Chan, Re [2010] QMHC 32

MENTAL HEALTH COURT CITATION: Re Chan [2010] QMHC 032 PARTIES: REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF HAU CHANG CHAN PROCEEDING NO: 0008/10 DELIVERED ON: 3 November 2010 DELIVERED AT: Brisbane HEARING DATE: 3 November 2010 JUDGE: A Lyons J ASSISTING PSYCHIATRISTS: Dr J Lawrence Dr E N McVie FINDINGS AND ORDERS: 1. That at the time of the alleged offences the subject of the reference the defendant was of unsound mind as described in Schedule 2 of the Mental Health Act 2000 (Qld); 2. That the defendant be detained as a forensic patient to the Princess Alexandra Hospital authorised Mental Health Service; 3. Approval of limited community treatment on the conditions stated in the submission from the Director of Mental Health. CATCHWORDS: MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where the defendant is charged with two counts of grievous bodily harm; two counts of unlawfully wounding another and one count of attempted murder – where evidence that the defendant suffers from a major psychotic depression – where no evidence the defendant has a history of mental illness – where evidence the defendant suffered a brain injury many years ago – whether the defendant was of unsound mind at the time of the alleged offences as described in Schedule 2 of the Mental Health Act 2000 (Qld). COUNSEL: J Noud for the defendant S Bain for the Director of Public Prosecutions J Tate for the Director of Mental Health SOLICITORS: Sciacca's Lawyers for the Defendant Crown Law for the Director of Mental Health The Director of Public Prosecutions (Qld) -- 1 of 5 -- 2 ANN LYONS J: The Offences [1] This is a reference by the Director of Mental Health in relation to Mr Hau Chang Chan. Mr Chan is charged with five indictable offences, all of which occurred on 30 September 2009. He is charged with two counts of grievous bodily harm; two counts of unlawfully wounding another and one count of attempted murder. [2] All of those offences arise out of a situation which occurred at his home at Runcorn around 9pm on 30 September last year. It would appear that Mr Chan had delusional beliefs about his wife and her friends and that they were trying to deprive him of his wealth. He is alleged to have repeatedly stabbed his wife Ming Zhu Wang, his niece Shu Yun Wang, and his wife’s sister-in-law Chun Chun Xun. [3] Police were called to Mr Chan’s home at Runcorn where it was alleged he had repeatedly stabbed these three persons. He was located in the backyard with a large metal knife. It would appear that Wang and Chan had been watching television. Mr Chan has then gone into the kitchen and returned with a knife and presented it to Wang and then stabbed her in the left thigh. He is then alleged to have run after Xun and stabbed her in the back of the head and shoulder. Zhu Wang then tried to shut the door and Mr Chan managed to get his foot inside and cut her on the left hand. Wang then grabbed the knife away from the defendant and threw it into the backyard. Dr Saraf’s Evidence [4] Dr Sudeep Saraf has provided a s 238 report to the Director of Mental Health dated 11 December 2009 and he also gave evidence at the hearing. Dr Saraf in his report states that the defendant is a 69 year old man who was born in China and is a retired chef and restauranteur. Dr Saraf makes a diagnosis of schizophreniform psychosis and notes that on 9 October 2009 Mr Chan was floridly psychotic with delusions of persecution, auditory hallucinations, thought control and schematic pacificity. Dr Saraf indicated however that no delirium was present and he did not consider he was depressed on admission but thought it could subsequently develop. It is clear that in the first week of the admission to the Princess Alexandra Hospital Mr Chan believed that staff were mixing his blood into his food and drink and he refused to leave his room and refused to eat or drink. [5] Dr Saraf’s report indicated there was no past history of mental illness but that he had a motor vehicle accident in 1967 in Hong Kong. A CT of the brain and an MRI at the Princess Alexandra Hospital noted a volume loss involving the left temporal lobe and superficial frontal lobe, possibly from the previous trauma. Dr Saraf considers however that it may be a schizoaffective disorder. Dr Saraf noted the history given by his wife about his evolving symptoms in the weeks before the offences; “ ..it is apparent that Mr Chan was labouring under the delusional belief that his wife and her friends were attempting to deprive him of all his wealth and possessions for approximately three months prior to the incidents on the 30th September 2009. His wife Mrs Wang reported that he had been isolating himself for about three months prior to the date of the -- 2 of 5 -- 3 alleged offences. She reported that he was saying things that he (sic) felt was odd and unusual for him. For eg; in early September he asked the students of Chinese heritage who were boarding in their house to leave because he was going to die soon. Approximately two to three days before the alleged offence he told his wife that the house was going to be sold, wheras according to her no such thing had been planned.” [6] Dr Saraf noted that his mental state improved with increasing doses of Risperidone and that the neuropsychological assessment done on 12 November 2009 indicated that his general cognitive functioning was in the average range with no indication of dementia. [7] In relation to the offences Dr Saraf considered that Mr Chan had a delusional belief about his wife and her friends. He believed that they were trying to deprive him of his wealth. He says that there is no dispute of facts and considers that Mr Chan was deprived of the capacity to know he ought not do the act and of the capacity for control. Dr Saraf considers that Mr Chan was out of touch with reality and was labouring under a mental illness. [8] Dr van de Hoef’s evidence [9] Dr Pamela van de Hoef also examined Mr Chan. She examined him on 25 February 2010 and her report to the Mental Health Court is dated 1 April 2010. Dr van de Hoef conducted a three hour long interview with Mr Chan at the Princess Alexandra Hospital’s psycho-geriatric unit with the assistance of a Cantonese interpreter. I consider Dr van de Hoef’s report is far more extensive than that prepared by Dr Saraf. The views of the assisting psychiatrists also accord with the diagnosis proffered by Dr van de Hoef. Consequently I prefer Dr van de Hoef’s conclusions in relation to diagnosis. [10] Dr van de Hoef considered that intoxication with drugs or alcohol was not an issue and that in relation to the offences it is clear that Mr Chan thought that the victims had been after his money and that his wife indicated that he had not been speaking normally for about two months prior to the incident and had increased memory difficulties for six months prior. She also indicated that he had been very worried and had lost a lot of weight and was ruminating over his imminent death and was concerned about giving away his possessions. Dr van de Hoef noted that after his arrest he described feeling confused and frightened and thinking that everyone was conspiring against him. When he was admitted to hospital he thought people were going to kill him. [11] Dr van de Hoef also noted a history of a brain injury in 1967 after which he could not speak or recognise people for several months. Dr van de Hoef also noted the MRIs which indicated volume loss in the superficial temporal and superficial frontal lobes which were consistent with old trauma. On interview with Dr van de Hoef, Mr Chan indicated that he was now aware his previous persecutory beliefs were erroneous. [12] Dr van de Hoef considers that Mr Chan was suffering from a severe major depressive illness, with psychotic features at the time of the offences. She -- 3 of 5 -- 4 considered he may be predisposed to depression, delirium and psychosis because of his acquired brain injury in 1967. She considered that he was depressed first and psychotic second. Dr van de Hoef also stated that all the witnesses indicated how uncharacteristic it was for Mr Chan to act in this way. [13] She considered he had a psychotic disorder, characterised by irritability, social withdrawal, sleep disturbance, weight loss, as well as depressive and negative ruminations about dying and persecutory delusions. [14] Dr van de Hoef concluded that Mr Chan was deprived of the capacity to know he ought not do the act. She considered that a forensic order was required given the severity of his illness and his wife’s attempts to get treatment for him prior to the offences. She considered that a forensic order would give him better protection. Current Circumstances. [15] The Report of Dr Best dated 27 October 2010 sets out the current situation with Mr Chan. That Report indicated; “Recommendations In the event that Mr Chan is found to be of unsound mind at the time of the offence, I recommend that he be placed on a forensic order and be returned to Princess Alexandra Hospital psychogeriatric unit for the remainder of his treatment. This unit would be an appropriate place of treatment given that Mr Chan has already developed a strong therapeutic alliance with the team and a structured routine and effective treatment program is already in place. The close proximity of the hospital to Mrs Chan would also allow meaning and frequent contact with his only family member in Brisbane. Given that escorted leave thus far has been highly successful, we recommend that the amount of time for the escorted leave be extended to four hours. We would instigate safeguards for the increased freedom by the following measures: (a) closely monitoring mental state prior to and following leave (b) ensure continued medication compliance and maintain therapeutic engagement with the treating team. (c) Continuing education for relapse prevention would also help minimize risk in the future (d) Regular urine drug screens would occur with increased leave and regular education regarding the effects of alcohol and illicit drugs on mental health would be provided. (e) Although the risk of absconding is assessed to be low, should this occur in the future, the treatment team have a clear plan in place that immediate notification to family, police, and director of mental health need to occur, and an Authority to Return to be effected. -- 4 of 5 -- 5 Increased length of escorted leave is recommended as a method of graduated reintegration into a meaningful social role. It would also be important as part of illness prevention as continued isolation from his cultural links and social supports has an impact on Mr Chan’s mental state. We would also consider the use of a depot medication in the future if the risks of on-compliance increase. A referral is currently in process for linkage with a psychogeriatric case manager to provide additional support and monitoring.” The views of the Assisting Psychiatrists [16] Both Dr Lawrence and Dr McVie considered that the evidence supported a finding that Mr Chan had a major psychotic depression which had been building for some months at the time of the commission of the alleged offences. They stated that it was clear that Mr Chan held delusional beliefs of a paranoid kind which were consistent with a depressive state. Dr Lawrence also considers that other features of a depressive illness were also present. Dr Lawrence indicated that she preferred the views of Dr van de Hoef in relation to a diagnosis and agreed with her views that a major depressive illness was present with psychotic features. Dr Lawrence stated that this diagnosis meant that there was a different prognosis for the future management of Mr Chan’s condition as a psychotic depression meant that there should be a good return to normal functioning. She considered that this was an important feature in relation to Mr Chan’s future management. [17] Dr Lawrence supported a finding that Mr Chan was of unsound mind at the time of the commission of the alleged offence as he was deprived of the capacity to know he ought not do the act. Dr Lawrence indicated that a forensic order was required and that limited community treatment should be in the terms of the draft conditions submitted by the Director of Mental Health. She considered that LCT should be gradual and should be escorted fro the time being. [18] Dr McVie agreed that there should be a finding of unsoundness and agreed in relation to the need for a forensic order which at the moment was restricted to escorted leave on and off hospital grounds. She also considered that the Forensic Order should contain a requirement that Mr Chan should refrain from the consumption of alcohol. Conclusion [19] I am therefore satisfied that at the time of the commission of the alleged offence on 30 September 2009 Mr Chan was of unsound mind as defined in schedule 2 of the Mental Health Act 2000 (Qld). [20] A forensic order is clearly required and should be in the terms of the amended Draft conditions contained in the submission of the Director of Mental Health dated 1 November 2010. -- 5 of 5 --