference was heard on 31 March, 1 and 3 April 2003.
Circumstances of the Offences
6 March 2001 - wilful damage, assault occasioning bodily harm and common assault.
The defendant was aged 16. He had gained entry to the complainants’ house about a week earlier, damaging a chain lock in doing so. He had been squatting there for several days when the complainants arrived unexpectedly and discovered him. The male complainant told his wife to call the police. The defendant tried to escape, and a scuffle ensued.
8 March 2001 – stealing
A youth stole a carton of premixed drinks from the drive through bottle shop of a hotel. When two hotel employees chased him, he ran to a group of three males (including the defendant) and one female. As he ran, he dropped half of the contents of the carton. There was an incident in which the youth who had stolen the drinks threatened one of the hotel employees with a knife. Meanwhile the other young people picked up cans that had been dropped. The young people all decamped, but the defendant returned to the scene and picked up cans. One of the hotel employees gave chase and caught him. Police observed that he appeared to be intoxicated.
5 April 2001 - possession of a dangerous drug (cannabis sativa) and two counts of obstructing police
Police approached the defendant in Ann Street, Nambour, apparently grossly affected by drugs. When they advised him they were detaining him, he decamped. Later they located him in another street. When told he was under arrest, he took flight but was caught soon after. A scuffle with police ensued. Later when he was searched at the police station a clip seal plastic bag containing marihuana was found in his clothing.
11 May 2001 - serious assault of a police officer and two counts of obstructing police
The defendant’s mother contacted police about his breaching his bail conditions. When they arrived at his residence, there was a scuffle in which he struck out at two police officers, and spat on one of them.
11 May 2002 - robbery with actual violence, common assault, stealing, attempted robbery and threatening violence
The defendant entered a service station armed with a wooden fence picket. He demanded that the console operator give him cigarettes whilst threatening him with the picket. He started smashing things with the picket and jumped the counter. There was a struggle, and then the defendant left with one packet of cigarettes.
Later that evening the defendant returned to the service station armed with a carving knife. He demanded money from the till, threatening the console operator with the knife. The console operator ran out of the side door with the defendant chasing after him. The console operator reached the police station, and the defendant took flight.
The defendant’s antecedents
The defendant was born on 31 December 1984. He has a history of congenital visual problems including nystagmus.
In June 2000 he was injured when he rode his bicycle into a parked truck. He was knocked out for ten minutes and sustained two fractured forearms and a fractured nose. He was admitted to the Nambour Hospital, where he experienced clouded consciousness for four to five hours. He was discharged 48 hours later, and was then drowsy for three weeks.
His mother observed a change in his behaviour after the accident. He became abrupt, angry and demanding, and easily frustrated. He started arguing with his mother. He used marihuana and drank alcohol, although his friends told his mother this was not a serious problem and remarked on significant differences in his behaviour. He was not happy living with his mother, and so she contacted the Department of Families Youth and Community Care to organise hostel accommodation. His mother observed him showering with his clothes on, staying up all night yelling and punching the air, being forgetful, talking and laughing to himself, having uncontrollable body movements such as bending down, making a ball of his fist near his ankle and raising it to his knee, and frequently inspecting the fridge and pantry but not eating.
Clinical assessments
Initially there was some difficulty in differentiating between an illness stemming from his head injury and the development of schizophrenic illness, in that he presented with symptoms that could be interpreted either way. However, as Dr Wood (one of the assisting psychiatrists) explained, over time and a process of careful observations of his symptoms and his response to treatment, it has become clear that he is indeed suffering from a schizophrenic illness.
In about May 2001 the defendant was placed in the Brisbane Youth Detention Centre as a result of a breach of bail. About a week later he was seen by Dr Barbara McGuire, a consultant psychiatrist, who considered he was suffering from mental illness necessitating inpatient treatment.
On the material before this Court, it is not possible to construct a precise chronology of his placements thereafter. He was remanded in custody by the Maroochydore Magistrates Court on 12 June 2001. On 18 June 2001 he was admitted to the John Oxley Memorial Hospital, and transferred to the Royal Brisbane Hospital the same day.
While he was in the Royal Brisbane Hospital Adolescent Mental Health Unit in July 2001, he was assessed by Dr Alistair Barron, the Director of the Unit. Various tests were carried out, including a sleep deprived EEG which was abnormal, with some fronto-temporal abnormality. No overt epileptic activity was noted. Psychometric testing in July 2001 showed a verbal IQ of 84, verbal comprehension of 93 and working memory of 71, indicating difficulties with attention and concentration related to auditory information. Occupational therapy living skills assessment demonstrated that his self care skills were at minimal dependency level. There was marked improvement in his cognition and behaviour after he received anti-convulsant and anti-psychotic medication. Dr Barron diagnosed head injury related problems and recommended referral to the Acquired Brain Injury Unit at the Royal Brisbane Hospital for further testing.
The defendant was readmitted to the Brisbane Youth Detention Centre after breaching his bail. That seems to have been in about October 2001. In oral evidence Dr McGuire said that she saw him on quite a number of occasions (10 to 20, she guessed) between May and November 2001. His mother told Dr McGuire that his condition fluctuated and that he did not seem to be able to organise his life. She said he knew how to operate his key card and could discuss the steps necessary to do this, but could not actually do it because he did not know the number of the card. He knew how to catch a bus, but could not actually do it. He would put his clothes on without towelling himself dry after a shower and he could not work out how to shampoo his hair. He could not cook because he could not organise. If she tried to help him with organisation, he became irritable. He had kicked holes in the walls. He was aggressive to his mother and younger siblings, and his mother felt she had no control over him. He had not been eating properly, would not eat regular meals and was neglectful of his personal hygiene. His mother said he had pre-programmed answers to any conversational initiatives such as “for sure” and “what do you mean”. But if he were asked what had been discussed, he would swear and become irritable. He appeared vague and unaware of his surroundings. That state fluctuated: sometimes he appeared to know what was going on around him, but was uncooperative. He laughed to himself a lot and had bursts of energy when he ran around the block, jumped fences and did silly childish things. The stereotype movements had continued: he shook his head from side to side, took some steps to the left, lifted his leg and stood one legged for a few seconds. The caravan in which he lived was incredibly dirty and he refused to let anyone else in. He talked of “going on a mission” and demonstrated odd behaviours such as walking from Nambour to Noosa. At one stage he said he had a twin brother called Ian, and that it was Ian, not he, who had undertaken certain actions. The odd behaviour continued in the Youth Detention Centre, and was the subject of comment by staff. Dr McGuire considered that he was psychotic, and that there was very little evidence that the brain injury had been significant. She diagnosed schizophrenia.
Ms Maggie Bailey, a clinical neuropsychologist, assessed the defendant in November 2001. Her testing indicated the possibility of frontal lobe damage, but, as Dr Wood has said, what she observed was very close to, if not the same as, symptoms of severe and disorganised schizophrenia.
Dr Ian Colls, consultant psychiatrist, examined the defendant at the Arthur Gorrie Remand Centre on 1 July 2002. He was not taking any medication at the time. His was noticeably malodorous and his clothes appeared to be stained with food. He was fatuous, vague, mildly disinhibited and with poor concentration. He was disorientated in time and place. He denied auditory hallucinations, although his behaviour suggested that he may have been experiencing these, and no explicit delusions could be elicited. He denied any recall of his belief that he had a twin. Dr Colls diagnosed schizophrenia (disorganised type), rather than a head injury related problem, but thought a little more time was need to clarify the situation.
Dr Ness McVie, the Clinical Director of the Community Forensic Mental Health Service, reviewed the defendant over the period from July 2002 until March 2003. In her opinion he clearly suffers with schizophrenia characterised by formal thought disorder, auditory hallucinations, thought insertion, thought broadcasting and passivity phenomena.
Whether of unsound mind
On the evidence, I am satisfied that the schizophrenic illness was present from shortly after the accident (in June 2000). Although it fluctuated in its symptoms, he remained severely unwell throughout that period. I accept Dr McGuire’s description of the illness as severe and her opinion that it was likely to have been of the same intensity from the time his mother first noticed the fairly abrupt changes in his behaviour until she (Dr McGuire) first saw him in May 2001. She considered that throughout that period there was a very acute and florid psychosis and frontal lobe impairment (whether as the result of the accident, the psychosis or some other cause), and that he was at the mercy of his illness, which deprived him of the capacity to know what he was doing was wrong and of his capacity to control his actions. Dr Colls was also of the opinion that he would have been deprived of the capacity to know that what he was doing was wrong.
Counsel for the Director of Public Prosecutions sought to show by reference to the defendant’s answers to police questioning that he had at least some understanding that what he was doing was wrong. However, insofar as he gave affirmative answers to questions on that topic, I am satisfied that those answers must be seen in the context of the leading style of questioning employed by the police officers, and that they are consistent with his illness. Had he given such answers in response to open ended questions, there may have been reason to doubt this conclusion.
Police observed evidence of intoxication (presumably by alcohol) on 8 March 2001, and of the adverse effects of drugs on 5 April 2001. The evidence is not very specific. Be that as it may, in Dr McGuire’s opinion the psychosis was so acute that it deprived him of the relevant capacities, and intoxication would not have played any part in that deprivation. In so far as Dr Colls may have held a different view on the significance of intoxication on his mental state, I prefer the evidence of Dr McGuire whose opportunities to assess the defendant were far greater than his.
It was common ground at the Bar table that the evidence supports findings of unsoundness of mind on 11 May 2001 and 11 May 2002. I agree.
Thus I find that at the time of each of the offences alleged against him, the defendant was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000.
The defendant is presently on remand at the Arthur Gorrie Correctional Centre, where he is receiving treatment on a voluntary basis from the Prison Mental Health Service. He requires ongoing treatment.
Having regard to the seriousness of the offences, his treatment needs and the protection of the community, I order that he be detained in the Prince Charles Hospital and District Authorised Mental Health Service for involuntary treatment and care.
Dr McVie considers that he does not require inpatient care, but as the Director of Mental Health has pointed out, he has not previously been managed in the community. I accept the advice of the assisting psychiatrists, which I understand to accord with the submission of the Director of Mental Health, that there ought to be a period of inpatient assessment prior to his release to care at home.
I approve limited community treatment, to commence only after a period of inpatient care sufficient in the opinion of the treating psychiatrist to allow a proper assessment of his condition and treatment needs, and then only at the discretion of the treating psychiatrist, on the following conditions:
(i)that the defendant reside at a place approved in advance in writing by the treating psychiatrist;
(ii)that the defendant attend all follow up appointments and inpatient care as required by the treating psychiatrist;
(iii)that the defendant comply with the requirements of the treating psychiatrist in relation to the taking of prescribed medication and other treatment;
(iv)that the defendant refrain from using alcohol and illicit drugs and co-operate fully in random medical tests for those substances as required by the treating psychiatrist;
(v)that the defendant be prohibited from possessing a firearm or other offensive weapon and that if he be in possession of same, he surrender it to the proper authorities.
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