Re Tith

[2012] QMHC 2

MENTAL HEALTH COURT

CITATION:	Re Tith [2012] QMHC 2
PARTIES:	REFERENCE BY THE LEGAL REPRESENTATIVES  IN RESPECT OF VEASNA TITH
PROCEEDING NO:	0066/11
DELIVERED ON:	Ex tempore reasons – 31 January 2012. Written reasons – 7 February 2012.
DELIVERED AT:	Brisbane
HEARING DATE:	31 January 2012
JUDGE:	Ann Lyons J
ASSISTING PSYCHIATRISTS:	Dr E N McVie Dr F Varghese
FINDINGS AND ORDERS:	That at the time of the alleged offence the defendant was of unsound mind as described in the Schedule to the Mental Health Act 2000 (Qld); That the defendant be detained, pursuant to a forensic order, to The Park High Security Program Authorised Mental Health Service; That limited community treatment is approved at the discretion of the authorised psychiatrist, on the conditions set out in the submission of the Director of Mental Health
COUNSEL:	J Briggs for the defendant J Tate for the Director of Mental Health A Lossberg for the Director of Public Prosecutions
SOLICITORS:	Legal Aid Queensland for the defendant Crown Law for the Director of Mental Health Office of the Director of Public Prosecutions (Qld)

A LYONS J:

1. This is a reference by the legal representatives for Mr Veasna Tith dated 16 March 2011. Mr Tith is currently 27 years of age. On 31 January I delivered short ex tempore oral reasons and indicated that, given the serious nature of the charges, I would give more extensive written reasons at a later date. These are my written reasons. 

1. Mr Tith is charged with attempted murder, entering a dwelling with intent, wounding and grievous bodily harm, all of which occurred on 11 December 2010.

Circumstances of the Offence

1. The circumstances of the offences are that Mr Tith went to the front door of the next door neighbour’s home armed with two samurai swords. He kicked in the door and entered the dwelling. He went upstairs and attacked a young 20-year-old man with the two swords. The victim saw Mr Tith walking up the internal stairs of the house carrying the swords. Mr Tith asked the victim if “he was ready” and then said “I want your life”.

1. Mr Tith then attacked Mr Richards with the swords, striking him on the arm. He then said words to the effect that he wanted to kill him. He pointed the sword at him and also told him to call police. He followed him with the sword pointed at him and kept yelling at him to call the police. When the victim called the police Mr Tith stabbed him twice with the sword. The victim managed to stagger out of the house where he collapsed but received assistance from passers-by. He was later conveyed to hospital and was operated on for life threatening wounds to his stomach. He suffered lacerations to his stomach, chest and wrist and was hospitalised for several weeks. The victim impact statements of the victim and his mother indicate the truly terrifying nature of the attack on the young victim and the long term residual affects on both him and his family.

1. Mr Tith then fled the scene carrying the two swords and forced his sister to drive him to a house at Wooloowin where he entered that house also carrying the swords. At that scene there was a brief standoff with police and he was arrested.

1. There are a number of psychiatric reports in relation to Mr Tith’s mental health by Dr Michael Beech, Dr Pamela van de Hoef and Dr Ian Coyle. At the hearing of the reference Dr van de Hoef and Dr Beech also gave oral evidence.

Dr Beech’s Report dated 22 October 2011

1. Dr Beech, in his report dated 22 October 2011 and in his oral evidence, outlined Mr Tith’s deteriorating mental health. He stated that he had a history of depression in primary school in the context of family stress and at the age of 25 years he started hearing voices and believed that people he was working with were talking about him. He was eventually seen at Mental Health Services as an outpatient and received treatment including risperidone injections. He continued on that medication for two years but ceased treatment as he felt well.

1. It would appear there were no problems until May 2010 when the voices returned. Mr Tith told Dr Beech that there were three particular voices he could recall:  one was the devil’s voice, the second was the neighbour’s voice and the third was a girl’s voice. Initially they said pleasant things to him but they then changed and began to tell him the world was going to end; that people were going to change into monsters and that he needed to get ready to protect himself. He also developed a belief that people were spying on him and tapping his phones. He also developed a belief that demons had taken over the world. As the year progressed he thought people were against him. He also thought there were demons outside the house. He became withdrawn because of this.

1. Dr Beech indicated that by the time of the incident Mr Tith said he developed a thought that the neighbours were deliberately annoying him by eating him spiritually. In the months leading up to the incident his sleep had declined and by the time of the incident he had not slept for four days. He said his thinking had become jumbled and the voices confused him. He also heard his deceased father’s voice telling him to make the world right. His father had died when he was eight. The voices told him that he had to kill the neighbour. Mr Tith said that he refused to do this because he knew it was wrong. However, he eventually decided that he had to go ahead and do what the voices said. He said at the time he was confused about what he was doing.

1. Mr Tith told Dr Beech he had purchased the samurai swords three months earlier for protection and that he slept with the swords every night. On the day of the incident he decided he would wound the victim with the sword. He cannot recall what he said to the victim but he did recall telling him to call the police. While the victim was calling the police Mr Tith said that he thought about killing him but felt confused and instead stabbed him twice.

1. Since his arrest Mr Tith has had treatment with risperidone injections and after three or four months his condition improved. His thoughts became clearer and the voices disappeared.  Dr Beech confirmed that the Mental Health Services CIMHA database indicates that Mr Tith had contact with Mental Health Services in 2010 but the last contact was in May 2010. He noted that a provisional diagnosis of paranoid schizophrenia had been given. He stated that that file suggested a prodromal period of four years with a complex delusional system relating to his former workplace and childhood upbringing. 

1. Dr Beech concluded that Mr Tith showed a history of preceding schizophrenia which had required treatment with antipsychotic medication. Prior to the incident he had ceased medication for some time and that his account indicated a development of a psychotic relapse over months leading up to the incident with auditory hallucinations and persecutory delusions. This was accompanied by a sense of mental confusion. Dr Beech confirmed that the collateral information documents his decline.

1. Dr Beech also concluded that when seen after the accident he was perplexed and psychotic with thought disorder, incongruent effect and paranoid beliefs. Dr Beech concluded that Mr Tith’s account, whilst it varies in amount and detail to various reports, does give a reasonably consistent account outlining the development of delusional beliefs about his neighbour on which he felt compelled to act.

1. Dr Beech concluded that at the time of the attack Mr Tith was suffering from the mental illness paranoid schizophrenia and was deprived of the capacity to understand the wrongfulness of his actions with any moderate degree of sense.

Dr Coyle

1. Dr Coyle in his report (erroneously dated 11 August 2010) indicated that he interviewed Mr Tith on 17 December 2010. Dr Coyle notes that Mr Tith gave him a history of drug use two years prior to the offence. He denied using any drug on the day in question with the possible exception of some cannabis and whilst he could not remember if he had used cannabis he considered he might have smoked four joints in the morning or the afternoon.

1. Mr Tith also gave Dr Coyle a history of previous contact with the Mental Health Services and gave a history of numerous persecutory themes, particularly in relation to his next door neighbour.

1. Dr Coyle saw Mr Tith six days after the alleged offences were committed. At that time Dr Coyle considered that Mr Tith was not oriented as to place and time and that he did not know what day or month it was; he did not know when Christmas was and he thought he had been in the correctional centre for over a week when he was being seen. However he had only been there two or three days, having been transferred from the Brisbane Watch House the previous day. Whilst he had been in the watch house for three days, he thought he had only been there for one. He did not know why he was in the correctional centre, but considered it might have been related to the next door neighbour’s stabbing. He could not recall seeing any doctors in the Brisbane Watch House and indicated that he liked being in jail.

1. Mr Tith told Dr Coyle that he felt comfortable in jail and enjoyed not having to put up with loud music from the neighbours. He told Dr Coyle he had been watching violent movies and playing video games for days. Whilst watching the music channel he found it had too much colour and was angry and confused about the bad music being played which made him angry. He believed his next door neighbour had something to do with this. He was also convinced that messages were being delivered to him via the television and radio. He also stated that he heard voices all of the time unless he was playing video games which kept them under control.

1. When Dr Coyle asked him why he stabbed the next door neighbour he said that the voices told him to do it. The voices were described as male and female. The male voice told him to “stab the guy, respect yourself, everyone else is lying”. When asked by Dr Coyle what he was thinking when he stabbed his neighbour Mr Tith stated he thought the neighbour did not want to be stabbed but then said he did want to be stabbed because ‘he was smiling when I stabbed him’.

1. Dr Coyle considered that Mr Tith was grossly psychotic at the time he saw him, six days after the alleged offences, despite taking risperidone. He considers that Mr Tith was suffering from paranoid schizophrenia with some elements which were characteristic of disorganised type, particularly his inappropriate affect. Dr Coyle considered that Mr Tith’s actions were not voluntary as they were a direct consequence of his mental illness.

Dr van de Hoef

1. Dr Pamela van de Hoef, in a report dated 14 July 2011 and in her oral evidence stated that the account given to her by Mr Tith, as well as his presentation after he was remanded and his current mental state, indicates that he was a floridly psychotic man, deluded, paranoid and terrified, who responded to command hallucinations to kill and he did indeed threaten to kill and then in panic fled while still overwhelmed by numerous psychotic experiences.

1. Dr van de Hoef noted that a urine drug screen collected on 20 December 2010, some 9 days after the alleged offences, was negative. Dr van de Hoef also noted Mr Tith’s history of auditory hallucinations which were first experienced in 2007/2008 and a history of depression as a child. She also noted an overnight stay in the emergency department of the Princess Alexandra Hospital in 2008 when he had suicidal ideation. Dr van de Hoef further noted that the Princess Alexandra Hospital records described a complex delusional system involving his upbringing and a work place as well as delusions of reference. She stated that Mr Tith had attended the Mt Gravatt Mental Health Clinic as a voluntary patient and had been prescribed risperidone for a diagnosis of paranoid schizophrenia or schizo effective disorder with a psychotic prodrome of four years.

1. Dr van de Hoef indicated that he had ceased medication about a year before his arrest. Dr van de Hoef noted that Dr Aboud assessed him in the Arthur Gorrie Correctional Centre as being acutely psychotic on 16 December 2010, five days after the alleged offences. He also commenced him on risperidone at that time. Dr Coyle also thought he was floridly psychotic when he interviewed him on 17 December 2010.

1. Dr van de Hoef concluded that Mr Tith suffers from severe chronic paranoid schizophrenia which probably had its onset around 2005/2006 and clearly became worse in the last months of 2010, particularly in the seven months after ceasing anti-psychotics and even worse in the five weeks prior to the offences.

1. Dr van de Hoef considered that his illness was characterised by thought disorder, delusional thinking, auditory hallucinations, as well as hallucinations in other sensory modalities. In particular the delusional thinking incorporated his neighbour, the victim, and the auditory hallucinations included command hallucinations to kill. He also experienced delusions of reference, mood disturbance, insightlessness and non compliance with treatment when unwell.

1. Dr van de Hoef noted he has responded significantly to the reinstatement of antipsychotic medication and has voluntarily complied with the medication although she considers he still has residual psychotic symptoms.

1. Dr van de Hoef stated that she considers Mr Tith was clearly suffering from a mental disease, namely severe paranoid schizophrenia, which had been untreated for seven months at the time of the alleged offences and, that for at least four to five weeks beforehand, he had been floridly psychotic with delusions about the victim and he responded to intense command auditory hallucinations to kill him, perhaps to prevent the end of the world. He had procured knives for protection and had purchased two samurai swords. He exhorted the victim to call the police even as he stabbed to prevent more violence on his part. Whilst he knew his actions would get him into trouble he was also trying to flee and resist commands to kill his family.

1. Dr van de Hoef considered he remained floridly psychotic for some time and still has residual symptoms.

1. Dr van de Hoef stated that she would support a defence of unsoundness of mind as she considers he was deprived by his severe, untreated mental illness of the capacity to know he ought not do the act.

The advice of the assisting psychiatrists

1. Both Dr McVie and Dr Varghese considered that Mr Tith was suffering from a severe mental illness at the time of the commission of the alleged offences. The assisting psychiatrists also supported a defence of unsoundness of mind and considered that he was deprived of the capacity to know he ought not do the act.

1. Dr McVie advised that the clear opinions of Dr Beech and Dr Van de Hoef should be accepted that at the time of the offense Mr Tith was so severely affected by his paranoid schizophrenic illness that he had lost contact with reality and was acting on his delusions and hallucinations. She considered that he was therefore unable to reason with any sense of composure and was clearly deprived of the capacity to know that he

ought not do the act.

1. Dr Varghese advised that Mr Tith was suffering from schizophrenic and at the time of the offence was in a state of florid psychosis such as to deprive him of at least two of the capacities, namely the capacity for control and the capacity for knowing the wrongfulness of the Act. He considered that Mr Tith therefore qualified for the defence of unsoundness of mind. 

1. On the basis of the evidence of the reporting psychiatrists, as well as the advice of the assisting psychiatrists, I am satisfied that Mr Tith was suffering from a mental illness at the time of the commission of the alleged offences, namely severe, chronic paranoid schizophrenia. He had clearly been suffering form this illness for some time. He was clearly grossly psychotic at the time of the offences and was overwhelmed by his psychotic thoughts. I note in particular that when Dr van de Hoef saw Mr Tith seven months later he still had clear signs of psychosis.

1. I am satisfied that he was of unsound mind at the time of the commission of the offences and was incapable of knowing that he ought not do the act.  

Is a forensic order required?

1. In terms of whether a forensic order is required, Dr van de Hoef considers he needs lifelong treatment with anti-psychotic medication, psychosocial rehabilitation and ongoing monitoring of his treatment and compliance. She considers that a forensic order is clearly required, given the severity of his illness, the seriousness of the offence and the risk he poses to others particularly given his non-compliance with treatment in the past.

1. Dr Beech also considers that a forensic order is required, given the nature of his illness and his past history of falling out of treatment and follow up, as well as the nature of the alleged offences. Dr Beech noted that Mr Tith’s condition has responded to treatment although there are some residual symptoms.

1. Dr Mc Vie stated that a forensic order is clearly indicated in this case due to the nature of the serious violent offence and the historical risk factors of non-compliance with treatment, drug abuse and the fact there had been at least one incident of prior violence.

1. Dr Varghese also supported the making of a forensic order which contained a non-contact order.

1. There is no doubt that Mr Tith is charged with very serious offences and that Mr Tith’s actions were deeply traumatic to the victim and his family. A forensic order is clearly required given the seriousness of the offences together with the fact that Mr Tith has a severe illness for which there are still residual symptoms.  It is also clear that Mr Tith has limited insight into the true nature of his illness and that he has fallen out of treatment in the past.

Should Limited Community Treatment (“LCT”) be approved?

1. Counsel for the Attorney General also sought orders that a non-contact condition be added to the forensic order as well as a condition that Mr Tith should be forbidden from entering the suburb of Kuraby given that Mr Tith’s family still reside next door to the victim and his family. 

1. As to whether there should be LCT Dr Beech considered that the transfer to The Park could be quite unsettling for Mr Tith. He therefore considered that the only LCT Mr Tith should have currently should be quite restricted and that it should be within hospital grounds only with two escorts. Dr Beech also queried whether the LCT in fact should be limited to the perimeter of the high secure facility. 

1. In relation to the escorted LCT, Dr McVie stated that such escorted leave refers to leave outside the boundaries of the High Secure complex and is usually walking around the old Park buildings to The Park canteen and library. Dr McVie shared Dr Beech's concerns about escorted leave and stated that in the first instance escorted leave would not be indicated and that if escorted leave was granted her advice was that the condition should require that at least two mental health staff accompany him on leave.

1. Dr McVie noted the victim's statements outlining the effects of this horrific experience on him and his mother and indicated that she would support the addition of a non-contact clause in the forensic order.

1. In terms of a condition forbidding entry into the suburb of Kuraby, Dr McVie considered that that issue would be better dealt with by the Mental Health Review Tribunal (“MHRT”) at a later date and stated that it is certainly an issue that has been clearly identified in the statements provided by the victims.

1. Dr Varghese advised that the question of limited community treatment and leave in particular is best assessed once Mr Tith has been in the High Secure unit and developed a therapeutical relationship with the treating team there.  He considered that it was difficult to assess this question of leave in the High Security setting of prison. Dr Varghese advised that the issue of leave is best assessed by the Tribunal.

1. Neither Dr McVie nor Dr Varghese would recommend escorted leave at this point in time. I note, however, that pursuant to the requirements of s 289 a non-contact condition can only be made if limited community treatment is actually approved. I consider that LCT should be approved but that such leave should be progressed only as considered appropriate by the treating psychiatrist who will be aware of the concerns of Dr Beech and the assisting psychiatrists. I consider that such leave should be limited to escorted leave only to the grounds of the hospital with two escorts.

1. I also consider that the forensic order should contain a non-contact condition which forbids Mr Tith initiating any contact with the victim or his family. 

1. Whilst I note the trauma of the victim and his family in this regard I consider that a condition forbidding Mr Tith’s entry into the suburb of Kuraby is a condition which is more appropriately considered by the MHRT when they review Mr Tith’s LCT conditions.  At this stage Mr Tith has very restricted LCT which is limited to the grounds of the hospital with two escorts.  A condition such as that sought by Counsel for the Attorney-General is premature at this stage and should be dealt with by the MHRT in the future when further LCT is considered.  By the time that occurs circumstances may have changed considerably and indeed there is always a possibility that one of the families may decide to relocate.

1. I also note Dr McVie’s concerns that this case represents “another example of what I'm seeing increasingly of incidents referred to the Court which have a history of patients and relatives having difficulty in accessing mental health services......I would hope that the Director of Mental Health has thoroughly investigated this issue in this case as it did lead to a significant incident of extreme violence.”

1. I also would like to commend the Court Liaison Services who identified at a very early stage of the proceedings that Mr Tith was a person whose mental health was of concern. It is also clear that Mr Tith was assessed very quickly by the Prison Mental Health Service and he was seen by a psychiatrist within days. Those approaches have meant that this Court has been able to access a great deal of collateral and contemporaneous material which is of great assistance to the reporting psychiatrists and the assisting psychiatrists and this Court.  

1. There should otherwise be orders in term of the submission of the Director of Mental Health.