Re Powerion[2015] QMHC 3

MENTAL HEALTH COURT

1. [1]
   BODDICE J: By reference filed 3 December 2013, the legal representatives for Mia Aqua Powerion referred to this Court her mental condition at the time of the offences of serious assault, assault police and obstruct police, all alleged to have been committed on 23 October 2011.  At issue are the questions of unsoundness of mind and fitness for trial.
2. [2]
   There is no dispute the defendant suffers from a long-standing chronic mental illness complicated by a significant history of polysubstance abuse.  At issue is whether any deprivation of capacity was due to her mental condition at the time of the alleged offence, or contributed to by her ingestion of intoxicating substances.

Background

3. [3]
   The defendant was born on 27 February 1981.  She lives in supported accommodation and is in receipt of a disability support pension.  She has a diagnosis of schizophrenia.  This mental condition is complicated by long-standing polysubstance abuse disorder and an emotionally unstable personality disorder of the borderline type.  In 2003 she was diagnosed with attention deficit hyperactivity disorder and prescribed dexamphetamine. 
4. [4]
   The defendant has a lengthy history of involvement with a number of mental health services.  Her treatment in the past has included numerous admissions to hospital.  She has, on occasions, been the subject of an involuntary treatment order.  She continues to receive regular treatment within the community.
5. [5]
   The defendant’s substance use commenced at the age of 12.  She soon became a regular user of cannabis and alcohol.  She has, in the past, also abused heroin and amphetamines.  Over the course of her treatment she has been treated with a number of psychotropic medications, mostly anti-psychotics and mood stabilisers.  Her past history has been characterised by erratic compliance with her prescribed medication needs.  During periods of deterioration, her self-care has declined and she has, in the past, exhibited symptoms which have been treated as signs of mania.

Offences

6. [6]
   The alleged offences all occurred on the one day.  Earlier that day, the defendant had attended a friend’s house and consumed cannabis and alcohol.  There are differing accounts as to the amount of each substance she consumed at that time.  Later, her presentation started to change and her friend’s flatmate contacted the authorities.  A physical confrontation took place when ambulance officers arrived, and the situation escalated after the arrival of police.  The defendant became irrational, yelling and screaming, and would not calm down when police requested she do so. 
7. [7]
   It is alleged the defendant rushed towards the police and punched a police officer hard in the upper chest with both her fists.  After being arrested by police, the defendant continued to struggle with police.  She subsequently kicked a police officer in the shin.  The defendant’s account of what occurred was to deny kicking or pushing the police officer, although she admitted spitting at a police officer who came too close to her and touched her chest.

Medical evidence

8. [8]
   After her arrest on 23 October 2011, the defendant was assessed at the watchhouse by a mental health liaison nurse.  Due to ongoing concerns about her mental state, the defendant was subsequently admitted to the Nambour Hospital.  Those concerns included that she appeared disorganised, volatile, verbally aggressive and possibly manic.
9. [9]
   The defendant was admitted to hospital on 24 October 2011 and discharged the following day.  According to the discharge summary, she had been brought to hospital as a consequence of her behaviour being described as extremely disruptive, agitated and displaying some thought disorder.  Her admission was not eventful and she appeared to settle whilst on the ward.  The assessment of hospital staff was that there was no evidence suggestive of relapse of bipolar affective disorder (either mood disturbances or psychosis).  The defendant at the time gave an account of having consumed cannabis, oxycontin and speed two days prior to her admission. 
10. [10]
    The defendant was discharged from hospital on 25 October 2011, with a revocation of her involuntary treatment order and follow-up medications and appointments.

Reporting psychiatrists

11. [11]
    Dr Kovacevic examined the defendant on 23 August 2013.  Dr Kovacevic noted no abnormalities in her thought, form or processes at interview.  Her thinking was logical and goal-oriented.  There was no evidence of delusions, overvalued ideas or obsessions. 
12. [12]
    In Dr Kovacevic’s opinion, the defendant was acutely mentally disturbed at the time of the alleged offences.  There were reports she had disengaged from treatment, and was non-compliant with her medications at that time.  Dr Kovacevic also noted reports suggestive that the defendant had consumed illicit substances shortly before the incident, which may have contributed to her mental state at the time.
13. [13]
    Dr Kovacevic opined the defendant suffered from Schizoaffective Disorder.  There was a possibility of an additional diagnosis of attention deficit hyperactivity disorder.  Her condition was complicated by frequent disengagement from treatment, non-compliance and polysubstance abuse.  In his opinion, the defendant was suffering from an acute deterioration of her schizoaffective disorder at the time of the alleged offences which affected her judgment, thinking and behaviour. 
14. [14]
    In Dr Kovacevic’s opinion, the defendant’s initial assessment at the Maroochydore watchhouse was strongly suggestive of a manic state with psychotic features, characterised by flight of ideas, irritability, disorganised behaviour, aggressiveness and a formal thought disorder.  Whilst that mental state settled relatively rapidly, Dr Kovacevic opined the initial mental state raised questions about the defendant’s capacities of the time of the alleged offences.  He opined the defendant may have been deprived of the capacity to control her conduct and of the capacity to appreciate what she was doing was wrong.  Those deprivations were as a consequence of her schizoaffective disorder alone, notwithstanding the consumption of alcohol and illicit drugs. 
15. [15]
    In evidence at the hearing, Dr Kovacevic maintained the defendant’s mental illness was such at the time of the alleged offences that it was sufficient alone to deprive her of the relevant capacities.  However, Dr Kovacevic accepted the consumption of intoxicating substances may have, to some extent, contributed to her mental condition at the time of the alleged offences.  He accepted that the change in her condition between the time of the offences and the following day may be consistent with those intoxicating substances playing a part in her deterioration.
16. [16]
    Dr Butler examined the defendant on 13 April 2015.  He opined the defendant suffers from schizoaffective disorder, cannabis use disorder and alcohol use disorder.  She also has a differential diagnosis of recurrent cannabis-induced psychotic disorder and cannabis-induced mood disorder.  In his opinion, the schizoaffective disorder has had a recent manic episode, whilst the cannabis use disorder is presently in remission and the alcohol use disorder is of a moderate severity.
17. [17]
    Dr Butler opined that at the time of the alleged offences the defendant was entering a disturbed mental state characterised by abnormal mood, disorganised behaviour and thought disorder.  In Dr Butler’s opinion, having regard to the defendant’s disorganised thought and manner, she was exhibiting a clear exacerbation of her schizoaffective disorder around the time of the alleged offence.  This mental condition was such that it deprived her of all three of the relevant capacities at the time of the alleged offences.
18. [18]
    Dr Butler accepted there was evidence of the presence of intoxicating substances, and evidence her behavioural disturbance did not last beyond two or three days.  However, in his opinion, its duration was well beyond that which would normally be expected with an episode of cannabis intoxication.  Accordingly, Dr Butler opined that whilst the use of illicit substances may have temporarily activated intrinsic psychotic phenomena, it was her disturbed mental state which deprived her of the requisite capacities. 
19. [19]
    Dr Butler maintained that opinion in evidence at the hearing.  However, like Dr Kovacevic, Dr Butler accepted the presence of the intoxicating substances may have contributed to the defendant’s mental condition at the time of the alleged offences.  It may be that those substances exacerbated her mental state.  However, if they did, they were probably not a significant contributing factor to the deprivation of her capacities.

Assisting psychiatrists

20. [20]
    The assisting psychiatrists advise I ought to accept the defendant suffers from a mental illness, and that that mental illness was operative at the time of the alleged offences.  However both advise the presence of intoxicating substances contributed to an extent to the defendant’s mental condition at the time of those alleged offences.  Dr Varghese advises that contribution was substantial.

Discussion

21. [21]
    There is no doubt the defendant suffers from a longstanding psychotic illness.  There is also no doubt the defendant had consumed intoxicating substances shortly before the alleged offences.  Those substances included cannabis, alcohol and amphetamines.  The question for determination by this Court is whether those intoxicating substances contributed, to an extent, to the defendant’s mental state at the time of the alleged offences. 
22. [22]
    In determining that issue, it is relevant to consider whether the presence of any underlying mental illness alone would have deprived the defendant of the requisite capacities.  If so, the concurrent presence of intoxicating substances at the same time will not deprive the defendant of a defence of unsoundness of mind.^[1]
23. [23]
    Both Dr Kovacevic and Dr Butler opined the defendant had a mental illness at the time of the alleged offences which, of itself, would have been sufficient to deprive her of the requisite capacities.  However, neither was able to exclude the presence of intoxicating substances as having contributed, to an extent, to her mental state at the time of the alleged offences.  Both accepted her rapid recovery in hospital following her admission from the watchhouse was consistent with the ingestion of intoxicating substances having exacerbated her mental state.
24. [24]
    Having considered the evidence, I am satisfied the ingestion of those intoxicating substances contributed, to an extent, to the defendant’s mental state.  As the assisting psychiatrist noted in their advice, the defendant was reviewed by relevant mental health staff following the alleged offences.  Their opinion was that the defendant was not suffering a significant mental illness episode.  That opinion was consistent with her relatively rapid return to a cooperative state, such that when she was discharged from hospital two days later she was not considered to be psychiatrically unwell. 
25. [25]
    The conclusion that the presence of intoxicating substances contributed, to an extent, to the defendant’s mental condition at the time of the alleged offences means the defendant is unable to avail herself of a defence of unsoundness of mind. 

Conclusion

26. [26]
    I am satisfied, notwithstanding the presence of an underlying mental illness at the time of the alleged offences, the defendant’s mental state at the time of the alleged offence was contributed to by the presence of intoxicating substances.  The defendant was not suffering from unsoundness of mind at the relevant time.
27. [27]
    Both Dr Kovacevic and Dr Butler opine the defendant is fit for trial.  I accept their opinions.  There is no reason why the alleged offences should not proceed according to law.

Orders

28. [28]
    I order:

    1. At the time of each of the alleged offences the subject of the reference, the defendant was not suffering from unsoundness of mind as defined in the schedule to the Mental Health Act 2000 (Qld).
    2. In respect of each of the alleged offences, the defendant is fit for trial.
    3. Each of the alleged offences is to proceed according to law.
    4. Copies of the reports are to be released to the parties in the criminal proceedings.