DPC, Re [2010] QMHC 28

MENTAL HEALTH COURT CITATION: Re DPC [2010] QMHC 028 PARTIES: APPEAL AGAINST DECISION OF THE MENTAL HEALTH REVIEW TRIBUNAL DPC Appellant DIRECTOR OF MENTAL HEALTH Respondent by election PROCEEDING NO: 0200/10 DELIVERED ON: 2 November 2010 DELIVERED AT: Brisbane HEARING DATE: 1 November 2010 JUDGE: Ann Lyons J ASSISTING PSYCHIATRISTS: Dr F T Varghese Dr E N McVie FINDINGS AND ORDERS: 1. The decision of the Mental Health Review Tribunal of 8 July 2010 is confirmed. 2. The appeal is dismissed. CATCHWORDS: APPEAL AND NEW TRIAL – APPEAL PRACTICE AND PROCEDURE – QUEENSLAND – where the appellant appeals an involuntary treatment order of the Mental Health Review Tribunal (MHRT) – where evidence the appellant suffers a bipolar disorder – whether appeal should be allowed or dismissed. COUNSEL: Appellant appeared on his own behalf J Tate for the Director of Mental Health SOLICITORS: Appellant appeared on his own behalf Crown Law for the Director of Mental Health ANN LYONS J: [1] This is an appeal by the appellant, DPC, against a decision of the Mental Health Review Tribunal. The decision he is appealing is the confirmation of the involuntary treatment order by the Tribunal on 8 July 2010. [2] The grounds of the appeal stated that he was told he would be represented by Legal Aid. He stated that this was not the case and when he did go into the Tribunal they -- 1 of 5 -- 2 “didn’t table any letters of support and they hurried me through like they weren’t interested.” The appellant states that he felt bullied and suicidal because of this treatment. [3] The reasons of the Tribunal indicate that the documents they relied on included three references that were produced by the appellant at the hearing. The Tribunal also relied on the clinical report dated 25 June 2010 and the initial involuntary treatment order dated 18 December 2009. The Tribunal’s Reasons also indicate that it heard oral evidence from those who were present at the hearing including the appellant, his case manager, Ms Temperly and his partner. [4] It is clear that in an appeal to the Mental Health Court it is not necessary for the appellant to show an error in the reasons of the Mental Health Review Tribunal. An appeal to this court is an appeal by way of rehearing and this court, therefore considers all of the material that was before the Mental Health Tribunal as well as material which has subsequently been provided. [5] Pursuant to s 325 of the Mental Health Act 2000 (Qld) (the Act), in deciding the appeal the Mental Health Court may confirm or set aside the decision appealed against. If the Mental Health Court sets aside the decision then the court may make a decision the Tribunal could have made on the review of the application and the decision is taken to be that of the Tribunal. The material before the Tribunal [6] In considering the material that was before the Tribunal, particularly the involuntary treatment order dated 18 December 2009 and the clinical report, that material indicates that in December 2009 the appellant’s mental state deteriorated. That deterioration occurred as a consequence of non-compliance with his medications as well as exacerbation by psycho-social stresses. On examination in December 2009 the appellant was noted to be elevated in mood with pressured speech, expansive behaviour as well as irritability. He was also seen wearing a photo of his new son pegged to his pocket, dancing at times and expressing sexually inappropriate behaviour. Collateral information also indicated that there were verbal threats and phone calls to particular people at this time. He also had a reduced need to sleep and was lacking in insight. He was placed on an involuntary treatment order at that time as there was no less restricted manner to manage his mental state and contain his moods. [7] Prior to the Mental Health Review Tribunal review on 8 July 2010 the appelant was examined on 21 June 2010. The report dated 25 June 2010 indicated that he was still experiencing flashbacks about his witnessing a motor vehicle accident involving his partner and daughter in December 2006 when they were hit by a bus on a pedestrian crossing, sustaining various injuries. The appellant had witnessed the incident and experienced post traumatic stress disorder symptoms, such as flackbacks and ruminations. He also was having difficulty with anger and aggression. The report noted that an extensive psychiatric review report prepared in mid-2009 concluded that the appellant was likely to have had a longstanding -- 2 of 5 -- 3 anxiety disorder, secondary to the 2006 accident which occurred on a background of a major psychotic illness of bipolar disorder. [8] The 25 June 2010 report noted that there were no ideas of reference or delusions and there were no disorders or perceptions, no ideas of flight distractibility or hyperactivity. However, it was noted that he appeared to be holding a grievance towards his family in relation to the role the motor vehicle accident has had in contributing to his post traumatic stress disorder. The Report acknowledged that the appellant stated that he might have bipolar and that he was taking tablets. He indicated that if he was diagnosed with that illness he would accept that. The Report noted that the appellant does not consider he is a threat to his family. [9] The report also referred to a social circumstances report which indicated that whilst he ordinarily resides with his partner and three children, “A” aged 12, “B” aged 2, and “C”, born late 2009, he was no longer doing so. The two younger boys have developmental disabilities. After mental health and child safety investigation it was determined by Child Safety that the appellant should reside separately from the family and only have contact with the children when supervised by a nominated person. The report noted that the appellant maintains regular contact with the children and his partner is raising the children with his support. [10] In addition to that material which was before the Mental Health Review Tribunal and upon which that Tribunal made its decision, this court has additional information, namely a report of the current treatment which is signed by Dr Amanda Taylor, a consultant psychiatrist dated 26 October 2010. That report indicated that the appellant has an established diagnosis of bipolar affective disorder in addition to alcohol abuse and that he was first transferred to the Mental Health unit at Logan Hospital from 1 February 2007 until 23 February 2007 following a three week admission to the Royal Brisbane Hospital Mental Health Unit. The report then detailed the appellant’s second admission from 17 December 2009 to 19 January 2010. At that time, he was stabilised on lithium and risperidone and discharged on a Community involuntary treatment order for follow up at the Bayside Area Mental Health Service and under the care of Community Psychiatrist, Dr Tibor Molnar. [11] The update report noted that risperidone had been ceased due to side effects but the lithium continued. The report noted that the appellant had requested a transfer to another psychiatrist in August 2010 and accordingly was reviewed by Dr Amanda Taylor on 1 September 2009. She stated that the appellant presented as superficially well with no major mood symptoms that were evident. However, he talked in a paranoid manner about the mental health system, being on an involuntary treatment order and blaming it for restricting his access to his children. His insight was impaired and he admitted to ongoing alcohol abuse. The update report noted that in mid September the appellant’s mental state deteriorated and he was referred for an admission on an authority to return following concerns regarding an aggressive incident. He was also sexually inappropriate and had operated a motor vehicle whilst under the influence of alcohol. The appellant was admitted from 16 September to 20 October. He had presented with elevated mood, irritability, questionable compliance with medication, grandiose ideas, impulsivity and sexually -- 3 of 5 -- 4 inappropriate behaviour. It would appear that he had taken diazepam prior to his doctor’s appointments to ensure he appeared settled. [12] Dr Taylor also gave evidence at the hearing and indicated that during that admission the appellant was stabilised on lithium and risperdal and his diagnosis on discharge was manic exacerbation of bipolar disorder, against a background of longstanding narcissistic and antisocial traits. [13] The appellant was discharged to Acmena House and a report from the team leader at the house to the treating psychiatrist indicated that whilst his manic symptoms have largely settled, there are periods where he is mildly elevated and disorganised. He is still angry with the authorities and the system and does not acknowledge his mental health issues. The treating psychiatrist indicated that taking into account the appellant’s past psychiatric history and his recent manic exacerbation of his bipolar effective disorder, she considered that the illness requires immediate and ongoing treatment. That treatment currently consists of depot medication (risperidone) and lithium. He also has regular monitoring of his mental state by staff at Acmena House and regular reviews by his treating psychiatrist. [14] Dr Taylor considered that because of his illness there is still an imminent and ongoing risk that he would cause harm to himself or someone else or others. Dr Taylor considered that the appellant has behaved in an aggressive and impulsive manner in the recent past and remains an ongoing risk. He was noted prior to his admission to have caused harm to others and was intoxicated and aggressive and had taken the car and driven off. He is still angry with the mental health system and his restricted access to his children. Dr Taylor considers that his insight is limited and that long-term this is an issue of concern. The treating team considered that the community category of the involuntary treatment order is appropriate in ensuring the appellant continues to receive appropriate treatment. [15] The appellant presented his arguments to the court. One of his main concerns related to the late hour at which his matter was heard and his perception that his matter was rushed through without the Tribunal really looking at his material. He also was concerned that the material in the hospital files is not always accurate and he feels he is not kept fully informed about changes in his medication levels. [16] The appellant told the Court about his ongoing concern for his family and his desire to assist in their care. He told the Court that he didn’t necessarily agree that he had a diagnosis of bipolar disorder and would not necessarily take his medication if he was not required to by the ITO. The Views of the Assisting Psychiatrists [17] Dr Varghese considered that the diagnosis of bipolar disorder was justified given his history. He also considered there was current evidence of a hypermanic state. Dr Varghese also considered that the bipolar onset and reactivation may well be stress related. He also stated that improvement was unlikely unless the appellant -- 4 of 5 -- 5 continues to receive treatment. However if the appellant complied with treatment then his condition was very treatable and his symptoms would respond to treatment. [18] Dr McVie agreed with Dr Varghese’s views and considered that the appellant was in a resolving hypomanic state and that his illness and relapses are clearly related to his stressors. She considered however that he needed to work with Dr Taylor in managing his mental illness as well as his lithium levels. Conclusion [19] I consider that the appellant has a diagnosis of bipolar affective disorder which requires immediate and continuing treatment. He meets the criteria in section 14 of the Act for the continuation of an involuntary treatment order. [20] It would seem clear that on the basis of that material and on the basis of the material which was before the Mental Health Review Tribunal that the appellant has continued to display impaired insight into his bipolar illness and the long term need for treatment. It would seem that he has a long history of non compliance. It is also clear that his lithium levels were low on his recent admission. It would also appear that the appellant does not recognise the effect his mental illness has on his family. He continues to consider that his behaviour is a result of intoxication, rather than an acceptance of his mental illness. I am satisfied that there is no less restrictive way of ensuring the appellant receives treatment. [21] I agree with the conclusion of the Mental Health Review Tribunal that because of his lack of insight the appellant lacks the capacity to consent to his treatment. I also consider that he is at risk of mental state deterioration as well as aggression towards others and harm to himself if he does not receive treatment. [22] The decision of the Mental Health Review Tribunal of 8 July 2010 is therefore confirmed. -- 5 of 5 --