Re Reeves

[2014] QMHC 11

MENTAL HEALTH COURT

CITATION:

Re Reeves [2014] QMHC 11

PARTIES:

REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF PETER JAMES REEVES

FILE NO:

3 of 2013

DELIVERED ON:

28 November 2014

DELIVERED AT:

Brisbane

HEARING DATE:

3 November 2014

JUDGE:

Boddice J

ASSISTING PSYCHIATRISTS:

Dr J Lawrence
Dr J Reddan

ORDER:

The application for leave to withdraw the reference is refused. 1.   

There is a reasonable doubt the Defendant committed the alleged offence.2.   

The Defendant is temporarily unfit for trial.3.   

The Defendant be detained, pursuant to a forensic order, to the West Moreton Network Authorised Mental Health Service, with no approved limited community treatment.4.   

Copies of the reports, and of the transcript, be provided to the parties, to the treating team, to the Mental Health Review Tribunal, and to the Attorney General.5.   

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF

MENTAL ILLNESS OR INCAPACITY – where the Defendant is charged with unlawful stalking – where, after the Court heard the reference and reserved its decision, the Defendant applied to withdraw the reference – whether it is in the interests of justice to grant the Defendant leave to withdraw the reference – whether the Defendant was of unsound mind at the time of the alleged offence – whether the Defendant is fit for trial – whether there is a dispute of fact within the meaning of s 268 of the Mental Health Act 2000 (Qld)

Mental Health Act 2000 (Qld) s 268

COUNSEL:

J Millican for the defendant
J Tate for the Director of Mental Health

S Vasta for the Office of the Director of Public Prosecutions (Qld)

SOLICITORS:

Toowoomba Advocacy and Support Centre for the defendant
Crown Law for the Director of Mental Health

Office of the Director of Public Prosecutions (Qld)

1. BODDICE J: By reference filed 8 January 2013, the Toowoomba Advocacy and Support Centre referred to this Court the mental condition of Peter James Reeves at the time of an alleged offence of stalking on 1 July 2008. Both unsoundness of mind and fitness for trial are in issue. A subsidiary issue is whether there is a dispute of fact within the meaning of s 268 of the Mental Health Act 2000 (Qld) (“the Act”).

1. After the hearing, the Defendant made application to withdraw the reference, on the basis the Defendant wishes to have certainty and is prepared to proceed within the criminal jurisdiction.  That application is opposed by the Director of Public Prosecutions and the Director of Mental Health.  At issue on that application is whether it is contrary to the interests of justice to grant the Defendant leave to withdraw the reference.

Background

1. The Defendant was born on 28 November 1953.  He has four children.  He is a retired high school teacher, who has been in receipt of a disability support pension for almost 20 years.  He was placed on that pension as a consequence of a major psychotic episode in 1994.

1. The histories provided to the reporting psychiatrists, and to Dr Wong, on referral from his general practitioner, suggest the Defendant developed post traumatic stress disorder, following sexual abuse as a young child, and bipolar disorder in his late teens or early twenties.  Since his retirement, he has had numerous episodes in which he has become suicidal and/or psychotic, particularly in stressful situations.  The Defendant denies ever having been hospitalised for psychiatric reasons.

Alleged offence

1. The period of the alleged stalking extends between July 2008 and January 2012.  The complainant was a neighbour of the Defendant.  In July 2008, the complainant allegedly received a number of handwritten letters containing claims he was a paedophile and a drug dealer.  Some of the correspondence included direct threats to his life.  Later in 2008, Ipswich police received a number of handwritten letters alleging the complainant was a paedophile and a drug dealer.  As a consequence, a search warrant was executed on the complainant’s residence.  It, and subsequent police investigations, revealed no evidence to substantiate claims the complainant was involved in paedophilia, or was a drug dealer or user.

1. Notwithstanding the results of these investigations, it is alleged the complainant and police continued to receive anonymous letters in respect of the complainant throughout 2009 and in the subsequent years.  Ultimately, police forensic investigations allegedly produced evidence indicating the author of these letters was the Defendant.  The Defendant was interviewed and denied any involvement in sending those letters.  It is alleged the correspondence continued thereafter, and the Defendant was subsequently arrested and charged with unlawful stalking.  In all, the Defendant is alleged to have sent a total of 21 letters, between 2008 and 2012, to neighbours, police and the complainant.

Reporting psychiatrists

1. Dr Timmins interviewed the Defendant on 9 August 2013.  He gave an account to the effect the complainant was involved in drugs and sexually assaulting young girls.  He also said the complainant was “infected by Archons”.  He denied being involved in sending the correspondence the subject of the charge.  He reported having delusions about Archons and hearing derogatory voices.

1. Dr Timmins opined that whilst the Defendant, in interview, had expressed a pre-occupation with the alleged offence and the circumstances leading up to it, she was not convinced he had delusional beliefs or suffered ideas of reference, passivity or mis-identification phenomena.  In her opinion, the Defendant was not suffering from a mental disease, or natural mental infirmity.  He was suffering from a severe personality disorder – mix cluster A and B – schizotypal and borderline.  His presentation was complex with numerous elements.

1. Dr Timmins further opined that at the time of the alleged offence the Defendant was not completely deprived of any of the relevant capacities by virtue of a mental illness.  She noted there was, in any event, a substantial dispute of fact, as the Defendant denied any involvement in the alleged offence.  This dispute was not due to a mental illness.

1. In respect of fitness for trial, Dr Timmins opined the Defendant had an understanding of the nature of the charge and the nature of court proceedings.  He also had an ability to instruct counsel and to participate in a trial.  However, Dr Timmins had concerns as to his ability to endure a trial, without serious consequence for his mental condition.  It was likely the Defendant would become increasingly suicidal, and the risk of harm to himself or others would dramatically escalate if he were to appear in a court room or serve a prison sentence.

1. Dr Schramm interviewed the Defendant on 26 May 2014.  At that interview, the Defendant gave an account in which he again raised allegations in respect of the activities of the complainant.  He also spoke about his beliefs in relation to Archons, and how they can control the thoughts and behaviours of others.  He expressed a belief the complainant had been persecuting his wife, and that police had sided with the complainant in relation to the allegations.

1. Dr Schramm opined that whilst the Defendant subscribed to a complex set of persecutory and bizarre beliefs, and had bizarre ideas, he did not display true formal thought disorder.  However, his unshakable certainty in the beliefs featuring Archons in human form, and other aspects, was consistent with delusional beliefs.  In Dr Schramm’s opinion the Defendant had next to no insight in to his psychosis. 

1. Dr Schramm opined the Defendant had for a number of years been preoccupied by a complex delusional system such that he ought properly be diagnosed as suffering from schizophrenia, paranoid type.  He agreed with Dr Timmins that the Defendant may also suffer from some underlying cluster A type personality disturbance but considered the bizarre beliefs cross the line into delusion.

1. Dr Schramm further opined the Defendant would have been suffering from this mental illness at the time of the commission of the alleged offence.  Whilst his continuing denial of any involvement in sending the letters suggests a dispute of fact, Dr Schramm considered this denial arose out his delusional belief system.  Accordingly, any dispute was likely a function of his mental illness.  Dr Schramm considered the Defendant to be unfit for trial.

1. In a subsequent report, Dr Schramm opined that whilst the Defendant appeared to have improved since his last interview, and appeared to accept some of his ideas may have delusional aspects, he remained unfit for trial.  However, it may be that unfitness was of a temporary nature.  Dr Schramm also confirmed his opinion the Defendant was labouring under delusional ideas at the time of the alleged offence such that he was deprived of the capacity to know he ought not to do the act. 

Other medical evidence

1. Dr Douglas Scott, psychiatrist, provided a report dated 29 October 2014.  He had first met the Defendant in the Mental Health Unit at the Ipswich Hospital when he was being assessed and treated by another psychiatrist.  He subsequently saw the Defendant in private practice on two occasions in 2014.  At the last consultation, the Defendant presented as being hypomanic with some formal thought disorder.  Dr Scott considered he could possibly have bipolar effective disorder and suggested treatment options.  The Defendant did not return thereafter.

1. Dr Scott noted the Defendant, a successful athlete concerned as to the consequences of medication, considered his short stay in hospital had interfered with his training programme and diet.  Dr Scott opined a longer stay in hospital would have been detrimental.  If a good therapeutic alliance is established, outpatient treatment would be far more effective and longer lasting than a forced inpatient admission.  Dr Scott does not consider the Defendant represents a threat to the community.

1. Dr Huynh is the Defendant’s treating general practitioner.  He has provided a number of reports in which he expresses concerns as to the impact of stress upon the Defendant.  These concerns include both his physical and mental health.

1. The Court also has the benefit of copies of the clinical records of Dr Wong, psychiatrist, who assessed the Defendant in 2012 at the request of Dr Huynh.  Those notes record Dr Wong considered the Defendant had chronic post traumatic stress disorder, obsessive compulsive disorder and dysfunctional personality traits.  He was not convinced the Defendant had any bipolar or psychotic disorders.

Submissions

1. The Defendant submits the Court ought to prefer Dr Schramm’s opinion, and find he suffers from a mental disease, namely schizophrenia.  Further, the Court ought to find the dispute of fact arises out of his mental illness.  Alternatively, the Court ought to find the Defendant temporarily unfit for trial and grant immediate approved limited community treatment.  Any requirement for the Defendant to be hospitalised for assessment is likely to have detrimental effects.  A good therapeutic relationship is best established through outpatient treatment.

1. The Director of Public Prosecutions submits the Court ought to find there is a dispute of fact within the meaning of s 268 of the Act. The Defendant denies he sent the letters, an essential element of the charge. If the Court does not find there is a dispute of fact, and finds the Defendant was suffering from unsoundness of mind, the Defendant’s actions raise such serious concerns that a forensic order ought to be imposed, requiring his detention as an inpatient with no approved limited community treatment until a proper assessment has been undertaken.

1. The Director of Mental Health submits the differences in the opinions expressed by Dr Timmins and Dr Schramm give rise to a question as to what is the appropriate diagnosis.  This impacts on the understanding of any dispute of fact.  If a finding is made of unsoundness of mind, a forensic order ought to be made with approved limited community treatment.

Assisting psychiatrists

1. Dr Lawrence advised the Defendant presents as a complex and controversial case.  It was noteworthy the Defendant had not formed a longstanding therapeutic alliance with any psychiatrist.  The difficulties in forming such a relationship appeared to relate to the Defendant.

1. In respect of the question of a dispute of fact, Dr Lawrence advised she was persuaded by the opinion of Dr Schramm, although his most recent report indicated the Defendant was softening in his belief systems and was obviously now less stressed and anxious.  The Defendant’s ideas about the police amounted to persecutorial delusions and an elaborate conspiracy system continued to exist.  There was also a suggestion he had various personalities.  The complexities in these conflicting issues necessitated the Defendant be detained in hospital pursuant to a forensic order to allow a proper assessment.

1. Dr Reddan advised she agreed with much of Dr Lawrence’s advice but questioned whether the Defendant actually suffered delusions.  Dr Wong, who saw the Defendant in June 2012, did not consider him to be psychotic, nor did the Ipswich Mental Health Service when he was admitted for a three day period.  Further, whilst Dr Scott raised the question of bipolar disorder, he did not consider the Defendant was suffering from schizophrenia.

1. Dr Reddan advised it was doubtful the Defendant suffered from delusions.  Dr Schramm asked very leading questions of the Defendant, and his conclusion was very dependent upon an acceptance of the Defendant’s version.  Further, Dr Schramm, in his most recent report, refers to the Defendant having softened his position in relation to his beliefs.  Dr Reddan advised if that be the case, they cannot be delusions as a delusion by definition is a fixed belief that a person cannot be persuaded out of, even for a very brief period of time.

1. Dr Reddan further advised Dr Schramm’s apparent explanation for the improvement in the Defendant’s position from the first interview, namely the taking of medication, was not supported as the Defendant had been taking that medication in 2012 at a similar dosage.  Further, Dr Schramm’s opinion was heavily dependent on an acceptance that the Defendant’s beliefs about Archons were bizarre.  A belief about Archons is not unusual.  Such a belief system would not normally be considered delusional in nature.

1. Dr Reddan advised I ought to accept the opinion of Dr Timmins.  There is a dispute of fact.  It does not arise from the Defendant’s mental illness.  Further, there was no mental disease.  Dr Timmins had correctly noted the Defendant’s behaviour had escalated until he had achieved his ends of driving the complainant out of his home.  This escalation included inviting members of the public to harm the complainant.  It was also important to note the letters sent to the complainant made no mention of Archons or other actual delusional material. 

1. If I determined the Defendant is of unsound mind, or unfit for trial, Dr Reddan advised a forensic order was necessary, with a requirement the Defendant be subject to inpatient admission without limited community treatment until there has been a proper assessment.

Discussion

Leave to withdraw

1. An application to withdraw a reference may be made at any time before this Court decides the reference.[1]  This Court has the power to grant or refuse leave to withdraw the reference.  The Court must not refuse the application unless the withdrawal of the reference is contrary to the interests of justice.[2]

   [1]Mental Health Act 2000 (Qld) s 261.

   [2]Ibid s 263(2).

1. The interests of justice is a broad concept involving considerations wider than just the entitlement of a Defendant to pursue other available options in the criminal justice system.  In the present case, the relevant considerations include the circumstances under which the application is made.  The Defendant did not make the application prior to the hearing of the reference.  The application was made after the hearing had concluded, and whilst the decision was reserved. Further, the application was made after a submission had been made on behalf of the Defendant that the Court would accept the Defendant was suffering from unsoundness of mind at the time of the alleged offence or, alternatively, would find he was temporarily unfit for trial.

1. The Defendant’s stated desire to withdraw the reference centres on a concern as to the consequences of the imposition of a forensic order, or a finding he is temporarily unfit for trial.  The advice of the assisting psychiatrists was that there was a need for the Defendant to be subject to a period of inpatient care so that he may be properly assessed as to his long term treatment needs. Against that background, there is force in the submissions of the Director of Public Prosecutions, and the Director of Mental Health, that if leave is granted to withdraw the reference, there will remain a live issue as to the Defendant’s fitness for trial.  Withdrawal of the reference will necessitate that in the criminal proceedings a jury will have to be empanelled to determine that issue.  In circumstances where this Court is seized with the matter, and has had a hearing and reserved its decision, it is contrary to the interests of justice for leave to be given to withdraw the reference.

1. The Defendant’s submission that as another system exists to allow for a determination of the question of fitness for trial, the interests of justice will not be impeded by the granting of leave to withdraw the reference, fails to have due regard to the broad circumstances encompassed by the concept of interests of justice.  A grant of leave to withdraw the reference will mean the community will incur considerable expense in circumstances where the Defendant engaged the jurisdiction of this Court, and actively participated in the hearing of the reference.  There was a positive submission by him that there is an issue in respect of fitness for trial.  It cannot be in the interests of justice to allow the Defendant to withdraw the reference, yet seek to agitate the same issues in the criminal proceedings.  Such a scenario is contrary to the interests of justice.

1. I am satisfied it is contrary to the interests of justice to grant the Defendant leave to withdraw the reference.  I refuse that application.

Unsoundness

1. The question of unsoundness of mind raises significant, complex issues.  There is a divergence of opinions between the reporting psychiatrists.  The assisting psychiatrists also diverge in respect of the advice given to me. 

1. Having considered all of the evidence, I prefer the opinion expressed by Dr Timmins.  That opinion gives due and proper regard to all of the surrounding collateral material.  Further, her conclusion in respect of the absence of a psychotic disorder is consistent with the conclusions reached by Dr Wong in 2012, and the assessment of the Defendant at the Ipswich General Hospital in 2013.

1. By contrast, Dr Schramm’s opinion was not persuasive.  Dr Schramm disregarded the significant collateral material which was inconsistent with his conclusions.  Further, his conclusions were very dependent upon an unqualified acceptance of the Defendant’s version of the factors motivating his conduct, and an acceptance that those factors constituted a delusional belief system.  Significantly, Dr Schramm, in his most recent report, appeared to accept that that belief system was softening, a factor contrary to the beliefs being delusional beliefs.

1. However, it is clear from the versions given to Dr Timmins and Dr Schramm that the Defendant disputes sending any of the correspondence the subject of the charge.  I accept Dr Timmins’ opinion that that dispute does not arise as a consequence of his mental illness.  I do not accept Dr Schramm’s opinion to the contrary. It is based on his opinion as to the existence of a delusional belief system. I do not accept the existence of a delusional belief system.

1. I am satisfied, having considered all of the available material, that dispute gives rise to a reasonable doubt, within the meaning of s 268 of the Act, whether the Defendant committed the alleged offences. This Court cannot make a finding as to unsoundness of mind.

1. If I am wrong in that conclusion, I would, for the reasons set out above, accept and prefer the opinions expressed by Dr Timmins.  In that event, I would be satisfied the Defendant was not suffering from a mental illness at the time of the alleged offence.  I would also be satisfied the Defendant was not of unsound mind.

Fitness for trial

1. Dr Schramm opined the Defendant is currently not fit for trial, although that unfitness may be of a temporary nature.  Dr Timmins opined the Defendant was fit for trial but raised concerns as to his ability to endure a trial.  The ability to endure a trial without serious harm to the Defendant’s mental health is one of the factors to be considered in the determination of whether a Defendant is fit for trial. 

1. The concern raised by Dr Timmins, coupled with the opinion expressed by Dr Schramm, satisfies me the Defendant is presently unfit for trial.  I accept that unfitness is of a temporary nature.

Future management

1. The finding of temporary unfitness for trial means a forensic order must be made by this Court.  Whilst the Defendant submits that in that event he ought to be granted full approved limited community treatment, and contends a period of hospitalisation would be to his significant detriment, the advice of the assisting psychiatrists in relation to the need for inpatient assessment is highly persuasive.  There are significant differences between the various psychiatrists as to the Defendant’s mental condition.  His alleged behaviour was very disturbing, particularly as the time period of the alleged offence suggests it was very persistent. 

1. I am satisfied it is necessary, for the protection of the Defendant and the community, that the Defendant’s mental condition be properly assessed before any determination be made as to whether he is fit for trial.  That assessment can only properly be made in an inpatient setting.  Having regard to the uncertainty as to his mental condition, and the risks it may pose, I am satisfied it is not appropriate to grant any approved limited community treatment at this time.

Orders

1.   The application for leave to withdraw the reference is refused.

2.   There is a reasonable doubt the Defendant committed the alleged offence.

3.   The Defendant is temporarily unfit for trial.

4.   The Defendant be detained, pursuant to a forensic order, to the West Moreton Network Authorised Mental Health Service, with no approved limited community treatment.

5.   Copies of the reports, and of the transcript, be provided to the parties, to the treating team, to the Mental Health Review Tribunal, and to the Attorney General.