AJB, Re [2003] QMHC 4

MENTAL HEALTH COURT CITATION: Re AJB [2003] QMHC 004 PARTIES: REFERENCE BY THE DIRECTOR OF MENTAL HEALTH IN RESPECT OF AJB PROCEEDING NO: No 0256 of 2002 DELIVERED ON: 21 July 2003 DELIVERED AT: Brisbane HEARING DATE: 30 June, 1 July 2003 JUDGE: Wilson J ASSISTING PSYCHIATRISTS: Dr D A Grant Dr J F Wood FINDINGS AND ORDERS: 1. At the time of the alleged offences, the defendant was suffering from unsoundness of mind as described in schedule 2 of the Mental Health Act 2000 (Qld); 2. Order that the defendant be detained as a forensic patient in the Royal Brisbane Hospital and Royal Women’s Hospital and District Authorised Mental Health Service for involuntary treatment and care; 3. Approval of limited community treatment in the nature of more than overnight leave at the discretion of the authorised psychiatrist on the following conditions: (a) that the defendant reside at a place approved in advance in writing by the authorised psychiatrist; (b) that the defendant attend all follow up appointments and in patient care as required by the authorised psychiatrist; (c) that the defendant comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment; (d) that the defendant refrain from using alcohol and illicit drugs and co-operate fully in random medical tests for those substances as required by the authorised psychiatrist; (e) that the defendant not drive a motor vehicle unless permitted to do so by the authorised psychiatrist; and (f) that the defendant be prohibited from -- 1 of 4 -- 2 possessing a firearm or other offensive weapon (including knives). CATCHWORDS: MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant is charged with one count of going armed in such manner as to cause fear to another and two counts of serious assault of a police officer – where defendant suffers from a schizoaffective disorder – where defendant experienced persistent and recurrent visual images of a violent and sadistic nature – where defendant has a history of alcohol abuse or dependence – where defendant had limited insight into his illness and was frequently non-compliant with treatment – whether defendant was deprived of any capacity in s 27 Criminal Code 1899 (Qld) Mental Health Act 2000 (Qld), s 288(3), schedule 2 Criminal Code 1899 (Qld), s 27 Stapleton v The Queen (1952) 86 CLR 358, cited COUNSEL: C Morgan for the defendant M Nicolson for the Director of Public Prosecutions J Tate for the Director of Mental Health SOLICITORS: Legal Aid Queensland for the defendant The Director of Public Prosecutions The Crown Solicitor for the Director of Mental Health [2] WILSON J: AJB [“the defendant”] has been charged with going armed in such a manner as to cause fear to another and two counts of serious assault of a police officer, all on 5 July 2002. The matter of his mental condition in relation to the alleged offences was referred to this Court by the Director of Mental Health. The defendant’s antecedents [3] The defendant was born on 28 May 1972. He had a history of psychosocial decline dating back ten years, and more than twenty admissions to psychiatric hospitals from 1998, usually in the context of depression or psychotic symptoms. He had been diagnosed with a schizoaffective disorder for which he had been prescribed multiple anti-psychotic medications (both oral and intramuscular), anti-depressant therapy and electro-convulsive therapy. He experienced persistent and recurrent visual images of a violent and sadistic nature, sometimes sexual. In the opinion of Dr Jon-Paul Khoo, a psychiatrist who treated him before the commission of the alleged offences and who examined him at the request of this Court, he also suffered from an obsessive compulsive disorder. The latter may have been a feature of his psychotic disorder. He had a history of alcohol abuse or dependence. His insight into his condition was limited, and he was frequently non-compliant with treatment. -- 2 of 4 -- 3 The alleged offences [4] At about 10.50pm on 5 July 2002 police were conducting mobile patrols in Brunswick Street, Fortitude Valley. Their attention was drawn to a cab driver in distress. They saw the defendant in the front passenger seat of the cab brandishing a knife. When police approached the cab, the defendant got out of the vehicle and held the knife in a threatening manner. Police drew their firearms. The defendant yelled “Shoot me!” several times. He walked aggressively towards police wielding the knife in a threatening manner. The police used capsicum spray on the defendant, who dropped the knife, but continued to stand in the middle of the road in a threatening manner. Police tackled him to the ground before handcuffing him. The defendant’s mental condition at the time of the alleged offences [5] The defendant had been out of hospital for about four months. He had been non- compliant with his medication for about five days. He told Dr Rodney Marsh, a psychiatrist who had previously treated him and who examined him on 15 July 2002 (ten days after the alleged offences) that this was because “he felt OK and ... [he] was busy”. He told Dr Khoo, who examined him seven months later, that he had run out of medication, and had not gone to collect more. He had not been sleeping well, and had been experiencing intrusive violent thoughts with increasing frequency, and an increasingly depressed mood. He went to a hotel to pass time and had about three or four standard drinks over a three hour period. He was worried he would lose control and injure people in the Valley. He had a knife at home, and was concerned that he might use it to enact some of his visual images. He caught a cab home and collected the knife, and wanted the cab to take him to Royal Brisbane Hospital so that he could give the knife to someone for safekeeping out of his control. At the time of the alleged offences he was actively experiencing intrusive violent visual images and thoughts. Unsound mind [6] I am satisfied that the defendant was suffering from a disease of the mind within s 27 of the Criminal Code 1899 (Qld) at the time of the alleged offences. Was he deprived by that disease of any of the three capacities - the capacity to understand what he was doing, the capacity to control his actions, or the capacity to know that he ought not do the acts in question? [7] Dr Khoo considered that the defendant’s psychosis deprived him of the capacity to know he ought not do the acts in question. [8] Dr Marsh initially thought that the behaviour was attributable to obsessions rather than psychotic experiences, but agreed in oral evidence that the conclusion that he was psychotic was equally open. He was troubled by the temporal association between the behaviour in question and the consumption of alcohol. However, in cross-examination he acknowledged that there was no evidence that the defendant was intoxicated. In fact by the conclusion of the hearing all parties agreed that intoxication was not a live issue in this case. Although Dr Marsh said in his report that he was unconvinced that the defendant was deprived of any of the relevant three capacities, I understood his opinion to change during his oral evidence when he agreed that the defendant was unable to reason about the moral rightness or wrongness of his actions with a reasonable degree of composure. In other words, I understood him to come round to the view that he was deprived of the capacity to -- 3 of 4 -- 4 know that he ought not do the acts. See Stapleton v The Queen (1952) 86 CLR 358 at 375. [9] I am satisfied that at the time of the alleged offences the defendant’s mental illness deprived him of the capacity to know that he ought not do the acts in question - that is, that he was of unsound mind as described in schedule 2 of the Mental Health Act 2000 (Qld). Forensic order [10] Dr Marsh described the defendant’s illness as brittle: he deteriorates very quickly in the absence of medication. On the evidence his illness has greatly improved since the alleged offences. His level of insight has improved and he is in more or less full-time work in a palliative care hospital. When seen by Dr Khoo in February 2003 he had had no violent ideation for 14 days and his mood was well controlled. Dr Mark Barnes has been the defendant’s treating psychiatrist most recently. He reported that he had seen him twice in the outpatient clinic at Royal Brisbane Hospital when he presented reasonably well. Dr Barnes noted that the defendant was compliant with injectable anti-psychotic medication, and that although he had continued to use alcohol and cannabis, this had apparently not resulted in any significant deterioration in his condition recently. There had been no concerning behaviours. [11] The Court must consider the seriousness of the alleged offences, the defendant’s treatment needs and the protection of the community in deciding whether to make a forensic order: s288(3) Mental Health Act 2000. Despite the opinions of Dr Khoo and Dr Barnes that his treatment needs were adequately met by an involuntary treatment order, all parties submitted that a forensic order would be appropriate in the circumstances. The assisting psychiatrists agreed. [12] I order that the defendant be detained as a forensic patient in the Royal Brisbane Hospital and Royal Women’s Hospital and District Authorised Mental Health Service for involuntary treatment and care. I approve limited community treatment in the nature of more than overnight leave (to commence immediately) on the following conditions: 1. that he reside at a place approved in advance in writing by the authorised psychiatrist; 2. that he attend all follow up appointments and in patient care as required by the authorised psychiatrist; 3. that he comply with the requirements of the authorised psychiatrist in relation to the taking of prescribed medication and other treatment; 4. that he refrain from using alcohol and illicit drugs and co-operate fully in random medical tests for those substances as required by the authorised psychiatrist; 5. that he not drive a motor vehicle unless permitted to do so by the authorised psychiatrist; and 6. that he be prohibited from possessing a firearm or other offensive weapon (including knives). -- 4 of 4 --