Re Vale

[2009] QMHC 15

MENTAL HEALTH COURT

CITATION:

Re Vale [2009] QMHC 15

PARTIES:

REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF MAXWELL GEORGE VALE

PROCEEDING NO:

No 0054 of 2009

DELIVERED ON:

9 September 2009

DELIVERED AT:

Brisbane

HEARING DATES:

9 September 2009

JUDGE:

Ann Lyons J

ASSISTING PSYCHIATRISTS:

Dr J M Lawrence
Dr E N McVie

FINDINGS AND ORDERS

1.   That at the time of the alleged offences on 5 May 2008 the subject of the references the defendant was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000 (Qld);

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

Approval of limited community treatment to the Redcliffe Caboolture Authorised Mental Health Service at the discretion of the authorised psychiatrist, on the conditions set out in the draft order.

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant was charged with attempted murder – whether the defendant was of unsound mind at the time of the offence

COUNSEL:

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

Ms D Holliday for the Director of Public Prosecutions

SOLICITORS:

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

ANN LYONS J:

1. This is a reference by the legal representatives for Mr Maxwell Vale.  Mr Vale is charged with attempted murder on 5 May 2008.

1. The circumstances would seem to be that Mr Vale was in a nursing home with a frail 66 year old man who had dementia.  At about 1.50 in the morning a nurse heard a noise, entered a room, and saw Mr Vale forcefully holding a pillow over the head of the victim saying, “You’re on the side of the Krauts and Germans.”  She wrestled with Mr Vale and Mr Vale took the torch and twice violently hit down on the victim’s face with the torch. 

1. Now, it is quite clear from the material in evidence that Mr Vale was in the nursing home at the time of this offence suffering from a number of conditions.  It is clear that he had been there for some time.  There were obviously a number of medical conditions already operating and he was on a considerable dose of Benzodiazepines at the time.

1. It is also clear from the evidence that there had been a fall some weeks earlier which was serious and on discharge from hospital there were demonstrable abnormalities that were noted.  In particular there was a resolving frontal lobe haematoma.

1. It is also clear that Mr Vale’s behaviour was disordered in the nursing home, in fact, had indicated a behaviour plan because of his disordered behaviour.  So it is against that background that this offence occurred.

1. The reports of the psychiatrists are as follows.  Dr Voita considers that in her opinion at the time of the alleged offence Mr Vale was suffering from a mental disease or natural mental infirmity, specifically a delirium due to multiple aetiologies including substance intoxications, including opioids and Benzodiazepines, and a general medical condition which was the frontal lobe haematoma.  She also indicated there was a history of underlying chronic cognitive defects due to alcohol abuse. 

1. Her opinion was that Mr Vale was not deprived of the capacity to understand the nature of the act or the capacity of control, but of the capacity to know he ought not do the act.  In her opinion Mr Vale, at the time of the offence, was experiencing auditory and visual hallucinations and delusional ideas which were consistent with psychotic symptoms secondary to organic pathology, that is a delirium and frontal lobe impairment.  Dr Voita had also noted the surgery and the fall in April as well as his deteriorating behaviour in the nursing home.

1. Dr Fama in his report indicates a diagnosis under the ICD10 of alcohol dependency syndrome which was currently largely abstinent as well as polymorphic psychotic disorder resulting from an overdose of Benzodiazepines and Risperidone.  Dr Fama agreed with Dr Voita that Mr Vale’s disorder arose out of both the drug overdose and an underlying brain condition namely frontal lobe injury from trauma.  He considered that the nature of the clinical features indicate that it transcended ordinary intoxication and that it persisted in custody at least until the date of Mr Vale’s interview with Dr Heffernan on 8 May.  He also noted that there was progressive subsequent improvement.

1. Accordingly it is clear that the doctors essentially agree that it was the psychosis that led Mr Vale to the offence, that he had a number of conditions that were impinging on his brain at the time and that the overdose was not a significant factor.

1. Accordingly on the basis of the evidence I am satisfied that Mr Vale acted under the delusions as a result of the delirium and that it deprived him of the capacity to know he ought not do the act.

1. It is clear from the evidence that Mr Vale was suffering from psychosis that was independent of the intoxication and that it transcended the intoxication.  It was that psychotic state that deprived him of the capacity to know.

1. The intoxicating substances clearly did not sustain those delusions and the delusions existed for several days, at least until 8 May, and I note that it took a further three weeks to resolve.

1. I am further satisfied that the substance abuse delirium is a disease of the mind in accordance with the decision of KAM [2002] QMHC 006. Accordingly in the circumstances there will be a finding of unsoundness of mind in relation to the offence which occurred on 5 May 2008.

1. As to whether there should be a forensic order, I consider the circumstances are such that a forensic order is clearly required.  I consider that the forensic order should be that Mr Vale is detained to the Redcliffe-Caboolture Mental Health Service.  I consider that the condition should be as per the submission from Legal Aid in its original form and that condition 5 should be that he refrain from using alcohol and illicit drugs.

1. Accordingly there will then be the conditions as per the draft which has been initialled by me and placed with the file.  In the circumstances then I will order a release of the medical reports to the legal representatives.  I will order that a copy of the transcript be made available to all representatives.