Re Patton
[2011] QMHC 10
•23 August 2011
MENTAL HEALTH COURT
CITATION:
Re Patton [2011] QMHC 10
PARTIES:
REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF BRENDAN MATTHEW PATTON
PROCEEDING NO:
0009/11
DELIVERED ON:
23 August 2011
DELIVERED AT:
Brisbane
HEARING DATE:
23 August 2011
JUDGE:
Ann Lyons J
ASSISTING PSYCHIATRISTS:
Dr J M Lawrence
Dr E N McVieFINDINGS AND ORDERS:
1. That at the time of the alleged offences on 21 April 2010 and 26 April 2010 the subject of the reference the defendant was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000 (Qld);
2. That the defendant be detained, pursuant to a forensic order, to the Park High Security Program Authorised Mental Health Service.
3. That limited community treatment is approved at the discretion of the authorised psychiatrist, on conditions one to 15 as set out in the submission of the Director of Mental Health
CATCHWORDS:
MENTAL HEALTH – DECLARATION OR FINDING OF
MENTAL ILLNESS OR CAPACITY – Where the defendant is charged with 16 offences – where there is evidence the defendant suffers from a psychotic disorder – whether the defendant was of unsound mind as defined by Schedule 2 of the Mental Health Act 2000 (Qld) at the time of the alleged offences
COUNSEL:
S Crofton for the defendant
K Parrott for the Director of Mental Health
C Kelly for the Director of Public ProsecutionsSOLICITORS:
Legal Aid Queensland for the defendant
Crown Law for the Director of Mental Health
Director of Public Prosecutions (Qld)
ANN LYONS J:
The offences
This is a reference in relation to Brendan Matthew Patton by the Director of Mental Health dated 10 January 2011. Mr Patton is charged with 16 offences, 15 of which occurred on 26 April 2010, and the other on 21 April 2010.
The charge on 21 April 2010 involves one count of committing a public nuisance. In relation to that charge police were called to a disturbance opposite a hotel at Scarborough Street, Southport. It would appear that Mr Patton had assaulted another person playing satanistic music at high volume. Mr Patton admitted to attempting to assault the complainant and that he was the instigator which then led to the complainant attacking him and causing a disturbance on the street at Southport.
In relation to the offences on 26 April 2010 there are seven counts of deprivation of liberty, two counts of wilful damage, two counts of assault occasioning bodily harm including one count of assault occasioning bodily harm whilst armed and in company with a further assault or obstruct charge. There is also a serious assault charge and a charge of entering a dwelling with intent at night and using or threatening violence.
On 26 April 2010 police at the Gold Coast were called to a unit after receiving information that a former occupant - the defendant, Mr Patton, had assaulted two occupants and was threatening the others with a knife obtained from the residence. All of the occupants had to jump from a second storey window to escape injury. Police cordoned off the unit and attempted negotiations. Whilst negotiations were occurring Mr Patton spat at police and threw a laptop and other items towards them and then barricaded himself at the top of the stairs. Police negotiators were called; the defendant continued his erratic behaviour and was eventually tazzered and restrained by handcuffs.
The reports of the Psychiatrists
Dr van de Hoef prepared a report dated 15 May 2011. Dr van de Hoef states that Mr Patton suffers from a psychotic disorder with a major manic mood component. She considers he could have a paranoid schizophrenic illness with a strong mood component or a bipolar affective disorder Type 1 with psychotic features. She also considers that until early 2010 it was exacerbated by use of methamphetamine. She states that his mental illness had its onset in at least 2002 and has been characterised by episodes of disorganised thoughts, persecutory, grandiose, religious and referential delusional thinking, irritable and elevated mood, probable auditory hallucinations, sleeplessness and extreme aggression. Dr van de Hoef also notes a recurrent history of recourse to weapons when psychotic, especially knives.
Dr van de Hoef states that Mr Patton has been difficult to treat because many of his symptoms are consistent with amphetamine intoxication or a psychotic disorder induced by that drug. She also notes that at times his symptoms settle within days of being floridly psychotic. She considers, however, that the severity of his mental illness and the timeframe of the presence of such severe symptoms persisting long after the last use of the drug, support the existence of a functional illness.
Dr van de Hoef notes that until his most recent admission he was insightless and able to give plausible accounts of his symptoms being all drug related. She notes that his mental state has improved significantly whilst in high secure at The Park.
Dr van de Hoef’s view is that at the time of all of the offences, Mr Patton was psychotic and probably manic due to a severe untreated mental illness. From the history she considers it likely that he injected and or smoked some form of methamphetamine as recently as two days prior to the offence, namely on 21 April 2010. If that was so, it is possible and even likely, she considers, that such drug use would have worsened his psychotic and mood symptoms.
Dr van de Hoef considers, however, that his history and subsequent events in the absence of further drug use indicate that his mental illness was of such severity that it would have deprived him of the capacity to know he ought not do the acts with respect to all of the charges in any case. She considers he has a defence on all of the charges on the ground of unsoundness of mind.
Dr Scott prepared a report dated 23 December 2010 and has provided an update report dated 16 August 2011. Dr Scott agreed that Mr Patton has a mental illness namely bipolar affective disorder which was untreated at the time of the alleged offences. He considers that he was deprived of the capacity to know that he ought not do the acts. He does not consider he was intoxicated as he noted that following his arrest Mr Patton was highly irritable and agitated and did not participate meaningfully in an assessment by the Mental Health Service at the Southport watch house. He was subsequently remanded to the Arthur Gorrie Correctional Centre (AGCC).
In late June 2010 Dr Scott stated that Mr Patton was found by his mother to be highly agitated and distractible at AGCC. He told her that he had a mission and had saved the Gold Coast from Asian terrorists who were plotting to blow up important buildings. Mr Patton was also convinced that he had been shot by police and that there were snakes in his prison cell. He was later transferred to the High Secure Unit. Mr Patton described to Dr Scott his beliefs about the mistreatment of the young girl at his former residence and he had resolved to rescue her and to confront her abusers.
Dr Scott considered that whilst Mr Patton understood what he was doing and had the control over what he was doing on 26 April he was deprived of the capacity to know he ought not do the acts which gave rise to the multiple charges on that date. He considers that in the context of his untreated psychotic illness Mr Patton may have experienced auditory hallucinations which he believes were the cries of a girl being mistreated.
Dr Scott does not consider that there is evidence that Mr Patton was intoxicated at the time. He considers that the evidence indicates that during his assessment at both the Gold Coast Hospital and the Southport watch house no signs of intoxication were documented and that there was no documentation of any paraphernalia or illicit substance use or evidence of alcohol use when he was found by police or when he was arrested. There was no indication that he had recently used drugs intravenously. Dr Scott noted that no urine drug screen or breath analysis performed. Dr Scott noted that Mr Patton’s elevated irritable mood and disorganised thinking persisted for months in the correctional facility. Dr Scott also considers that Mr Patton’s mental illness has responded well to antipsychotic and mood stabiliser medication.
The assisting psychiatrists Dr McVie and Dr Lawrence both agreed that there was clear evidence that Mr Patton was suffering from an exacerbation of his mental illness at the time of the commission of the offences which they considered would support a finding of unsoundness of mind.
Having considered the psychiatrist’s reports as well as the advice of the assisting psychiatrists I am satisfied that Mr Patton was of unsound mind at the time of the commission of all of the offences. There is no doubt that he was psychotic at the time and it is also clear that those symptoms took many months to settle. I am also satisfied that intoxication did not play a role.
Is a forensic order required?
Dr van de Hoef considers that a forensic order is required given the severity of his mental illness, his history of his resort to weapons when unwell and his long standing lack of insight. She also considers that there have been compliance issues in the past and that he is a grave risk to others when unwell.
Dr van de Hoef states that he is appropriately placed at The Park and notes that he has responded well to treatment and that he has abstained from illicit drugs.
Dr Scott agreed that a forensic order was appropriate. Both assisting psychiatrists also considered that a forensic order was vital given his past history and the seriousness of his offending.
I am satisfied that a Forensic Order is required. The only real contention is the extent of the limited community treatment which should be approved.
The first fifteen draft conditions tendered by the Director of Mental Health are appropriate. Those conditions include requirements that he must comply with the requirements of the authorised psychiatrist in terms of medication and treatment, that he must not use alcohol, that he must abstain from taking illicit drugs and that he must not drive a motor vehicle unless permitted to do so by the authorised psychiatrist. I also note and approve the additional conditions which include the followin;
Condition 5 “That the patient not travel to the Southport or Gold Coast area.”
Condition 6 “That the patient not have any contact, direct, or indirect, with the victims of the index offence or the victims family or friends”
Condition 7 “That the patient not have any contact, direct or indirect, with previously known substance using associates”
Those additional requirements are clearly appropriate given the circumstances of the alleged offences and the trauma experienced by the seven victims.
The real issue is whether the limited community treatment should commence immediately and be implemented in a three stage process as suggested by Dr Scott. Dr Scott recommended graduated escorted and non escorted leave both on and off grounds. He also recommended that at stage two, which was to commence two months after the making of the forensic order, Mr Patton be permitted over night leave at his mother’s home once per fortnight at the discretion of the treating psychiatrist. In stage three, which was recommended to commence in four months time, Dr Scott recommended that Mr Patton be allowed up to two nights per fortnight overnight leave at his mother’s residence.
Whilst the graduated process in relation to escorted and unescorted leave was not opposed by Counsel for the DPP, objection was taken to overnight leave being commenced in the first six months of the forensic order given that Mr Patton had not yet had any unescorted off ground leave. The submission was essentially that the progression to overnight leave was happening too quickly and should not occur until there had been clear evidence that Mr Patton had responded appropriately to unescorted off ground leave. Counsel indicated that the question of overnight leave could be considered by the Mental Health Review Tribunal at the first review of the forensic order in six months time.
This concern was endorsed by the assisting psychiatrists.
Dr McVie noted that Mr Patton has a history of aggression when psychotic with weapon use and attempts to procure a gun in the past. Dr McVie thought it bizarre that Mr Patton’s involuntary treatment order (ITO) was previously revoked when clearly he is a patent requiring long term future treatment.
Dr McVie opined that a forensic order is very clearly indicated in this case. She also stated she held some concerns about the rapidity of the progression of Mr Patton’s leave. She advised that the progression of leave should be much slower so that Mr Patton’s progress at each stage of leave can be monitored.
Dr McVie advised that having regard to Mr Patton’s significant history of psychosis, the history of staff having difficulty in identifying his psychosis when unwell, the nature of the offence, and his past criminal history it is very important that his rehabilitation be taken slowly. Dr McVie advised it was “way too premature at this point in time for overnight leave” and that Mr Patton should be trialled on unescorted off ground leave for a considerable period before any overnight leave was considered. .
Dr Lawrence also noted that it was unusual that Mr Patton’s ITO was revoked given his history. Dr Lawrence stated that she would certainly recommend a forensic order and that it must be borne in mind Mr Patton is potentially a very dangerous man. She stated that one should be very cautious in his rehabilitation and return to the community. Dr Lawrence indicated she would not recommend any overnight leave at this stage but that the Mental Health Review Tribunal could re-evaluate the situation when Mr Patton is next reviewed.
In my view overnight leave should not be allowed at this stage. There is no doubt that Mr Patton has, as Dr Scott points out been compliant with treatment to date and has never refused medication. I also accept that his insight into his illness has improved and he is fully aware of the need for medication. There is also evidence that he has developed a good relationship with his treating team. However the sixteen offences Mr Patton was charged with are very serious offences and involved serious assaults and deprivation of liberty. It is also clear that Mr Patton has been non compliant in the past and there is also evidence that he deteriorates quickly if he fails to take his medication or uses substances. I consider therefore that overnight leave should not be approved at this stage given that he has not successfully completed any unescorted off ground leave to date. I agree with the assisting psychiatrists that the progress to overnight leave should be implemented more slowly.
Accordingly the conditions of the forensic order will be in accordance with conditions one to 15 as follows;
1. That the patient complies with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;
2. That the patient must not use alcohol and must co-operate fully in random medical tests for alcohol as required by the authorised psychiatrist;
3. That the patient abstain from all illicit drugs and must co-operate fully in random medical tests for those substances as required by the authorised psychiatrist;
4. That the patient not drive a motor vehicle unless permitted to do so by the authorised psychiatrist;
5. That the patient not travel to the Southport or Gold Coast area;
6. That the patient not have any contact, direct or indirect, with the victim of the index offence, or the victim’s family or friends;
7. That the patient not have any contact, direct or indirect, with previously known substance using associates.
Stage 1
Unescorted leave on grounds of the hospital
8. For up to 2 hours up to a maximum of 4 times per week
9. That the patient returns to the ward at the time specified by the authorised psychiatrist
Escorted off the grounds of the hospital
10. For up to 6 hours once per fortnight
11. That the patient is to remain under the escort of health service staff member/s nominated by the authorised psychiatrist for the duration of the limited community treatment;
12. For the purposes of escorted limited community treatment, the patient complies with the directions of the nominated staff member/s for the duration of the limited community treatment.
Stage 2
13. To commence two months after the forensic order is made and in addition to stage 1
Unescorted leave off grounds of the hospital
14. That the patient be accompanied by a responsible adult approved in advance in writing by the authorised psychiatrist for up to 6 hours once per fortnight;
15. That the patient be unaccompanied for up to 6 hours three times per week for structured rehabilitation activities;
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