Re PWM

[2004] QMHC 18

MENTAL HEALTH COURT

CITATION:

Re PWM [2004] QMHC 018

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF PWM

PROCEEDING NO:

0126 of 2003

DELIVERED ON:

14 July 2004

DELIVERED AT:

Brisbane

JUDGE:

ASSISTING PSYCHIATRISTS:

Wilson J

Dr J F Wood
Dr D A Grant

FINDINGS:

      1)        That there is reasonable doubt the defendant
                  committed the offence of possession of a 
                  dangerous drug;

     2)        That the defendant is fit for trial;

3)          That proceedings against the defendant for the offence of possession of a dangerous drug be continued according to law;

4)          That the defendant was of unsound mind at the time of the alleged offences of break and enter on 28 March 2003, two counts of wilful damage on 28 March 2003, wilful damage and destruction on 28 March 2003 and wilful damage between 26 March and 29 March 2003;

5)          That the defendant be detained as a forensic patient in the Princess Alexandra Hospital and District Authorised Mental Health Service for involuntary treatment and care;

6)          Approval of limited community treatment to commence immediately on the following conditions:

1. That he reside at [address stated] or at such other address as is approved in advance in writing by the authorised psychiatrist.

2. That he attend all follow-up appointments and inpatient care as required by the authorised psychiatrist.

3. That he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment.

4. That he abstain from using alcohol and illicit drugs and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist.

5. That he not drive a motor vehicle unless permitted to do so by the authorised psychiatrist.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where the defendant has been charged with possession of a dangerous drug – where there is reasonable doubt as to whether the defendant committed that offence – where defendant is fit for trial - where the defendant has been charged with break and enter, three counts of wilful damage and one count of wilful damage and destruction – where the defendant was suffering from unsoundness of mind when he committed those offences – where the defendant suffers from bipolar affective disorder – where the defendant is not receiving regular psychiatric treatment – whether a forensic order should be made

Mental Health Act 2000 (Qld) schedule 2

COUNSEL:

D Shepherd for the defendant
B Isdale for the Director of Mental Health
P Feeney for the Director of Public Prosecutions

SOLICITORS:

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

1. WILSON J:  PWM has been charged with a number of offences allegedly committed in late March 2003.  First there is the offence of possession of a dangerous drug on 28 March 2003.  I am satisfied there is reasonable doubt he committed that offence and that the doubt is not one arising solely in consequence of his mental condition.  Accordingly that matter ought go to trial subject to any question of his fitness for trial.  I am satisfied he is fit for trial.

1. The other offences with which he has been charged are break and enter on 28 March 2003, two counts of wilful damage on 28 March 2003, wilful damage and destruction on 28 March 2003 and wilful damage between 26 March and 29 March 2003. 

1. With respect to those offences I am satisfied that at the relevant times he was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act.

1. The issue which has caused most debate in this reference is that of whether a forensic order ought to be made. 

1. The defendant was born on 18 October 1960.  He suffers from bipolar affective disorder which is a recurring condition.  He has been under the care of Dr Eastwell, a psychiatrist, for a period of about 10 years.  There are two reports from Dr Eastwell before the Court, one dated the 22 June and the other the 2 July 2004.  According to the earlier of those reports, Dr Eastwell saw him at three monthly intervals; however those consultations seemed to have ceased at or about the time of the offences presently before the Court because he was admitted to the Princess Alexandra Hospital in a grossly psychotic state on 28 March 2003.  He responded extremely slowly to treatment and was not able to be discharged until 12 August 2003.

1. Thereafter he was followed up in the community seeing Dr Hugh Daniel at the Inala Mental Health Clinic and receiving assistance from a psychologist who has been his case manager.  He was last seen medically by Dr Daniel in January 2004.  Dr Daniel said then that he had been in remission since September 2003.

1. In fact he did not attend a psychiatrist again until he saw Dr Eastwell on 7th May 2004 and 25 May 2004.  Dr Eastwell said in his report that he was still disturbed and symptomatic when seen on those dates, his concentration was still below average as was his memory for recent events.  He was still excitable when seen and inclined to be a bit overactive as he was on his old diagnosis.

1. Dr Eastwell gave evidence before this Court by telephone.  He indicated that he has not seen the defendant again since the 25th of May and no appointment has been made for a further consultation. 

1. When the defendant was under the care of Dr Daniel he was receiving mood stabilising medication as well as tranquilising medication.  Dr Eastwell was apparently unaware of this and as far as he is concerned he has prescribed tranquilising medication only. 

1. Indeed, it is a matter for concern that Dr Eastwell was apparently unaware of the nature of the treatment he had received and of the ongoing involvement of a case manager from the Inala Mental Health Clinic.

1. There is a report from the case manager before the Court dated 6 July 2004.  She noted that the defendant voluntarily attends the Inala Mental Health Clinic for case management provided by her.  She went on:

"He is currently seen every three weeks.  The primary purpose of case management has been to monitor his mental state and his management of his financial situation.  PWM appears to reliably take his medication, has remained stable since discharge from hospital and has demonstrated the ability to manage his work, home and finances in an appropriate manner.  Should PWM continue to remain stable I would expect that case management may no longer be required in the not too distant future."

1. According to Dr Eastwell he does need to attend a psychiatrist regularly.  There is nothing in place for that to happen at the moment. 

1. I have been informed by the defendant's counsel that he is living by himself.  He is receipt of a disability support pension.  The house in which he lives is his, but because of financial difficulties may have to be sold.  If that happens he will move back to living with his mother.

1. In all of the circumstances I am not satisfied that his treatment needs are presently being adequately met and I am confirmed in that view by the advice I have received from the assisting psychiatrists.  The offences with which he has been charged were comparatively serious ones.  I have to take account of that and of the need to protect the community.  His condition being a cycling one, it is probable that there will be a further relapse at some time in the future. 

1. The community's interests would best be protected by his remaining under psychiatric care and being compliant with treatment.  I have formed the view that in order to meet his treatment needs and to protect the community the safeguards of a forensic order are warranted.  Accordingly I order that he be detained as a forensic patient in the Princess Alexandra Hospital and District Authorised Mental Health Service for involuntary treatment and care.

1. I approve limited community treatment to commence immediately on the following conditions:

1. That he reside at [address stated] or at such other address as is approved in advance in writing by the authorised psychiatrist.

2. That he attend all follow-up appointments and inpatient care as required by the authorised psychiatrist.

3. That he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment.

4. That he abstain from using alcohol and illicit drugs and cooperate fully in random medical tests for those substances as required by the authorised psychiatrist.

5. That he not drive a motor vehicle unless permitted to do so by the authorised psychiatrist.

1. I direct that a transcript of this morning's proceedings be prepared.  A complete transcript of the two days should be made available to the parties and to the authorised mental health service and in due course to the Mental Health Review Tribunal.  Similarly, the reports which are before this Court may be released to the authorised mental health service and to the Mental Health Review Tribunal.