Re Van Hassell

[2006] QMHC 28

MENTAL HEALTH COURT

CITATION:

Re Van Hassell [2006] QMHC 28

PARTIES:

REFERENCE BY THE DIRECTOR OF PUBLIC PROSECUTIONS IN RESPECT OF PATRICK VAN HASSELL

PROCEEDING NO:

No 0079 of 2005

DELIVERED ON:

13 April 2006

DELIVERED AT:

Brisbane

HEARING DATE:

13 April 2006

JUDGE:

ASSISTING PSYCHIATRISTS:

Holmes J

Dr J F Wood
Dr D A Grant

FINDINGS AND ORDER:

1. There is a reasonable doubt that the defendant committed the alleged offences, not arising solely from any mental illness, and therefore no finding of unsoundness is made
2. The defendant is temporarily unfit for trial
3. The defendant is detained to The Park High Security Programme Authorised Mental Health Service

CATCHWORDS:

MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with two counts of rape and with stealing from the person – where defendant subsequently exhibited irrational behaviour at a review in the District Court and on examination by psychiatrists – whether the behaviour was psychotic – whether the defendant has a mental illness or an anti-social personality disorder – whether he is fit for trial

Mental Health Act 2000 (Qld), Schedule 2

COUNSEL:

Mr J Farmer for the defendant
Mr J Tate for the Director of Mental Health
Ms C Kelly for the Director of Public Prosecutions

SOLICITORS:

Legal Aid Queensland for the defendant
Crown Law for the Director of Mental Health
The Office of the Director of Public Prosecutions

1. HOLMES J:  Mr Van Hassell is charged with two counts of rape and one of stealing from the person, those offences allegedly occurring on 5 November 2002.

1. He has been on remand in respect of those charges since November 2002.  This is a reference by the Director of Public Prosecutions, made after some apparently irrational behaviour displayed by Mr Van Hassell at a review in the District Court.

1. Dr Fama has given evidence about an account given to him by Mr Van Hassell, which raises a defence to the charges, of consent.  Dr Fama says that that account was apparently rational and he did not consider it to arise out of any illness.  There also seems to have been an account by Mr Van Hassell, it should be mentioned, of mistaken identity.

1. At any rate for today's purposes I am satisfied that there is a reasonable doubt not arising solely because of any mental illness and that no finding as to unsoundness should be made.

1. The real question is whether Mr Van Hassell is unfit for trial and that seems to come down to two questions: whether he experiences psychotic symptoms and, if so, whether that is the result of mental illness or alternatively personality disorder.

1. It is apparent that there are a number of features of Mr Van Hassell's behaviour which have made him extremely difficult to assess.  I think it is fair to say that the psychiatrists and the one psychologist assessing him fall into two camps.  The view of the first group is that he has an anti-social personality disorder, so that he is either feigning his psychotic symptoms or in consequence of his disorder is regressing into psychosis under stress, but is not suffering any mental disease.  The alternative view is that it is genuine psychosis that he manifests, resulting from schizophrenia which Dr Fama describes as chronic undifferentiated schizophrenia.  Dr Kar called it schizophrenia disorganised type.  I am informed that there is no meaningful difference between the two.

1. Taking the first group, those who diagnose anti-social personality disorder, first, it does seem to be the case that the treating psychiatrists generally fall into it.  Dr Purssey gave a report on 1 July 2004.  That was when Mr Van Hassell had spent a period of one month at the high secure unit at The Park.  Dr Purssey wrote a discharge summary.  He said in it that Mr Van Hassell had complained of hearing voices but there were no psychotic symptoms observed in the unit although Mr Van Hassell was not medicated.  He, as far as I can see, was the first of those to diagnose anti-social personality disorder.  He also made an ancillary diagnosis of poly-substance abuse.

1. The next in this group is Dr Scott, who reported on 23 July 2005.  Mr Van Hassell had had another admission from remand to The Park.  He had made it clear to Dr Scott that he preferred conditions in the high secure unit and would prefer to serve any sentence there.  Dr Scott said that there were no clear psychotic features; but it should be noted, as Dr Wood has pointed out, that there were features identified in his report, in the section “Mental State on Admission”, and also in the “Nursing Staff Notes of Behaviour”, which would be expected in schizophrenic psychosis.  It was during this period that Mr Van Hassell was said to have assaulted a psychiatrist at a time when he became aware he was to be returned to gaol.  Dr Scott diagnosed him again as having anti-social personality disorder and polysubstance abuse.  He did, however, note that Mr Van Hassell appeared to decompensate with psychotic-like symptoms when stressed. 

1. Also in that period at The Park Mr Van Hassell was assessed by Dr Barnes, a psychologist.  She said that there were no psychotic features evident during her assessment.  Dr Barnes observed that Mr Van Hassell was not co-operative and was possibly manipulative.  She noted inconsistencies between his speech content, his performance and his functional behaviour and raised the possibility that he was feigning his mental health problems.

1. Much later, Dr Hannah became Mr Van Hassell's treating psychiatrist.  She has given a report of 2 February 2006.  She too concluded that he had an anti-social personality disorder which, under stress, caused him to regress into a psychotic state.  She thought that he was fit for trial although it was possible, she conceded, that he might present differently under the stress of a court appearance. 

1. Dr McVie has also given a report, dated 31 January 2006, but she did not carry out any independent assessment.  Rather, her report is a review of assessments conducted at The Park, the effect of which was to point out that Mr Van Hassell had been thoroughly assessed and found fit for trial.

1. Dr Arthur is the last of this group of psychiatrists, and he has seen Mr Van Hassell quite recently.  He reported on 5 April 2006 after examining Mr Van Hassell on three separate occasions while he was in the detention unit at the Wolston Correctional Centre.  He spent periods of around 30 minutes, 15 minutes and 15 to 20 minutes respectively, with him.  He did not think that Mr Van Hassell's behaviour was psychotic, although it seemed disorganised and bizarre.  He thought that he was feigning psychiatric symptoms.  He seems to have been particularly influenced by the fact that Mr Van Hassell's behaviour changed as between transfers to Dr Arthur's presence and while with Dr Arthur, and then again once he was returned to the custody of correctional officers.  Dr Arthur gave the examples of Mr Van Hassell asking him who he was although he had already been introduced; and being relaxed and appropriate with the guards but then sullen and uncommunicative with him. 

1. Dr Arthur conceded that he was influenced, to some extent, by the discharge summary which Dr Scott had written.  At any rate, he considered that Mr Van Hassell had anti-social personality disorder with borderline features and a severely impaired ability to communicate.  He accepted that the history of Mr Van Hassell appeared to indicate that he regressed to psychotic symptoms under stresses but those symptoms, in his view, seemed to resolve with a change in environment.  He considered that they were too fluctuant to be typical of the sort of psychosis one would associate with schizophrenia, which one would expect to be more pervasive.  He noted, too, that that was manifested in the differing responses to him and Dr Fama, although they both saw Mr Van Hassell within a couple of days.  Another feature was that Mr Van Hassell's symptoms did not appear to be responsive to anti-psychotics, so he considered that they were not typical of schizophrenia in that regard.

1. As to fitness for trial, Dr Arthur said that he thought it depended on whether Mr Van Hassell was feigning psychotic symptoms; he thought there was a high possibility he was doing so for secondary gain.  If that were so, it became difficult to assess his true functioning level.  He did concede that Mr Van Hassell's behaviour, as he was able to observe it over the telephone, manifested in Court today might present some difficulties for trial.  On the other hand, he thought Mr Van Hassell might come to terms with the prospect of facing trial and remit his behaviours.

1. Dr Arthur accepted that it was difficult to feign thought disorder but he thought it might be possible over the short period of an interview.  Alternatively, Mr Van Hassell might genuinely be experiencing thought disorder under stress, which would be the product of his personality disorder.  At any rate, he adhered to his view that Mr Van Hassell was not suffering from schizophrenia and that it was an underlying personality disorder which produced his symptoms.

1. On the other side of the argument was Dr Kar, who was the first of the reporting psychiatrists to diagnose schizophrenia, at least in terms of the reports the Court has before it.  He assessed Mr Van Hassell in the Correctional Centre and was not able to extract anything from him about the charges.  However, he agreed with the 1994 assessment by Dr Stephenson to the effect that Mr Van Hassell had a genuine psychotic illness.  Dr Kar considered that when he saw him he was grossly psychotic and suffered from severe mental illness which, as I have said, he diagnosed as schizophrenia, disorganised type.  He thought that because Mr Van Hassell had had lucid intervals, his conduct had been misinterpreted as the result of a personality disorder.

1. Dr Kar considered Mr Van Hassell unfit, at the time, for trial.  He would not have the capacity to provide instructions.  He thought that position should improve with the administration of anti-psychotics.

1. Dr Fama examined Mr Van Hassell quite recently, on 5 April 2006, in an interview lasting about an hour.  He, as I have said, took Mr Van Hassell's account raising a defence to the charges.  He thought in any event that there was no clear history of any psychotic process at the time of the offences, although that was a matter that might warrant re-exploration when Mr Van Hassell was better.  On an examination of Mr Van Hassell's history, including discharge summaries from the Baillie Henderson Hospital and the Cairns Base Hospital and on his own observations, Dr Fama concluded that he suffered from chronic undifferentiated schizophrenia with a possible alternative diagnosis of epileptic schizophrenic form psychosis.  He found him vague and thought-disordered.  He did not believe it was possible to simulate that symptom to the extent that it was manifested in his interview.  Dr Fama also thought that Mr Van Hassell would have presented some difficulties in assessment of his personality, from the perspective of considering personality disorder, because of his long term unwellness.  He thought that if it were a case of Anti-Social Personality Disorder, Mr Van Hassell would have manipulated his circumstances in gaol rather better.

1. His conclusion was that Mr Van Hassell's diffuse and erratic thinking would render him unfit for trial.  I should also say that, like Dr Varghese, he made the point that Mr Van Hassell's distinctly unattractive presentation, including the assault of the psychiatrist, may have been rather alienating and counter-productive for assessment by other professionals. 

1. At any rate, Dr Fama considers that Mr Van Hassell requires prolonged hospital treatment to which he may respond; hence his conclusion that the unfitness, as presently to be judged, was of a temporary nature.

1. I have been much assisted by the view of Dr Wood and Dr Grant.  Dr Wood, as I have said, pointed out that many of the features identified in Dr Scott's report would be consistent in fact with schizophrenic psychosis.  That, he says, is also born out by Mr Van Hassell's history extending back to his 18th birthday.

1. Both Dr Wood and Dr Grant say that a personality disorder might co-exist with the illness but it is possible, too, that the symptoms which have been attributed to personality disorder might, in fact, be those of schizophrenia.

1. Dr Wood and Dr Grant urge me to accept the views of Dr Fama, Dr Kar and Dr Varghese.  Dr Grant says that, in his experience, this combination of symptoms, especially the thought disorder, are unlikely to be feigned.  He raises too, the possibility of some organic component to the illness; a cerebral dysfunction, which might, in fact, produce some of the symptoms ascribed to Anti-Social Personality Disorder.  He makes the point that it is unusual for somebody with Anti-Social Personality Disorder to function so badly in gaol.

1. Both Dr Wood and Dr Grant support a finding of temporary unfitness and both urge Mr Van Hassell's management in the high secure unit.  Accepting, as I do, what they say and what Drs Fama, Kar and Varghese say, to the effect that the psychotic symptoms are genuine, it is clear that Mr Van Hassell would not meet the Presser tests of being able to follow a trial or instruct counsel.

1. Accordingly, I find him temporarily unfit for trial.  I will make a forensic order.  He clearly requires treatment.  I order that he be detained to The Park High Security Programme Authorised Mental Health Service.

1. As Dr Grant has recommended, I will order that a transcript of today's hearing, together with a transcript of my reasons, be provided to the treating team, together with any of the reports which did not themselves emerge from The Park and are hence, unlikely to be in the possession of the treating team already.