Re SKM

[2010] QMHC 20

MENTAL HEALTH COURT

CITATION:

Re SKM [2010] QMHC 020

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF SKM

PROCEEDING:

No 227 of 2009

DELIVERED ON:

10 September 2010

DELIVERED AT:

Brisbane

HEARING DATE:

10 September 2010

JUDGE:

Philippides J

ASSISTING PSYCHIATRISTS:

Dr F T Varghese
Dr E N McVie

FINDINGS AND ORDER:

1. That the defendant was of unsound mind at the relevant times as described in Schedule 2 of the Mental Health Act 2000 (Qld);

2.   That the defendant be detained as a forensic patient at The Cairns Authorised Mental Health Service;

Approval of limited community treatment to commence immediately, at the discretion of the treating psychiatrist, on the conditions contained in the submission from the Director of Mental Health.3.   

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with three counts of wilful damage, one count of wilful damage of police property, one count of obstruct police, one count of unlawfully entering a yard or dwelling – where defendant has history of illicit drug use – where expert psychiatric opinion was that defendant suffered from a psychotic illness and was deprived of at least one of the relevant capacities – where expert opinion differed as to whether drug induced intoxication was a factor at the relevant time – whether defendant was of unsound mind at the relevant times as described in Schedule 2 of the Mental Health Act 2000 (Qld) – whether a forensic order should be made

Mental Health Act 2000 (Qld), Schedule 2

COUNSEL:

J Briggs for the Defendant
J Tate for the Director of Mental Health

A Lossberg for the Director of Public Prosecutions (Qld)

SOLICITORS:

Legal Aid Queensland for the Defendant
Crown Law for the Director of Mental Health
The Director of Public Prosecutions (Qld)

PHILIPPIDES J:

1. The defendant is charged with the following offences: three counts of wilful damage, one count of wilful damage of police property, one count of obstruct police, and one count of unlawfully entering a yard or a dwelling, all on 8 November 2008.

1. The evidence indicates that at the relevant time the defendant was psychotic and deprived of capacity, but an issue is raised as to the role of intoxication on her state of mind.

1. The defendant has a history of obtaining counselling at the age of 15 in the context of interpersonal conflict and self-harm.  She also experienced seizures at age 15.  She also has a history of cannabis use commencing at age 16 and the evidence indicates that she was a regular user of cannabis.  By the age of 19 she had had two children. She did not come into contact with Mental Health Services until 2008.  She did so in the context of a relationship break-up in March 2008.  She attended her GP in mid-2008 and was diagnosed as possibly suffering from post-natal depression and prescribed anti-depressant medication which she took for a short period, but ceased taking because of side effects.  I note the evidence indicates that in the month before the events in question the defendant had been depressed and crying a lot and had lost a considerable amount of weight, up to ten kilos.  There was a report to Dr Heffernan by the defendant of LSD use on 5 October 2008 and also a week later.  I note that the hospital records have differing accounts of drug use and in particular, LSD use in the period preceding the events in question. 

1. I note that on 17 October 2008 the defendant was diagnosed provisionally with severe depressive episode and possibly personality disorder.  Thereafter, Dr Trivitt noted possible delusions and, additionally, various possible diagnosis, including drug-induced psychosis and adjustment disorder.  The defendant was prescribed Risperidone.

1. There was also a report by the defendant’s mother of the defendant suffering a seizure on 5 November 2008 in the context of being non-compliant.  On the day following the events in question, the defendant was assessed at the Cairns Hospital with possible drug-induced psychosis, but I also note that the hospital records refer to a diagnosis of possible Schizophreniform illness.  She remained an in-patient for two weeks, being discharged on the 24th of November 2008.

1. As mentioned, the clinical material before the Court is united in opining that the defendant was, at the relevant time, suffering from a psychotic illness and deprived of at least one of the relevant capacities.  Dr Heffernan saw the most likely diagnosis as one of drug-induced psychosis, but he did not rule out entirely the other diagnoses that had been made in the past. 

1. In relation to the issue of intoxication, he clarified the opinion provided in his report by making the following observations.  He noted a history of cannabis use, but discounted cannabis intoxication as being operative at the relevant time, although he did not rule it out, in terms of historical relevance, to the diagnosis of drug-induced psychosis.  Nevertheless, he did not see cannabis intoxication as operative on the defendant's state of mind, resulting in deprivation at the relevant time, rather he saw the matter, clinically, as there being an existing psychotic process.  I note that view is supported by Dr McVie and that Dr Varghese, whilst holding a different view, particularly in relation to LSD, did not rule out that clinical position, although he considered that the picture in relation to drug use was somewhat clouded and was not able to advise that drug intoxication was not a factor.

1. As to the issue of LSD, Dr Heffernan saw LSD use as being one of the factors that could be seen as playing a role in the genesis of the defendant's psychosis, that is, in terms of being a precipitant and having a historical relevance to the development of the defendant's psychosis.  He did not see it as having any temporal effect on the defendant's state of mind.  It is clear from his evidence, that he gave very careful consideration to the relevance of LSD but ruled out any temporal effect of that drug on the defendant's state of mind at the relevant time.

1. On the basis of the evidence of Dr Heffernan in particular, I find that the defendant was of unsound mind at the time of the alleged offences. 

1. I note that it was submitted that a forensic order is not warranted in the circumstances of this case, but I have some concern about that submission, given her complicated history and bearing in mind her quite fragile mental state, even as of today, as was apparent in the video link-up.

1. In those circumstances, I consider that a forensic order is warranted, bearing in mind that the charged offences involved violence, that the defendant required treatment and psychiatric overview and that she is subject to a number of stressors which appear to be ongoing. 

1. I order that the defendant be detained to the Cairns Authorised Mental Health Service.  I approve limited community treatment to commence immediately, at the discretion of the treating psychiatrist, on the conditions contained in the draft submission from the Director of Mental Health which includes a residency requirement, a requirement that the defendant attend Dr Lyder on 21 September 201 at 4.30 for follow-up appointments.  I note also that there is a requirement that she abstain from alcohol and drug use and that she participate in medical tests for those substances to be performed randomly.