Re Wilson

[2011] QMHC 2

MENTAL HEALTH COURT

CITATION:	Re Wilson [2011] QMHC 2
PARTIES:	REFERENCE BY THE PATIENT’S LEGAL REPRESENTATIVES IN RESPECT OF CRAIG JOHN WILSON
PROCEEDING NO:	0191/09
DELIVERED ON:	4 April 2011
DELIVERED AT:	Brisbane
HEARING DATE:	24 March 2011
JUDGE:	Ann Lyons J
ASSISTING PSYCHIATRISTS:	Dr E N McVie Dr A S Davison
FINDINGS AND ORDERS:	That at the time of the five alleged offences on 18 July 2008 and 24 January 2009 the subject of the reference the defendant was of unsound mind as described in Schedule 2 of the Mental Health Act 2000 (Qld); That the defendant be detained as a forensic patient to the Townsville Network Authorised Mental Health Service; That limited community treatment is approved to commence immediately at the discretion of the authorised psychiatrist, on the conditions set out in the submission of the Director of Mental Health.
CATCHWORDS:	MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with one count of common assault, one count of  attempted murder, one count of acts intended to cause grievous bodily harm and two simple offences of possession of a knife in a public place and public nuisance – where evidence the defendant was suffering from auditory hallucinations and persecutory delusions at the time of all of the offences – whether defendant was of unsound mind at the relevant times – whether intoxication relevant – whether a forensic order should be made
COUNSEL:	S Bain for the defendant J Tate for the Director Mental Health BG Campbell for the Director of Public Prosecutions
SOLICITORS:	Legal Aid Queensland for the defendant Crown Law for the Director of Mental Health Director of Public Prosecutions (Qld)

ANN LYONS J:

1. This is a reference dated 4 August 2009 by the legal representatives of Craig John Wilson. Mr Wilson is facing five charges: three indictable offences which include one of common assault on 18 July 2008 as well as attempted murder and acts intended to cause grievous bodily harm which were alleged to have occurred on 24 January 2009. The two simple offences include possession of a knife in a public place and public nuisance.

1. These are the circumstances surrounding those offences. In relation to the 18 July 2008 offences, at 9.30am Mr Wilson was in Kmart at Mt Isa and had a serrated edged steak knife in his back pocket. He proceeded through the store in a disorderly way and approached a particular complainant and said “I told you to stop looking.” He then punched him in the head and continued to be abusive, threatening and disruptive. This was seen on security footage.

1. Later he was seen in Coles within the same shopping centre, where he asked an employee in the bread section if there was any acid or poison in the bread. He asked if she was taking photos of him and to see her mobile phone. He then asked three employees in the meat section if there was any arsenic or poison in the meat and he threatened to cut their throats if there was poison in the meat. He swore at a staff member and said that if his groceries were not packed properly he would kill the attendant. He also made threats to return to the store with a gun. Several employees had observed a knife in his pocket.

1. On 24 January 2009 at 8.30am Mr Wilson had engaged in a verbal altercation with a person on a driveway in Mt Isa. He then produced an orange handled knife and threatened the complainant. When the complainant attempted to back away Mr Wilson slashed the complainant’s arms as he tried to protect his face. When the complainant started to run Mr Wilson chased him, slashing at his back causing superficial lacerations. He was then seen wrestling with the complainant and stabbed him in the belly causing two lacerations. When he was told to stop, by a witness, he shrugged his shoulders and thrust the knife into the complainant’s chest. The force of the thrust bent the knife at the hilt. He then removed the knife, dropped it and walked away. The complainant was later found to have 25 stab or slash wounds.

Report of Dr Gundabawady

1. Dr Gundabawady has provided a report dated 24 July 2009. In that report Dr Gundabawady states that at the time of the July 2008 offences Mr Wilson was having auditory hallucinations and persecutory delusions and was not able to control his actions.  Mr Wilson considered that the complainant was going to cut him because of the way he was looking at him and laughing and he also thought the bread and meat were poisoned. During the time of those actions, he heard a male voice saying that people were trying to get him. He said he had a few caps of scotch on the day of that offence.

1. In relation to the January 2009 offences, Mr Wilson said that the complainant had had a lot visitors and there was lots of drinking in front of the house. He also said that the neighbours had poisoned his plants with diesel. He also stated he had a quarter of a bottle of whiskey on the day and heard voices saying “go over there and sort it out”. He said that the victim told him to “piss off” and he then went into a rage and stabbed him.

1. Dr Gundabawady considers that Mr Wilson was experiencing persecutory delusions and voices at the time and did not know what he was doing and was unable to control his actions.

1. In relation to the five offences, Dr Gundabawady did not believe that alcohol consumption in itself would have led to the alleged offences and he considers that Mr Wilson was entitled to a defence of unsoundness of mind for all of the charges.

1. Dr Gundabawady noted that Mr Wilson’s mother had reported that he had become unwell in February 2008, saying that his food was poisoned and that people were out to get him. His mother took out a Justice’s Examination Order on 24 July 2008 and the Mental Health Team assessed him and discharged him on 28 July 2008. He was next seen at the watch house where he was observed as having racing thoughts and was preoccupied with somatic and persecutory delusions. He was admitted to hospital in February 2009 and diagnosed with paranoid schizophrenia, drug abuse and steroid abuse. He was then admitted to the Secure Mental Health Service in Townsville, after a deterioration in his mental state. He had been non-compliant in prison. He was placed on an involuntary treatment order. He now has depot Clopixol.

Report of Dr Heffernan

1. Dr Heffernan provided a report to the Court dated 2 October 2009. Dr Heffernan noted that Mr Wilson became unwell around February 2008 following the death of his stepfather, to whom he was close and for whom Mr Wilson had been a carer. He stated that after the death of his stepfather, he started consuming large quantities of alcohol and dramatically increased the use of anabolic steroids. In a period of 10 months he gained 20kgs in weight and started taking prescribed methadone and using Buprenorphine patches.

1. Dr Heffernan stated that Mr Wilson told him that he started to hear voices in February 2008 which were very distracting. He felt there were people talking about him generally in a derogatory manner and he believed that people were out to harm him and he developed referential delusions. These symptoms became prominent in the middle of 2008 and he began to fear for his safety. He believed that people were coming into his yard at night and that most of his neighbours had bad intentions towards him. He also had longstanding disputes with some of his neighbours about rubbish. He stated that when he went out into public places he was plagued by derogatory auditory hallucinations and he feared that people wanted to harm him.

1. Dr Heffernan stated that due to his fears, Mr Wilson spent a large amount of time at home doing weight training. He also consumed alcohol daily, reporting the use of one to two bottles of scotch per day. Mr Wilson also advised Dr Heffernan that he was taking three different types of steroids, particularly Dynabolan and Sustanon 250. Mr Wilson also reported that at night he was taking 10 tablets of Valium and smoking three or four marijuana cones a night. He stated that his alcohol, cannabis and Diazepam use was to try and combat his heightened, anxious, paranoid and stimulated state. Mr Wilson stated that whilst his steroid use had been longstanding due to his interest in body building, in mid to late 2008 he became focused on ensuring he had sufficient bulk and energy to ensure he was able to defend himself.

1. In relation to the offences on 24 January 2009 Mr Wilson did not dispute the offences and he told Dr Heffernan that he had had a grievance with the neighbours across the road for some time, in that they had drinking sessions and then would throw the empty bottles into his yard. On the Friday evening prior to the events on Saturday morning he had a fight with some neighbours in a Housing Commission unit and they had “punched him up”. That attack had followed a verbal argument earlier in the day. Apparently on the Friday night he couldn’t sleep due to fear of a further attack and he consumed a bottle of scotch and took 10 Valium tablets. He stated that throughout the evening he continued to experience derogatory auditory hallucinations and in the morning he took his morning dose of Methadone and then had some Stanozolol about 6.30am and then trained. He had a further dose of Stanozolol at approximately 8am. He also had consumed cannabis as well as alcohol on the morning of the offences.

1. On the morning of the alleged offences at about 8.15am, he ran out into the front yard and saw that more bottles had been dumped in his yard; he then yelled abuse at his neighbours; he became angry, ran into his house and grabbed a knife. He headed off to the neighbours, where he wanted to confront three men. He stated that two of the men ran back inside, but one of the men came and confronted him and told him to “piss off”. He then went into a rage and attacked the man. He recalled slashing the man with a knife.

1. In a record of interview, subsequent to his arrest, Mr Wilson stated he was not intoxicated at the time and had only had two nips of rum. He denied any other drug or alcohol use. However, he had complaints about somatic symptoms and the nurse assigned to the Court noted that he described his thoughts as racing. The summary at the time raised the possibility that his mental state reflected substance abuse or a psychotic disorder.  A referral was made to Prison Mental Health Service to follow him up. He was seen two days later by a locum psychiatry house officer, Dr Teoh, who noted that Mr Wilson appeared thought disordered and perplexed, and that he was expressing some “rather bizarre somatic delusions”. Dr Teoh considered that Mr Wilson was suffering from schizophrenia (paranoid type). He noted that Mr Wilson had been placed on anti-psychotic medication but this was ceased and he changed his medication to Olanzapine, 10mgs at night. Mr Wilson was admitted to the Secure Mental Health Unit at the Townsville Hospital on 2 February and was discharged on 10 February.

1. At that time it was recorded that he was expressing persecutory delusions of neighbours trying to poison his fruit trees and also somatic delusions of his liver being poisoned and enlarging. He was discharged for follow up by the Townsville Prison Mental Health Service. Mr Wilson’s mental state deteriorated in custody and he became non compliant. Mr Wilson told Dr Heffernan that he became extremely stressed in custody because it was known that he had stabbed an Aboriginal man. He subsequently became involved in a number of assaults with indigenous inmates. He was badly assaulted during one of the incidents and apparently his auditory hallucinations returned. At the time of his second admission to the Mental Health Unit he was described by Dr Gundabawady as suffering from a deterioration of mental state with persecutory and somatic delusions.

1. Dr Heffernan opined that in relation to the offences on 18 July that it was likely that Mr Wilson was suffering from a mental disease, schizophrenia or a substance induced psychotic disorder and the effects of substances. He considered that at the time of the alleged offences he was suffering from psychotic symptoms including auditory hallucinations, persecutory delusions and ideas of reference that were of such a severe nature as to make him unable to reason with any degree of sense or composure about his actions and were manifest in his actions which included those which resulted in the charges.

1. Dr Heffernan noted that it would seem likely that, on the morning of 18 July, Mr Wilson was suffering from the effects of intoxicants, because he told him that before he arrived at the supermarket he had consumed 240mls of scotch and he had injected himself with steroids. He had also taken Methadone and was wearing a Buprenorphine patch. He described himself as feeling intoxicated. Dr Heffernan stated that it was likely that intentional intoxication with alcohol contributed to his mental state at the time of the alleged offences. Dr Heffernan stated that, although he had psychotic symptoms, the alcohol was likely to have further disinhibited his behaviour. He also thought the steroids were likely to have contributed to the onset, perpetuation, expression and development of the psychotic illness and that in this sense this substance had a continued effect on his mental state. He did not think it was likely that the Methadone taken shortly before the offence and the slow release Buprenorphine patch would have contributed to his state of mind.

1. In conclusion, Dr Heffernan’s view was that Mr Wilson was suffering from mental disease, namely, schizophrenia or a substance induced psychotic disorder with manifest psychotic symptoms, and he was deprived of the capacity to know he ought not do the act, however he believed that his deprivation was due to his mental illness and the substance misuse both long term and on the morning of 18 July 2008.

1. In relation to the attempted murder and the acts intended to cause grievous bodily harm which occurred on 24 January 2009, Dr Heffernan stated that it was his view that Mr Wilson was suffering from a mental disease, namely schizophrenia or a substance induced psychotic disorder at the time of the offences. He believed he had active psychotic symptoms and had been experiencing those for some time. Although Mr Wilson explained the offences in terms of retribution, Dr Heffernan believed that his interpretation of retribution was most likely to be explained by his disturbed mental state at the time. He believed he was deprived of the capacity to know he ought not do the act. He believed that this deprivation reflected both his mental disease and deliberate intoxication.

1. Dr Heffernan stated that from the history he had obtained Mr Wilson had consumed a bottle of scotch in the late evening and early hours of the morning prior to the offence. He consumed further whiskey during the day and then an estimated 50mgs of Diazepam. Dr Heffernan stated that there is little doubt, if Mr Wilson’s account is accurate, that he would have been intoxicated with alcohol and probably benzodiazepines at the time of the alleged offences. Dr Heffernan noted that Mr Wilson also stated he had consumed some steroids and it is likely that that was also significant to the issue of intoxication.

1. Dr Heffernan considered Mr Wilson was fit for trial. 

Report of Dr Fama

1. Dr Fama considered that the appropriate diagnoses are:

1.          Paranoid schizophrenia currently in remission,

2.          Alcohol dependent syndrome, currently abstinent in a protected environment, and

3.          Multiple drug dependence, namely cannabinoids, anabolic steroids and benzodiazepines, also currently abstinent in a protected environment.

1. Dr Fama provided a report dated 21 November 2009. In relation to the events of July 2008, Mr Wilson told Dr Fama that he recalled the day vaguely and that he had once worked as a storeman at Coles and knew and disliked the complainant. He rode to Coles with the intention of buying some supplies and stated that at the time he was taking regular and excessive quantities of steroids which had made him irritable. He stated that around 6 or 7am that day he had consumed one-third of a bottle of whiskey and he was suspicious and fearful as usual. He thought people were against him; he thought people were going to attack him. He said that he carried the steak knife with him as “protection”. Mr Wilson does not contest the essential facts as presented in the police brief, but stated to Dr Fama that he remembered he had a strong belief that the food on display was laced with poison.

1. Dr Fama considered that the police account of events, as reported by the witnesses, is clear evidence of delusional thinking by Mr Wilson. He also stated that the paranoid symptoms ultimately persisted in custody, long after the possible effects of intoxication would have worn off. He, therefore, considered that intoxication by itself would be insufficient to explain his disorder.

1. Dr Fama considered, therefore, that in relation to the events of July 2008, Mr Wilson was afflicted with a mental disease within the usual meaning of s 27 of the Criminal Code and that that disease did not deprive him of the capacity to understand what he was doing. Nor did it deprive him of the capacity to control his actions, although he considered there was probably some impairment of control due to intoxication. Ultimately, however, Dr Fama considered that Mr Wilson’s mental disease did deprive him of the capacity to know that he ought not do the acts. He was retaliating, in his view, by threat and violence against what he believed to be serious attempts to poison him.

1. Dr Fama also considered that the offences of attempted murder and acts intended to cause grievous bodily harm attract the same defence. Dr Fama stated that on 24 January, as he had been at the time of the offences at Coles in July 2008, Mr Wilson was still very paranoid in his thinking. He also indicated that on the morning of those offences Mr Wilson may have drunk half a bottle of scotch.

1. Dr Fama considered that the intensity of the attack on his neighbours was attributable both to “’roid rage” and to intoxication, mainly with alcohol. However he considered that it took place in a setting of chronic psychosis with delusions of persecution and with hallucinations. Dr Fama considered that Mr Wilson’s mental disease independent of the intoxication has been extensively documented.

1. In the offences of January 2009, Mr Wilson’s savage assault persisted, even when challenged and warned by another neighbour. Accordingly, Dr Fama considered that Mr Wilson was deprived of the capacity to control his actions, but that that deprivation however, was probably accounted for chiefly in terms of intoxication. Dr Fama stated that the deprivation that arose primarily from Mr Wilson’s mental disease was that of knowing that he ought not do the act. In particular, he saw the threat from the neighbour of such a magnitude as to deserve an attempt to kill or at least to assault.

1. Dr Fama considered that a defence of unsoundness of mind was available under s 27 of the Criminal Code. Dr Fama considers that Mr Wilson is fit for trial.

The views of the Assisting Psychiatrists

1. Dr McVie advised that there was no doubt Mr Wilson suffered from a chronic psychotic illness characterised by auditory hallucinations as well as persecutory, somatic and referential delusions in the context of a strong family history in which his father and grandmother suffer schizophrenia.

1. Dr McVie opined that the illness may have commenced around his stepfather’s death in February 2008 but there are factors which predate that event including his severe pain which required a referral to the methadone clinic and his GP treating him for depression. 

1. Dr McVie also noted the clear evidence from February 2008 of increasing steroid abuse and probable increasing alcohol abuse which continued in the lead up to the July 2008 offence and which in combination with his illness led to disorganisation. However, she advised that there is some doubt as to the actual extent of Mr Wilson’s substance abuse and intoxication at the time of each offence. 

1. Dr McVie also noted the difficulty in determining from the reports, the exact impact of Mr Wilson’s illness on his substance use and vice versa. She commented that the two may have occurred simultaneously as in oral evidence Dr Heffernan noted Mr Wilson’s psychosis did increase his steroid use as he had a paranoid belief that he needed to protect himself and thus needed more steroids to maintain his size and strength.

1. In relation to the discrepancies in the various reports Dr McVie noted that the report to Dr Gundabawady is similar to the accounts that Mr Wilson gave when assessed on 27 and 29 January and on his admission to the Townsville Hospital on 2 February. She noted that Mr Wilson was assessed by Drs Fama and Heffernan some 8 or 10 months later and speculated the discrepancy may be explained by increased insight or an attempt to rationalise his actions when psychotic.

1. Ultimately Dr McVie advised that Dr Fama’s diagnosis of a paranoid schizophrenic illness be accepted. She indicated that the facts of the offences and Mr Wilson’s behaviour immediately following the offences clearly indicate that his actions were based on his psychotic beliefs and persecutory delusions.   She further advised that the psychotic symptoms themselves were independent of and not caused by intoxication.

1. Dr McVie stated:

“Mr Wilson's case is not a case where an illness is clearly dependent on any illicit substance use or intoxication.  I would thus advise your Honour if it's accepted that there is no dispute of facts in terms of level of intoxication, that the advice of Dr Fama be accepted and the finding of unsoundness of mind be made.”

1. Dr McVie indicated a Forensic Order was appropriate in the terms of the submission of the Director of Mental Health.  

1. Dr Davison advised that he agreed with the views expressed by Dr McVie that Mr Wilson had a mental illness and was of unsound mind at the time of the offences.  He also considered that a forensic order was required.  

Conclusion

1. On the basis of the medical reports of Drs Fama, Heffernan and Gundabawady, as well as the advice of the assisting psychiatrists, I am satisfied that at the time of both sets of offences Mr Wilson was suffering from a mental disease namely chronic psychotic illness namely schizophrenia which was characterised by auditory hallucinations as well as persecutory delusions.  I am also satisfied that he was of unsound mind at the time of the offences as he was deprived of the capacity to know that he ought not do the acts.  I am also satisfied that Mr Wilson’s psychotic symptoms were independent of and not caused by intoxication. I agree that Mr Wilson’s mental disease independent of the intoxication has been extensively documented.

1. Given the serious nature of the offences and Mr Wilson’s current treatment needs I am satisfied that a Forensic Order is required and accordingly there should be an Order in the terms of the submission of the Director of Mental Health.