Re Soakai

[2016] QMHC 3

MENTAL HEALTH COURT

CITATION:

Re Soakai  [2016] QMHC 3

PARTIES:

REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF JOHN FAKATETE SOAKAI

FILE NO/S:

No 0297 of 2014
No 0297a of 2014

DELIVERED ON:

25 February 2016

DELIVERED AT:

Brisbane

HEARING DATE:

3 February 2016

JUDGE:

Boddice J

ASSISTING PSYCHIATRISTS:

Dr E N McVie
Dr J J Sundin

ORDERS:

1.   At the time of each of the alleged offences the subject of the reference and amended reference, the defendant was not of unsound mind as defined in the Schedule to the Mental Health Act 2000 (Qld).

2.   In respect of each of the alleged offences, the defendant is fit for trial.

3.   Each of the alleged offences is to proceed according to law.

4.   Copies of the reports and of the transcript are to be released to the parties in the criminal proceeding.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant committed various offences –  where defendant had schizophrenia – where defendant had a longstanding history of substance abuse – where defendant consumed amphetamines two to three days prior to the offences – where defendant consumed cannabis on the evening before the alleged offences – where defendant consumed alcohol and cannabis during the morning of the alleged offences – whether defendant was of unsound mind as defined in the Schedule of the Mental Health Act 2000 (Qld) at the time of the offences – whether intoxicating substances contributed to the defendant’s state of mind.

COUNSEL:

M B Lehane for the Director of Public Prosecutions
J Tate for the Director of Mental Health

J D Briggs for the Defendant

SOLICITORS:

Office of the Director of Public Prosecutions
Crown Law for the Director of Mental Health

Legal Aid Queensland for the Defendant

1. By reference, filed 25 November 2014, and amended reference, filed 19 January 2016, Legal Aid Queensland referred to this Court the mental condition of John Fakatete Soakai at the time of various offences allegedly committed between 16 July 2012 and 29 September 2014.  A schedule of the offences is attached to the references. 

2. It is accepted the defendant was not of unsound mind at the time of all of those alleged offences, except for alleged offences committed on 29 September 2014.  The issue in dispute in relation to the alleged offences on 29 September 2014 is whether intoxicating substances contributed, to any extent, to the defendant’s deprivation of the capacity to know he ought not do the acts in question.

   Background

3. The defendant was born on 8 August 1980.  He has a past diagnosis of schizophrenia.  It appears the defendant had limited insight into the existence of that condition or the need for treatment.  Accordingly, there had been issues with compliance with his treatment regime in the past. 

4. The defendant also has a longstanding history of substance abuse.  Relevantly, those substances include amphetamines, cannabis and alcohol. 

   Alleged offences

5. The complainant, in respect of the alleged offences on 29 September 2014, is the defendant’s father.  It is alleged sometime after 11.00 am on that date, the defendant stabbed his father in the neck area.  The defendant, who was arrested at the scene, told police he stabbed his father because he was no longer willing “to tolerate his shit”. 

6. The defendant gave a history of having consumed amphetamines in the days prior to the alleged offences.  He also consumed cannabis on the evening before and in the hours prior to the alleged offences on 29 September 2014.  He estimated his total cannabis use on those two occasions at one and a half grams.  He also consumed three pre-mixed vodka drinks in the hours prior to the alleged offences.  Those consumptions occurred against a background of regular, almost daily, use of cannabis and alcohol for weeks prior to those alleged offences.  He also was a regular user of amphetamines, although not on a daily basis.

   Reporting psychiatrists

7. Dr Kovacevic examined the defendant on 20 October 2014.  The defendant gave a history of having developed delusional thoughts in the months prior to the alleged offences on 29 September 2014.  These delusional thoughts crystallised some time shortly prior to those alleged offences into a delusional belief his father sexually molested the defendant’s daughter.  The defendant decided he had to do something about his father’s behaviour.  He obtained a knife, went to his parents’ premises and repeatedly stabbed his father. 

8. Dr Kovacevic noted the defendant had a confirmed diagnosis of paranoid schizophrenia, for which he had been receiving treatment.  His symptomatology involved paranoid ideation.  Dr Kovacevic also noted the defendant’s account of having used illicit substances in the lead up to those alleged offences.  However, police and court liaison officers who dealt with the defendant shortly after observed no indicia of intoxication. 

9. Dr Kovacevic opined the defendant was, at the time of the alleged offences on 29 September 2014, acutely psychiatrically unwell, experiencing a range of psychotic symptoms including paranoid delusions, thought disorder and perceptual abnormalities.  The available information strongly suggested the defendant was suffering from an acute exacerbation of his chronic paranoid schizophrenia.  In Dr Kovacevic’s opinion, as a consequence of that mental illness, the defendant was deprived of the capacity to understand the wrongfulness of his actions. 

10. In his initial report, Dr Kovacevic considered the question of intoxication.  He noted the extensive history of substance abuse might complicate the defendant’s access to a defence of unsound mind.  However, Dr Kovacevic opined the fact the defendant remained psychiatrically unwell despite treatment was suggestive of an extended duration of psychosis in the absence of substance abuse. 

11. Dr Kovacevic expanded on his opinion in respect of intoxication in an addendum report.  In his opinion, the defendant’s psychosis did not arise from the use of illicit substances, was not sustained by the use of illicit substances and was not exacerbated by the use of those substances.  The presence of those intoxicating substances was coincidental and did not contribute to any extent to the deprivation of the requisite capacity. 

12. Dr Kovacevic expanded on that opinion in evidence.  The defendant’s longstanding history of abuse of intoxicating substances suggested he had a significant tolerance for the effect of those substances, particularly cannabis and alcohol.  Trained professionals did not observe any indicia of intoxication shortly after the relevant alleged offences.  Whilst a blood test taken within some hours of the incident confirmed the defendant had consumed amphetamines, cannabis and alcohol, Dr Kovacevic did not consider those results to be suggestive of the defendant actually being intoxicated by those substances at the time of the relevant alleged offences.  Without objective evidence of the defendant having been intoxicated by those substances, Dr Kovacevic opined the defendant’s psychosis alone deprived him of the requisite capacity. 

13. Dr Voita provided a report dated 23 June 2015.  She had been involved in the defendant’s care following his arrest.  During the course of that treatment, the defendant continued to suffer delusional thoughts for some months after the relevant alleged offences.  In Dr Voita’s opinion, the defendant was suffering from an acute exacerbation of schizophrenia, paranoid type at the time of the alleged offences on 29 September 2014.  He was also abusing illicit substances on a regular basis at that time. 

14. Dr Voita opined, as a consequence of the defendant’s mental illness, the defendant was deprived of the capacity to reason with a moderate degree of sense and composure and therefore unable to appreciate the wrongfulness of his actions in respect of the alleged offences on 29 September 2014.  However, that deprivation of capacity was due to a combination of his mental disease and intoxication with cannabis, amphetamines and alcohol.  Whilst the defendant’s mental health had declined in the weeks leading up to those alleged offences, the defendant reported an increase in frequency and intensity of his delusions in the days prior to the incident when he was regularly abusing illicit substances.  The abuse of these substances contributed to the acute exacerbation of his psychotic illness and is likely to have exacerbated his paranoid delusions, including in respect of his father. 

15. In Dr Voita’s opinion, the defendant’s daily intake of cannabis and regular amphetamine use resulted in ongoing chronic intoxication, which sustained his persecutorial delusions and perceptual disturbances in the weeks and days before the alleged offences on 29 September 2014.  His use of alcohol would also have acted as a disinhibitor in relation to his actions on the day.  Whilst the defendant’s mental illness alone would have impaired his capacity to know he ought not do the act in question, it was insufficient to completely deprive him of that capacity.  Had it not been for the presence of intoxicating substances consumed in the lead up to the alleged offences, the defendant would not have been deprived of that capacity. 

16. Dr Voita expanded on her opinion in evidence.  She noted the defendant had a fairly longstanding psychiatric illness with a history of polysubstance abuse, significantly, amphetamines, alcohol and cannabis.  His use of all of those substances was significant in the lead up to the alleged offences on 29 September 2014.  Whilst the defendant had been having delusions about his father for a period of time, the presence of those intoxicating substances exacerbated his illness and contributed to the deprivation of the requisite capacity. 

17. Dr Voita accepted the defendant experienced delusional beliefs for some time and those delusional beliefs had continued for a period after the alleged offences.  However, his extensive history of substance abuse supported a consistent pattern that evidenced the contribution of the use of those illicit substances to an exacerbation of his mental illness.  It was likely the illness was exacerbated by his use of large amounts of amphetamines.  There was also a clear history of aggressive outbursts as a product of the use of those illicit substances. 

18. Dr Schramm examined the defendant pursuant to a Court Examination Order on 21 April 2015.  In his opinion, the defendant suffers from a persisting psychotic illness with features of referential and persecutorial delusional ideas.  This illness occurred in the context of significant and persistent polysubstance use featuring alcohol, cannabis and amphetamines.  The defendant presented as somewhat insightless into the existence of that illness.  Dr Schramm accepted the defendant was suffering from a schizophrenic illness at the time of the alleged offences on 29 September 2014 which deprived him of the capacity to know he ought not do the act in question.  However, Dr Schramm opined that deprivation was contributed to by the intoxicating effects of the illicit substances consumed by the defendant in the lead up to those alleged offences. 

19. Dr Schramm provided an addendum report dated 2 July 2015, in which he confirmed that earlier opinion.  Dr Schramm had at that time been given the opportunity to consider Dr Voita’s report.  Dr Schramm confirmed that opinion in evidence.  He conceded it was possible the mental disease alone may have been enough to deprive the defendant of the requisite capacity, but considered it more likely than not that intoxication, to some extent, contributed to the deprivation.  In expressing that opinion, Dr Schramm drew a distinction between intoxication imputing a person is extremely affected of the substance and the ingestion of an intoxicating substance that has a significant effect on a variety of mental functions. 

20. Dr Schramm noted the evidence established the defendant had been a regular user of amphetamines for some time prior to the alleged offences on 29 September 2014, having last used amphetamines two or three days beforehand.  He had been a regular user of cannabis, having used cannabis within hours of those alleged offences.  The defendant was also a heavy drinker and consumed alcohol that morning.  Laboratory investigations supported the use of these substances.  Against that background, Dr Schramm was satisfied it was more likely than not the presence of those intoxicating substances contributed to the deprivation of the requisite capacity. 

    Submissions

21. The defendant submits the Court would prefer the opinions expressed by Dr Kovacevic.  The defendant plainly held a delusional belief, at the time of the alleged offences on 29 September 2014, relevant to the victim.  It was more probable than not his deprivation of capacity was as a consequence of his mental illness alone. 

22. The Director of Public Prosecutions submits the Court would prefer the opinions expressed by Dr Voita and Dr Schramm.  They are consistent with the objective evidence and human experience.  The critical timing of the ingestion of intoxicating substances shortly before the alleged offences on 29 September 2014 supported a conclusion that those intoxicating substances contributed to an extent to the deprivation of the relevant capacity. 

    Assisting psychiatrists

23. Dr McVie advised the Court ought to accept the defendant has a longstanding, treatment resistant, paranoid schizophrenic illness.  One of the symptoms thereof was a variety of different types of delusions.  It was significant that even while in treatment the defendant retained some delusional beliefs and developed a depressive illness with delusions.  However, Dr McVie advised the defendant’s mental illness was significantly complicated by ongoing polysubstance abuse, namely alcohol, amphetamines and cannabis.  It was also complicated by his total lack of insight into the effects of his substance use on his illness and on his behaviour, and into the nature of his illness itself. 

24. Dr McVie advised the Court should accept the opinions of Dr Voita and Dr Schramm.  The objective evidence established the defendant used a variety of substances including alcohol, amphetamines and cannabis, within days of, and hours prior to, the alleged offences on 29 September 2014.  That use was supported by blood tests taken six hours after the event.  At the moment, the defendant made the decision to act on his delusions, his reasoning must have been, to an extent, affected by the combination of those substances, even though he may not have been in a state of what would be called clinical intoxication.  It is more likely than not the presence of those intoxicating substances contributed to the deprivation of the requisite capacity.  Dr McVie also advised the Court should accept the defendant is fit for trial.

25. Dr Sundin advised she entirely concurred with the advice of Dr McVie.  She advised the Court ought to accept the reasoning and evidence of Dr Voita and Dr Schramm. 

    Conclusions

26. There is no doubt the defendant suffers from a longstanding mental illness.  I accept that mental illness is properly diagnosed as a schizophrenic illness.  I also accept the defendant’s mental illness was characterised by delusional beliefs in the months leading up to the alleged offences on 29 September 2014.  One of those beliefs, at least in the days prior to those alleged offences, involved the victim. 

27. The objective evidence clearly supports a conclusion the defendant consumed amphetamines in the days prior to the alleged offences on 29 September 2014, and cannabis and alcohol in the hours prior to those alleged offences.  The blood tests support the presence of those substances.  The effects of those intoxicating substances on the defendant’s mental illness was supported by a consideration of the history of his mental illness. 

28. I accept that as a consequence of his mental illness, the defendant was, at the time of the alleged offences on 29 September 2014, deprived of the capacity to know he ought not do the act in question.  However, I do not accept that deprivation was solely as a consequence of the defendant’s mental illness.  I am satisfied the presence of intoxicating substances contributed to an extent to the deprivation of that capacity. 

29. In coming to that conclusion, I have had particular regard to the evidence of Dr Voita.  Her explanation as to the significance of the defendant’s longstanding substance abuse, particularly of amphetamines, cannabis and alcohol, to the exacerbation of the defendant’s mental illness was compelling and highly persuasive.  I accept that opinion.  In reaching that conclusion, I note Dr Voita’s opinion was supported by Dr Schramm.  I also accept his opinion.

30. By contrast, I did not find Dr Kovacevic’s evidence persuasive.  His attempts to minimise the effect of the presence of the intoxicating substances amphetamines, cannabis and alcohol defied common sense.  His reasoning was also illogical.  In Dr Kovacevic’s opinion, unless there was evidence of a person being clinically intoxicated, such as evidence of slurring or other relevant indicia, the presence of intoxicating substances is of no relevance to the question of deprivation of capacity.  That opinion disregards completely the effects of intoxicating substances on a person’s mental capacity and, in particular, the combined effect of multiple intoxicating substances.  I do not accept Dr Kovacevic’s opinion.

31. While the defendant was suffering from a mental illness at the time of the alleged offence on 29 September 2014, and was deprived of the capacity to know he ought not do the act in question, the deprivation of that relevant capacity was contributed to by intoxicating substances, namely amphetamines, cannabis and alcohol.  The defendant is not entitled to a defence of unsound mind. 

32. It is accepted the defendant is not entitled to a defence of unsound mind in respect of each of the remaining alleged offences the subject of the reference and amended reference.  It is also accepted the most recent reports supports a finding the defendant is currently fit for trial.  I am satisfied the defendant is fit for trial. 

    Orders

    1.   At the time of each of the alleged offences the subject of the reference and amended reference, the defendant was not of unsound mind as defined in the Schedule to the Mental Health Act 2000 (Qld).

    2.   In respect of each of the alleged offences, the defendant is fit for trial.

    3.   Each of the alleged offences is to proceed according to law.

    4.   Copies of the reports and of the transcript are to be released to the parties in the criminal proceeding.