Re PFE

[2013] QMHC 4

MENTAL HEALTH COURT

CITATION:

Re PFE [2013] QMHC 4

PARTIES:

APPEAL AGAINST DECISION OF THE MENTAL HEALTH REVIEW TRIBUNAL

PFE
Appellant

DIRECTOR OF MENTAL HEALTH
Respondent by Election

ATTORNEY-GENERAL FOR QUEENSLAND

Respondent

PROCEEDING NO:

0078 of 2013

DELIVERED ON:

Delivered ex tempore on 11 June 2013

DELIVERED AT:

Brisbane

HEARING DATE:

11 June 2013

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr J Lawrence
Dr Varghese

FINDINGS AND ORDERS:

The appeal is dismissed.1.     

The decision of the Mental Health Review Tribunal dated 24 January 2013 is confirmed. 2.     

The Forensic Order dated 16 August 2007 is confirmed.3.     

CATCHWORDS:

MENTAL HEALTH – APPEAL AND NEW TRIAL –  APPEAL BY WAY OF REHEARING – appeal against decision of Mental Health Review Tribunal confirming a Forensic Order – where appellant diagnosed with paranoid schizophrenia, had absconded from treatment, had a history of aggression when unwell and still suffered many positive symptoms – where very clear evidence that the appellant had no insight into her illness and would stop treatment if the Forensic Order were revoked – whether the Mental Health Review Tribunal should have been satisfied that the appellant represented an unacceptable risk to the safety of the appellant or others

COUNSEL:

D Shepherd for the appellant
J Tate for the Director of Mental Health
S Skubij for the Attorney-General

SOLICITORS:

Legal Aid Queensland for the appellant
Crown Law for the Director of Mental Health
Crown Law for the Attorney-General

A LYONS J:

1. This is an appeal by PFE against the decision of the Mental Health Review Tribunal (MHRT) of 24 January 2013 confirming PFE’s Forensic Order. PFE was placed on a Forensic Order on 16 August 2007. She was charged with one count of assault occasioning bodily harm on 1 August 2006. On that occasion, the Court was satisfied that PFE was of unsound mind at the time and in particular, that she was suffering from schizophrenia and was deprived of all of the capacities. In making the Forensic Order, the Court noted that PFE remained a high risk if her insight continued to be impaired and that at the time of the order, her recovery was incomplete. The Court also noted a significant lack of insight into her mental illness.

1. On 24 January 2013 the MHRT confirmed the Forensic Order and approved Limited Community Treatment. PFE’s treating psychiatrist gave evidence before the MHRT and before this Court. He indicated that PFE regularly absents herself from treatment and that she has no insight at all into her illness.

1. PFE, in her Notice of Appeal, indicated that the Forensic Order is now six years old and she considered that the order had finished on 28 November 2011.

1. PFE’s treating psychiatrist indicated in his evidence that PFE considers her mental health treatment to be an intrusion and that when she is off her medication, PFE is very disorganised and her behaviour often attracts the attention of police. In December 2012, PFE went to Sydney without permission and without telling any of her treating team. She was located in Sydney and admitted to hospital in Sydney. When she returned to Queensland, she was admitted to hospital for 10 days and was then discharged to a boarding house in the community.

1. PFE has a diagnosis of paranoid schizophrenia which is treatment resistant. She has had at least five admissions to hospital and the last was in December 2012. She was unwell at the time of the hearing of her appeal. Whilst medication has had some impact on her illness, PFE still has many positive symptoms of her illness. The very clear evidence is that PFE has no insight into her illness and would stop treatment if the Forensic Order were revoked. PFE is firmly of the view that the Forensic Order was ceased in 2011 and demands that it now be ceased so that she can discontinue treatment. PFE does not believe she has a mental illness and claims she is well.

1. An appeal to this Court is an appeal by way of rehearing and no error needs to be shown in the decision of the MHRT. This Court considers all of the material which was before the MHRT, together with all the material currently available. In terms of whether the Forensic Order should be revoked, it is clear that PFE still represents an unacceptable risk to herself and she would cease all treatment if her Forensic Order were revoked. I am satisfied that she would suffer a very serious relapse of her schizophrenic illness.

1. PFE is already attracting the attention of police and if her Forensic Order was revoked the inevitable deterioration in her mental state would attract further involvement of the police as PFE would discontinue treatment. There is a concern that PFE may become aggressive when unwell as there is a history of making threats with a knife. PFE was also charged with assault occasioning bodily harm in 2006. She has been verbally hostile and physically threatening towards other residents at her boarding house and she was verbally aggressive towards a case manager whilst in hospital in July 2011. 

1. Accordingly, I am satisfied that if the Forensic Order was revoked, PFE would disengage and there is a very real concern she would become itinerant.  I note the advice of the assisting psychiatrists that PFE benefits from treatment and she would relapse if treatment was discontinued.  I also note the advice that PFE should consider a possible trial of Clozapine.  I note Dr Varghese’s advice that it can have quite good results. 

1. I am satisfied that there is an unacceptable risk that PFE would relapse if the Forensic Order was revoked and, accordingly, she is an unacceptable risk to herself and others.  I am therefore satisfied the Forensic Order should continue. Accordingly, the decision of the MHRT is confirmed and the appeal is dismissed.

ORDERS:

1.     The appeal is dismissed.

2.     The decision of the Mental Health Review Tribunal dated 24 January 2013 is confirmed.

3.     The Forensic Order dated 16 August 2007 is confirmed.