Re SC

[2004] QMHC 1

SUPREME COURT OF QUEENSLAND

CITATION:

Re SC [2004] QMHC 001

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF SC

PROCEEDING NO:

0084 of 2003

DELIVERED ON:

11 March 2004

DELIVERED AT:

Brisbane

HEARING DATES:

11 March 2004

JUDGE:

Wilson J

ASSISTING PSYCHIATRISTS:

DR J M Lawrence
Dr J F Wood

FINDINGS AND ORDERS

1.    That at the time the alleged offence was committed, the defendant was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000 (Qld)

2.    Order that the defendant be detained as a forensic patient at Townsville District and Area Network Authorised Mental Health Service for involuntary treatment and care;

3.    Approval of limited community treatment in the nature of more than overnight leave at the discretion of the authorised psychiatrist on the following conditions:

a)   That the defendant reside at [address] or such other place as is approved in advance in writing by the authorised psychiatrist;

That he attend all follow-up appointments and in-patient care as authorised by the authorised psychiatrist;b)    

That he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment;c)   

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;d)    

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

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where the defendant is charged with unlawful wounding – whether defendant of unsound mind at the time the alleged offence occurred – where the defendant suffers from chronic paranoid schizophrenia – where defendant had delusions of persecution and manipulation – whether defendant deprived of one or more of the capacities in section 27 of the Criminal Code – where conflicting expert psychiatric opinions given

Criminal Code (Qld), s 27
Mental Health Act 2000 (Qld), Schedule 2

COUNSEL:

Mr. D Shepherd for the defendant
Mr J Tate for the Director of Mental Health
Mr P Rutledge 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:  SC [“the defendant”] has been charged with unlawful wounding on 19 June 2002. 

1. The defendant was born on 29 March 1958. He suffers from chronic paranoid schizophrenia and has done so for many years. The issue before the Court is whether he was deprived by that mental illness of one or more of the capacities in section 27 of the Criminal Code - that is, the capacity to know what he was doing, the capacity to know he ought not do the act, the capacity to control his actions.

1. When the matter commenced today the Court had written opinions from three psychiatrists, Dr Vorster, Professor James and Dr Allan.  Dr Vorster considered that he was deprived of the capacity of control.  Professor James considered that the capacities to know he ought not do the act and to control his actions were very substantially impaired but nevertheless not completely absent.  Dr Allan considered that he was deprived of the capacity to know he ought not do the act and of the capacity of control. 

1. The Court heard oral evidence from Professor James and Dr Allan.  At the conclusion of the evidence, counsel for the Director of Public Prosecutions conceded that there was evidence of unsoundness of mind on the basis of a deprivation of the capacity to know he ought not do the act.  I should recount the background.

1. The offence occurred in a hostel in Mt Isa where the defendant and the complainant were temporarily resident.  The complainant was asleep.  He awoke to find the defendant on top of him brandishing a knife.  The defendant stabbed him in the right upper arm area.

1. At the time the defendant was living an itinerant lifestyle.  About a month before the alleged offence he attempted suicide in Broome in Western Australia, apparently in response to voices.  After about a week in hospital he hitch-hiked to Mt Isa and then spent about a week in a boarding house which, I think, was the same hostel where the alleged offence occurred. 

1. Two days before the offence and over the two days leading up to the offence, he presented a number of times at the Mt Isa Hospital apparently deluded that a worker was accusing him of being a rapist and seeking information about being released.  He seemed to be trying to have assessment for schizophrenia and of the need for treatment.

1. It is as well to recall that at least in 1996 he was shown to have an elaborate systematised delusional system centred on an apparently non-existent doctor who was persecuting him by manipulating his thoughts and putting drugs in his food.  This was, in his delusional system, an aspect of "therapy".  The apparently non-existent doctor was, according to the delusional system, acting as an agent of an aunt of the defendant. 

1. By 2002 when the offence presently before the Court occurred the defendant had been off medication for about a year and a half.  He was suffering delusions of persecution.  He thought the complainant was publicly making allegations that he owed the complainant and his family money.  He thought that the complainant would become his carer and somehow get the money back.  He had delusions of being manipulated by "therapy"

1. He also suffered command hallucinations, but he apparently did the opposite to what the voices told him to do because he believed the voices had made him attempt suicide in Western Australia.  In an interview with police conducted shortly after the offence there is evidence of persecutory delusions, of a wish to retaliate, of passivity phenomena.  It is clear that at that stage he was influenced by his delusional beliefs.

1. As I have said, Professor James and Dr Allan took differing views of whether there was a deprivation or a mere impairment of two of the capacities.  I shall direct my attention to the capacity to know he ought not do the act. 

1. According to Professor James' opinion, there was considerable internal moral argument.  The defendant was aware of the likely consequences of doing the act, namely that he would go to prison.  He was subject to certain moderating influences such as the voices, but he nevertheless decided to proceed.  This was indicative in Professor James' opinion of an impairment rather than a deprivation of capacity.

1. In Dr Allan's opinion the defendant's conduct and his mental processes on that night were indicative of ambivalence.  He was ambivalent about the role of the "therapy".  On the one hand he wanted to rid himself of it.  On the other hand it was part of the “therapy” to do the act.  In weighing up whether or not to do the act there was also ambivalence.  There were contradictory ideas - he should/should not do the act -sometimes present at the same time.  As I understood Dr Allan's evidence this was indicative of a psychotic ambivalence.  The decision to go ahead and do the act was contrary to the moderating voices and the decision was itself based on delusional material. 

1. The capacity to know that one ought not do an act has been described in the cases as a capacity to reason with a moderate degree of composure as to the moral rightness or wrongness of the act.  It is not coterminous with knowing that an act is unlawful.  So the focus is on the quality of the reasoning process.

1. Here I am quite satisfied that the process was delusional and I am persuaded by Dr Allan's evidence that the defendant was actually deprived of the capacity to know that he ought not do the act.

1. Accordingly I am satisfied that at the relevant time he was of unsound mind as described in Schedule 2 of the Mental Health Act 2000.

1. The consensus of medical opinion is that he requires ongoing management, but that provided he complies with treatment he will not be a source of danger to the community.

1. It is appropriate in these circumstances, having regard to the seriousness of the offence, his treatment needs and the protection of the community, that a forensic order be made.  Therefore I order that he be detained as a forensic patient in the Townsville District and Area Network Authorised Mental Health Service for involuntary treatment and care. 

1. I approve limited community treatment in the nature of more than overnight limited community treatment to commence immediately on the following conditions:

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

2.      That he attend all follow-up appointments and in-patient care as authorised 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.