Re Og

[2007] QMHC 39

MENTAL HEALTH COURT

CITATION:

Re OG [2007] QMHC 039

PARTIES:

APPEAL BY OG AGAINST A DECISION OF THE MENTAL HEALTH REVIEW TRIBUNAL

PROCEEDING:

No 132 of 2007

DELIVERED ON:

18 July 2007

DELIVERED AT:

Brisbane

HEARING DATE:

18 July 2007

JUDGE:

Philippides J

ASSISTING PSYCHIATRISTS:

Dr J M Lawrence
Dr J F Wood

FINDINGS AND ORDER:

The appeal is dismissed

CATCHWORDS:

MENTAL HEALTH – CONFINEMENT AND RESTRAINT OF MENTALLY ILL PERSONS AND SIMILAR ORDERS – GENERALLY – where appeal against a decision of the Mental Health Review Tribunal confirming involuntary treatment order in respect of the appellant – where Tribunal found that appellant suffered from schizophrenia, required immediate treatment, was an imminent risk of harm to himself or to others in the absence of treatment – where appellant submitted that the mental state assessment was inconsistent with a diagnosis of disorganised schizophrenia, that appellant’s behaviour on several dates may have had origins in other disorders or problems, and that the risk of decline due to non-compliance had not been managed by less restrictive alternatives –  where appellant has been non-compliant with treatment on several occasions – where reporting psychiatrist stated that without treatment, appellant is likely to suffer mental deterioration – whether the decision of the Tribunal should be set aside

Mental Health Act 2000 (Qld), s 14, s 191

COUNSEL:

K Williams for the appellant

W Isdale for the Director of Mental Health

SOLICITORS:

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

PHILIPPIDES J:

1. The appellant is appealing against the decision of the Mental Health Review Tribunal of 19 April 2007 confirming an involuntary treatment order.

1. The patient has an extensive history of psychiatric problems.  In 2003, he presented with depression and psychotic features.  He was placed on an ITO.  He also overdosed, according to the evidence he gave today, on Zoloft.  In 2005, he presented to the Prince Charles Hospital by ambulance with classic catatonic schizophrenia.  He was hospitalised on an ITO and commenced on anti-psychotic medication.

1. On 28 August 2006, he presented to Dr Ishwood at the Aspley Community Mental Health Service in a near catatonic state.  He admitted he had been non-compliant.  He was observed to be in a perplexed state and with withdrawn presentation and decreased volition.  He was also observed on admission to hospital to have marked thought disorder.  He was, again, placed on an ITO.

1. On 1 September 2006, when on leave, he failed to return.  He was then, soon after on 4 September 2006, referred to the Royal Brisbane Hospital by a doctor at the University of Queensland and taken there by ambulance.  He presented with a psychotic condition secondary to non-compliance.  He was again placed on an ITO.

1. There was a change of category on 29 September 2006 when limited community treatment was provided.

1. He has, unfortunately, had a number of admissions to the Prince Charles Hospital mostly in the context of non-compliance and consequent deterioration in his mental condition.  These admissions occurred in December, February and March 2007.

1. In his clinical report of 16 April 2006, Dr Astill diagnosed the defendant as suffering from catatonic schizophrenia.  He observed that the patient’s mental condition was acutely responsive to medication and significantly observed that missing only a few days' medication was sufficient to result in the patient being in a regressed state with psycho-motor retardation.

1. On 19 April 2007, the Mental Health Review Tribunal heard evidence from the treating team and also from Dr John Reddington, as allied person, in relation to the ITO. All gave oral evidence. The conclusion of the Tribunal was that, having regard to the criteria in s 14 of the Mental Health Act 2000 (Qld), the patient suffered from schizophrenia, he required immediate treatment, the appropriate treatment was available at the Prince Charles Hospital, there was an imminent risk of harm to the patient or to others in the absence of treatment, and that there was no less restrictive way of ensuring that he received the appropriate treatment for his illness.

1. The Tribunal also had regard to the matters listed in section 191 of the Mental Health Act 2000.

1. The grounds of appeal are stated as follows:

1.    The mental state assessment of 12 April 2007 completed by Dr Guta is inconsistent with a diagnosis of disorganised schizophrenia;

2.    The behaviours of 28 August 2006, 1 September 2006 and 4 September 2006 and correspondent perplexity may have origins in other disorders or problems;

3.    The risk of decline due to non-compliance has not been managed by other, less restrictive alternatives - for example, Trans-cultural Mental Health Service and/or Community Services.

1. The Court has the benefit of an update report from Dr Astill.  He states that the patient's diagnosis is one of schizophrenia and has included presentations of catatonia, disorganisation and paranoia.  He states that the patient requires ongoing treatment and regular supervision of his medication as, without that treatment, he is likely to suffer mental deterioration.  He observes that the patient's illness appears to be a complex case of schizophrenia which has required two courses of ECT and changes in medications to achieve appropriate amelioration of the condition, but that there have been limited responses to the treatment.  He details a long list of failure to comply with treatment.  He observes that there has been some recent improvement on a change of medication but that the patient's condition is still such as to require treatment and strict supervision.

1. Dr Astill also observes that the patient has not yet developed sufficient insight into his condition and its need for treatment and is very concerned that, with the severity of the illness and the history of non-compliance, there is every chance of relapse and serious mental deterioration if the ITO is not continued.

1. We heard today evidence from the patient himself which serves to confirm that he lacks proper insight into his condition.  He does not consider that he has any mental health problems.  In fact, he does not want to have anything to do with mental health services.  He does not wish to take the medication and we have also heard that he considers his ongoing attendance with his treatment psychiatrist to be a waste of time.

1. I understand that the appellant has concerns about the side effects of the medication that he is on and that he considers that it has interfered with his playing soccer which is clearly something he highly values.  However, that is to nought compared with the ongoing and very important need to treat his mental condition.

1. A large premise of the appeal is a challenge to the assessment of the patient's mental condition.  Nothing was put before the Court to cause me to consider that the Tribunal has erred in following the advice and opinions of Dr Astill and Dr Guta. 

1. I can see no error in the reasons of the Tribunal and I dismiss the appeal.