Coombes, Re [2010] QMHC 2

MENTAL HEALTH COURT CITATION: Re Coombes [2010] QMHC 2 PARTIES: REFERENCE BY THE PATIENT’S LEGAL REPRESENTATIVE IN RESPECT OF SAMUEL MATTHEW COOMBES PROCEEDING: No 083 of 2009 DELIVERED ON: 24 February 2010 DELIVERED AT: Brisbane HEARING DATE: 8 February 2010 JUDGE: Philippides J ASSISTING PSYCHIATRISTS: Dr F T Varghese Dr E N McVie FINDINGS AND ORDERS: 1. That the defendant was of unsound mind at the time of the alleged offence as defined in Schedule 2 of the Mental Health Act 2000 (Qld). 2. That the defendant be detained as a forensic patient at The Park High Security Program Authorised Mental Health Service. 3. Limited Community Treatment is approved to commence immediately at the discretion of the treating psychiatrist on the following conditions: (a) That the defendant remain under the escort of health service staff member/s; limited to the grounds of The Park – Centre for Mental Health; and (b) That for the purposes of the Limited Community Treatment, the defendant comply with the directions of the nominated staff member/s for the duration of the Limited Community Treatment. CATCHWORDS: MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with murder – whether defendant suffered from a mental illness – whether a dispute of fact arises which is attributable to the defendant’s mental condition – whether defendant was of unsound mind as defined in Schedule 2 of the Mental Health Act 2000 (Qld) at the relevant time. Mental Health Act 2000 (Qld), Schedule 2 COUNSEL: Mr J Briggs for the Defendant Mr J Tate for the Director of Mental Health Mr D Finch for the Director of Public Prosecutions (Qld) -- 1 of 6 -- 2 SOLICITORS: Legal Aid Queensland for the Defendant Crown Law for the Director of Mental Health The Director of Public Prosecutions (Qld) [1] PHILIPPIDES J: The defendant has been charged with the murder of Michael John Betts in Mackay on 7 December 2008. The matter of the defendant’s mental condition at the time of the events leading to the charge has been referred to the Court. Background [2] Prior to the events in question the defendant has had a history of mental illness with multiple admissions and depot medication under Involuntary Treatment Orders (ITO). The defendant was last placed on an ITO in August 2007 and subsequently received anti-psychotic medication. The ITO was revoked in March 2008. In November 2008 he was seen for a physical ailment and noted to be psychotic and recommended for mental assessment, which he refused. Unfortunately, he absconded before he could be admitted. It appears that during much of 2008 he was not receiving medication. [3] In the month leading up to the alleged offence, the defendant had been living in his car and sleeping on the beach. On the night in question, the defendant approached a group of men, one of whom was the victim, at a Mackay surf club. He asked for the use of a mobile phone so he could “call the owner of all the mines”. One of the men gave the defendant his phone to use. The defendant was unable to contact the person he was calling. He became increasingly agitated, making accusations that those in the group had stolen his shoes and mobile phone, and eventually becoming involved in a physical altercation which resulted in him being subdued on the ground by one of the men. [4] The defendant left the group at this time and returned to his car, from which he retrieved a serrated hunting knife. At 2.30 am, the Mackay Police received a 000 call from an unidentified man who claimed to have been assaulted. During that call he stated, “I’m gonna grab my shit, gonna walk back up there and stab the fuck out of all of them. Is that ok?” That was the second 000 call the defendant made, the earlier call referring to being “beaten” and “an injury to my head”. [5] The defendant returned to the group of men approximately 15 minutes later and was described as “ranting and raving”; he was swinging the knife at the group and swearing at them. One of the men, the victim, had a bamboo pole which he was using to keep the defendant at bay. It appears from the eyewitness accounts that the defendant charged at the victim, yelling that he was going to kill him. The defendant and victim fell to the ground, where the defendant stabbed him several times to the chest and abdomen, fatally wounding him. [6] Police and ambulance were called immediately. However, the victim was unresponsive and not breathing. Ambulance officers were unable to revive him. [7] The defendant was observed by police standing near the crime scene. He was arrested without resistance. At that time he told the police, “I called you before I did this” and “they stabbed me twice before I got him”. The defendant continued to -- 2 of 6 -- 3 maintain that he had been “stabbed” in the face and chest. However, it was apparent that the defendant had no visible injuries consistent with having been stabbed. [8] The defendant was seen by a psychiatrist on 10 December 2008 and noted to be non-cooperative, confused and disorganised. It was initially thought that the defendant had suffered a pseudo-psychotic episode. In February 2009 the defendant was noted to be displaying thought disorder, befuddlement and bizarre behaviour. On a further review on 4 March 2009, the defendant was considered to be suffering from disorganised psychosis. The defendant was admitted to the High Secure Hospital at The Park – Centre for Mental Health on 15 May 2009 and placed on an ITO. He required seclusion and was treated with various anti-psychotic medication. Clinical evidence as to diagnosis [9] Each of the reporting psychiatrists agreed that the defendant suffers from a schizophrenic illness, although there were differences of opinion as to the precise type of schizophrenia the defendant suffers from. [10] Dr Fama provided a report dated 26 March 2009, following an examination of the defendant on 12 March 2009, after he had been in custody for some three months. Dr Fama’s diagnosis was of undifferentiated schizophrenia, which has “been aggravated in the past by illicit drug usage, and in recent times prior to his arrest by excessive drinking”. Dr Fama noted that the defendant had been intoxicated at the relevant time, but observed that “the persistence of core symptoms during custody over 3 months indicates that [the defendant’s] disability cannot be now attributed primarily to substance abuse of one kind or another”. I note that in oral evidence Dr Fama retracted the statements in his report that he had been unable to elicit any evident delusions, indicating that the defendant had at least overvalued ideas and “quite possibly delusions … that people were against him in general”. [11] Dr van de Hoef, in her report of 13 August 2009, compiled after seeing the defendant on 6 August 2009, diagnosed the defendant as suffering from “a severe psychotic illness, most likely chronic schizophrenia, probably of the paranoid type” which had its onset at least some years previously, and which was untreated at the time. [12] Dr Aboud provided a report dated 3 August 2009, after examining the defendant on 20 June 2009. In it he opined that the defendant suffered from undifferentiated schizophrenia, noting that: “… [he] suffers from a psychotic disorder that would robustly meet the criteria for a schizophrenic illness … his illness has been characterised by a wide range of symptoms, including obvious symptoms of hebephrenic schizophrenia (flattening of affect, prominent thought disorder, developing negative symptoms), but also some marked paranoid features (persecutory delusions, delusions of thought control and auditory hallucinations) and possible mild catatonic symptoms (psychomotor disturbance and possible posturing observed in the prison) … In my view his illness would best be categorised as Undifferentiated Schizophrenia (ICD- 10 F20.3). It is questionable whether he was ever fully responded to treatment in the past.” -- 3 of 6 -- 4 Dispute of fact [13] While the defendant’s version of the offence might be thought to raise a dispute of fact as to whether the defendant acted in response to an actual or perceived threat to him by the group of which the victim was a part, the reporting psychiatrists each took the view that any dispute was attributable to the defendant’s mental state. [14] Thus Dr van de Hoef opined that the defendant’s mental condition “caused him to experience psychotic misinterpretation of events, or perhaps form delusions of reference about events and people (to explain his bizarre and paranoid behaviour at the surf club, and his accumulation of weapons)”. She was of the view that “at the relevant time [the defendant] had delusional beliefs that he was under attack and had to defend himself from the group of strangers who shortly beforehand had actually assisted him”. Her conclusion in respect of the defendant’s claim of being attacked was that: “… the contemporaneous descriptions of his appearance and behaviour that night, and in custody indicate, I think he was floridly psychotic and the ‘dispute’ arose from symptoms of his mental illness … I therefore conclude there is no true dispute of facts.” [15] Likewise, Dr Aboud opined that the defendant’s version was “heavily impacted on by his psychotic misinterpretation” and that he did not consider that there was “a dispute of facts relevant to the case”. Dr Fama also reached the same conclusion. [16] The assisting psychiatrists both recommended that this clinical evidence of the reporting clinicians be accepted. I note that the clinical opinion on the matter is consistent with the objective evidence that the defendant had not sustained the injuries he claimed to have suffered prior to the alleged offence. Accordingly, I am satisfied that any dispute of fact as to the circumstances of the offence is attributable to the defendant’s mental condition. The Court is required, therefore, to consider whether the defendant was of unsound mind at the relevant time within the meaning of the Mental Health Act 2000. Intoxication and unsoundness [17] The defendant reported to Dr Aboud that he had consumed up to five beers and two bottles of wine on the evening of the offence. He also reported alcohol consumption to Dr Fama, but in different amounts. A blood alcohol analysis performed at 11.10 am on the morning following the offence revealed a blood alcohol level of 43mg per cent. Based on that figure, Dr Fama estimated that the defendant’s blood alcohol at the time of the offence would have been approximately 180mg per cent. [18] In oral evidence, Dr Fama confirmed that while intoxication was a factor in terms of the capacity for control, it did not feature to any extent in the deprivation of the capacity to know. In this regard, Dr Fama stated in his report: “Though alcohol may well have contributed to [the defendant’s] actions by its general disinhibiting effect, it was not the source of [his] morbid thinking which has in fact persisted for some months after the offence. -- 4 of 6 -- 5 In short, in my view [the defendant] was disturbed enough at the time by reason of mental disease, even were he sober, to have believed that he was doing nothing wrong.” [19] Dr van de Hoef likewise, in considering the role of intoxication, concluded that although the evidence indicated that the defendant was at least moderately and perhaps heavily intoxicated with alcohol at the material time, nevertheless, it did not contribute to any extent to the deprivation of capacity. Although Dr van de Hoef appeared to reach this conclusion in her report in respect of both the capacity to know he ought not to do the act and the capacity for control, in her oral evidence she clarified that her opinion was directed to the capacity to know. She indicated that she had reached that conclusion having regard to the evidence of psychotic and delusional thinking before (in November 2008) and after the events in question which continued while abstinent. [20] In respect of the issue of unsoundness of mind, Dr Aboud concluded: “… Mr Coombes was suffering from a state of mental disease, namely symptoms of schizophrenic illness, at the time of the alleged offence. There is evidence of a deteriorated mental state in the preceding weeks … In my view he was experiencing active symptoms of a psychotic illness when he called ‘000’, obtained a knife and returned to the scene. His thinking was paranoid, illogical, distressed and fearful, and consistent with the manifestations of his established illness … I do not believe he was able to reason about the matter with a moderate degree of sense and composure. I believe that he felt justified in his actions at the time. I therefore believe that at the material time he was deprived of the capacity to know that he ought not to do the act and that this deprivation arose directly from his psychotic mental state.” [21] Although Dr Aboud considered that the evidence indicated the defendant was intoxicated at the time of the offence, he stated in his report: “… it is my opinion that it was his schizophrenic illness and its psychotic manifestations that deprived him of the relevant capacity. I believe that he would have been deprived of this capacity in the absence of alcohol.” Findings and orders [22] The clinical evidence from the three reporting psychiatrists is to the same effect; that the defendant suffered from a severe schizophrenic illness at the time of the alleged offences. All are united in opining that the defendant’s mental state resulted in the deprivation of the capacity to know that he ought not do the acts in question. [23] I note that none of the reporters considered that intoxication contributed, to any extent, to the state of mind resulting in that deprivation. They considered that the defendant’s mental illness was of such severity that it alone resulted in the relevant deprivation of capacity. In reaching this view, the clinicians chronicled the evidence of psychosis prior to the events in question and the lengthy period following incarceration, during which he remained unwell although he was -- 5 of 6 -- 6 abstinent and receiving treatment. The clinicians’ view is supported by the assisting psychiatrists. [24] In the circumstances, I am satisfied that as a result of that mental illness the defendant was deprived of the capacity to know that he ought not to do the acts in question. Accordingly, I find that the defendant was of unsound mind at the material time within the meaning of Schedule 2 of the Mental Health Act 2000 (Qld). [25] The update report of Dr Morris, consultant psychiatrist at The Park, indicates that the defendant continues to retain some concerning delusional ideation in respect of his mother. It is apparent that the defendant has significant ongoing treatment needs. The gravity of the offence, the treatment requirements of the defendant and the need to protect the community, demonstrate that a forensic order is clearly required. It is also evident that limited community treatment should be quite constrained at present and confined to escorted ground leave. [26] Accordingly, I order that the defendant be detained as a forensic patient at The Park High Security Program Authorised Mental Health Service. I approve Limited Community Treatment to commence immediately on the following conditions: 1. That the defendant remain under the escort of health service staff member/s limited to the grounds of The Park – Centre for Mental Health at the discretion of the treating psychiatrist; and 2. That for the purposes of the Limited Community Treatment, the defendant comply with the directions of the nominated staff member/s for the duration of the Limited Community Treatment. -- 6 of 6 --