Re OMS

[2004] QMHC 9

MENTAL HEALTH COURT

CITATION:

Re OMS  [2004] QMHC 009

PARTIES:

REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF OMS

PROCEEDING NO:

0073 of 2003

DELIVERED ON:

16 March 2004

DELIVERED AT:

Brisbane

JUDGE:

ASSISTING PSYCHIATRISTS:

Wilson J

Dr J F Wood

Dr D A Grant

ORDER:

1) At the times of the alleged offences OMS was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000;

2)OMS is to be detained in the Gold Coast District and Area Network Authorised Mental Health Service for involuntary treatment and care.   

3)Limited community treatment on the following conditions is approved - 

1.  that he reside at [address stated] or at an address approved in advance in writing by the authorised psychiatrist;

2.  that he attend an appointment with Dr Hill, Southport Adult Mental Health Service, 60 High Street, Southport next Tuesday 23 March, at 3.30 p.m;

3.  that he attend all follow-up appointments and in-patient care as required by the authorised psychiatrist;

4.  that he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;

5.  that he abstain from using alcohol and illicit drugs and make himself available and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant has been charged with three counts of wilful damage and assault occasioning bodily harm – where the defendant suffers from schizophrenia and at the time of the alleged offences was in a state of relapse – where the defendant had persecutory delusions, chronic anxiety, concentration problems and difficulties with motivation - whether by reason of his mental illness he was deprived of the capacity to know he ought not do the acts in question

Mental Health Act 2000, schedule 2

COUNSEL:

D Shephard for the defendant
J Tate for the Director of Mental Health

P Rutledge for the Director of

SOLICITORS:

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

1. WILSON J:  OMS has been charged with three counts of wilful damage and one count of assault occasioning bodily harm, all on 19 August 2002.

1. The three counts of wilful damage involve conduct occurring in the morning and the assault conduct later in the day.  The wilful damage involved damage to two buses and a Falcon motor vehicle by the use of a skate board.  The assault involved an attack on a nurse at The Cottage, a mental health unit in Southport.

1. The defendant was born on 21 January 1978.  The Court has received evidence from two consultant psychiatrists who have examined him - Dr Fama and Professor Morris.  It is clear that he suffers from schizophrenia and that at the time of the alleged offences he was in a state of relapse.

1. The issue for the Court is whether by reason of that mental illness he was deprived of the capacity to know he ought not do the acts in question. 

1. At the commencement of the proceedings the capacity to control his actions was also an issue, but I am satisfied that the evidence does not support a deprivation of that capacity. 

1. The defendant's illness was diagnosed when he was aged about 20.  He suffered from social and personal decline.  The illness has recurrent features, including the hearing of voices, one of the voices being that of a born-again Christian, Daniel.  It is pertinent to note that the defendant is Muslim by faith.  Other recurrent features are persecutory delusions, telepathic communications and the receipt of messages through the media and television, a feeling that his mind is being influenced by others, and a loss of trust in the capacity of doctors and nurses to act in his best interests.  As well as these psychotic features, he has suffered from chronic anxiety, concentration problems and difficulties with motivation.  He has been socially withdrawn.

1. He went to Egypt for about nine months, returning to Australia in June 2002.  While he was away he stopped taking his anti-psychotic medication.  On his return, at first he seemed to be in comparatively good mental health; however, his condition declined.

1. The Court has a statement by his mother, MS, dated 19 November 2002.  She said this, "As weeks went by O started getting quieter and more withdrawn.  He would spend time alone in his room, staying awake at night.  He would get dressed up in a suit and wander off at different times of the night.  I said if he wanted to talk to me about anything I was there for him.  I did not want to pry too much because he is 24 and I felt he needed his private space.  I was aware all was not well and was worried about him."

1. On the night before the alleged offences she said he sat up all night with a curtain rod in his hand staring into space.  She made arrangements for his brother to come and talk to him.  She spoke to him herself and suggested he should go to the Gold Coast Hospital for a few days, but he just laughed at her and took his skateboard out, as he often did.  Shortly after that, the alleged offences occurred. 

1. The Court also has a statement from the defendant of November 2002.  He said this -

"On the day in question I felt the need to release my anger.  I felt annoyed and frustrated at the prolonged problems I was having in relation to the voices." 

He went on later -

"On the day in question I was hearing a voice which was over-powering.  I felt that the Born Again Christian Daniel was talking to me and in the end I felt so annoyed and frustrated that I had to release my anger.

I remember leaving the house and I saw the bus.  I had an anxiety feeling that someone else was putting things through me.  I felt as though it was a build up of energy.  I was so tense I needed an outlet.  I did not feel in control.  If the bus was not there I would have taken it out on my skateboard and smashed the skateboard.  I remember hitting the side of the bus and I remember hitting the windows.  I remember a glass crashing down.

Prior to the incident I was sleeping for about eight hours.  Sometimes I would wake in the middle of the night as I was hearing voices.  The voices were not aggressive and I did not have severe nightmares."

1. After the damage to the motor vehicles, he was questioned by police and released.  Later that day he went to The Cottage at Southport.  There a nurse was questioning him.  He perceived the nurse to be treating him in a derogatory fashion.  There is no evidence that the nurse was in fact doing so, and difficulties of perception were a feature of his illness.  When the nurse was not looking, he punched him twice.

1. The examining psychiatrists were of the common view that he was in a very disturbed state.  He was suffering frustration, anger and irritability which were themselves a product of the psychosis and which put him at risk of aggression and violence.

1. The issue before the Court is whether his mental state was such that he was able to reason with a moderate degree of composure as to the moral rightness or wrongness of his conduct.

1. Dr Morris thought there was insufficient evidence that he was unable so to reason.  Dr Fama was of the contrary opinion. 

1. At first Dr Morris seemed to be saying that because he was not satisfied the conduct was in response to sufficient voices or delusions he could not conclude that he was of unsound mind.  However, in oral evidence, I understood him to concede that these factors are not always necessary to amount to a deprivation of capacity. 

1. The case comes down to an assessment of evidence and whether the Court is satisfied on the balance of probabilities that he was unable so to reason.  I am satisfied that he was unable so to reason, and I note that after hearing the evidence counsel for the Director of Public Prosecutions conceded this to be the case.

1. In the circumstances, I find that at the times of the alleged offences he was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000.

1. His treatment needs, the protection of the community and the seriousness of the offences all warrant the making of a forensic order.  I order that he be detained in the Gold Coast District and Area Network Authorised Mental Health Service for involuntary treatment and care. 

1. I approve limited community treatment on the following conditions -

1.  that he reside at [address stated] or at an address approved in advance in writing by the authorised psychiatrist;

2.  that he attend an appointment with Dr Hill, Southport Adult Mental Health Service, 60 High Street, Southport next Tuesday 23 March, at 3.30 p.m;

3.  that he attend all follow-up appointments and in-patient care as required by the authorised psychiatrist;

4.  that he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;

5.  that he abstain from using alcohol and illicit drugs and make himself available and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist.

I can see no reason why that limited community treatment ought not commence immediately.

1. I direct that a copy of my reasons be made available to the treating team.