Attorney-General v Watkins[2024] QSC 228

1. [1]
   The respondent is a 55-year-old male who has been in custody for approximately 25 years for violent sexual assaults he committed against a woman in 1990, and a female child in 1998. For nearly eight of the past 25 years, the respondent has been subject to an order detaining him for an indefinite term for control, care or treatment under Part 2, Division 3 of the Dangerous Prisoners (Sexual Offenders) Act 2003 (Qld). This continuing detention order was made following the first hearing under the Act on 6 February 2017, after Brown J (as her Honour then was) found that the respondent was a serious danger to the community in the absence of such an order.^[1]
2. [2]
   Section 27 of the Act requires the Attorney General to file an application for an annual review of a continuing detention order within 12 months of the completed hearing of the last review.^[2] This is the sixth such application by the Attorney-General for such a review. The previous reviews being on:

   1. 12 December 2018, by Burns J;
   2. 6 December 2019, by Brown J;
   3. 1 March 2021, by Williams J;
   4. 31 May 2022, by Kelly J; and
   5. 13 July 2023, by Cooper J.
3. [3]
   Following each of the above reviews, the court affirmed Brown J’s initial finding that the respondent was a serious danger to the community in the absence of a Division 3 order under the Act; and ordered that he continue to be subject to the continuing detention order.
4. [4]
   On this review, the Attorney-General again submitted that the court would affirm the initial finding and order that the respondent continue to be subject to the continuing detention order. The respondent accepted that the evidence supports a finding that he is a serious danger to the community in the absence of a Division 3 order and therefore that the decision of Brown J at the first hearing should be affirmed. But contrary to the Attorney General’s position, the respondent submitted that the evidence supports a finding that the adequate protection of the community can be ensured by the making of a supervision order and that he should be released back into the community on such an order.

Relevant legal principles

5. [5]
   On review, the court may affirm the original decision [that the respondent is a serious danger to the community in the absence of a Division 3 order] only if it is satisfied by acceptable, cogent evidence and to a high degree of probability, that the evidence is of sufficient weight to affirm the decision.^[3] In making such a decision, the court must have regard to “required matters” which relevantly include the matters in s 13(4) of the Act.
6. [6]
   If the court affirms the decision, it may order that the respondent (a) continue to be subject to the continuing detention order or (b) be released from custody subject to a supervision order.^[4]
7. [7]
   Protection of the community from the risk that the respondent will commit a serious sexual offence is the paramount consideration in deciding between these alternatives.^[5] In determining whether the adequate protection of the community can be reasonably and practicably managed by a supervision order, it is also necessary to consider whether the requirements of a supervision order can be reasonably and practicably managed by corrective services officers.^[6]
8. [8]
   It is well established that the respondent’s liberty should not be constrained to any greater extent than is warranted by the Act.^[7] It follows, therefore, that if, after having regard to the respondent’s risk to the community, the court is satisfied that his supervision would be sufficient to ensure adequate protection of the community, then an order for supervised release should, in principle, be preferred to a continuing detention order.^[8]

Relevant background to the continuing detention order being made

9. [9]
   On 24 September 1990, the respondent pleaded guilty in the District Court at Southport to several offences including the vicious rape of an adult woman. He was sentenced to eight years’ imprisonment for the rape offence, with a recommendation that he be eligible for parole after serving two years in custody. The details of this offending (as extracted from the sentencing remarks) were recounted by Brown J at the first hearing as follows:^[9]

“Your Honour, dealing with those convictions on 24 September 1990 briefly relating to that, the complainant’s residence was on top of a dental technician’s office premises. The prisoner and two other people — males — broke and entered this office with the intention of stealing money from a safe that was believed to be there. They were unsuccessful in that and they broke into the dwelling by opening an internal door. A knife or knives was obtained from the kitchen of the dwelling and the male and female occupants of the dwelling were found in bed and they were threatened with the knife or knives.

The prisoner at one stage threatened the female with the knife. The male was taken out of the bedroom and bound, tied up, and…the prisoner then had intercourse with the female without her consent and one of the other offenders had intercourse with her also after that. Property was taken from the two occupants and the prisoner and the other two left in a stolen car.”

10. [10]
    The respondent was granted parole in early 1993, but five years later and while still on parole, he committed a series of serious offences including assault with intent to rape, child stealing, indecent treatment of a child under 12 and rape. The respondent was sentenced to 13 years’ imprisonment for the rape offence and to lesser concurrent terms for the other offences. The victim of those offences was a 10-year-old girl. The offending was described by the sentencing judge as follows:^[10]

“You have pleaded guilty to 17 separate offences, by far the most serious of which are counts 5 to 8 inclusive, involving as they do various offences committed upon a 10 years old girl arising from your snatching her from the street near her school, forcing her into your car and driving her some distance, requiring her to put on a shirt to disguise her school uniform into bushland, where you demanded she remove her school uniform and lie naked face down on the rear seat of your car. You forced fingers into her anus to a substantial extent and following upon that you sodomised her.

The terror and horror she must have suffered in order for you to gain about one minute’s worth of sexual gratification is almost too terrible for any decent citizen, particularly a parent who has had the care of a 10 year old girl to contemplate.

Up until this time she was a normal young girl whose parents were doing all they could to provide a happy and secure upbringing for her and an older sibling. It is no exaggeration to say you have shattered their lives and left them with indelible memories of your disgraceful and degrading behaviour.

At the time of the commission of these offences, you were on parole, to make matters worse, in respect of sentences of eight years for rape, five years for armed robbery, three years for burglary and various other property offences, those sentences being served concurrently and you had almost completed your parole.

The previous rape was committed in serious circumstances on a female in her own home after she was awoken from her sleep. Her partner was disabled and there were threats with a knife or knives and you were in the company with two other persons, one of whom at least proved himself to be a rapist as well as yourself on this occasion.

It is in your favour that you managed to stay out of trouble for a substantial period of time after you were paroled on 26 February 1993, despite a long prior criminal history of various offences, notably offences of dishonesty commencing in December 1985.

It is almost as if the strain of staying out of trouble over the years you were on parole was too much for you to bear, because in January this year you went on a spree of predatory behaviour, stealing from people who had befriended you and shared their accommodation with you, and also stealing from strangers money, car keys, and on a number of occasions, driving off in their cars whilst they slept.

You contemplated a robbery by pretending to be armed on 23 February 1998, but elected instead to kidnap, to put it in ordinary language, this schoolgirl and committed the offences on her I have already outlined.

…

So far as the remorse is concerned, often times one suspects that that is simply in order to gain sympathy from the Court and it is feigned remorse, but in your case I have carefully observed you during the time that I have had you before me, and in all of the circumstances I am prepared to regard the remorse that you have demonstrated as genuine.

You significantly cooperated with police and the authorities and this is an early plea of guilty on an ex officio indictment. Also as I previously mentioned, a matter in your favour is that you had completed most of earlier your parole in respect of the matters. But for all…of the things in your favour have outlined, the sentence for rape in my view would quite properly be fixed at the higher end of the range of 15 to 18 years submitted by the Crown.

I should say I have taken into account also your unfortunate upbringing, your parents apparently leading what you have described as deviant lifestyles for much, if not all, of your formative years which no doubt had a significant damaging effect on you.

I have no hesitation in with counts 5, 7 and 8, that is, assault with intent to commit rape, aggravated indecent treatment and rape, in this case to be serious violent offences under the relevant provisions of the Penalties and Sentences Act and I make any declaration that may be necessary in respect of any or all of those offences. That is not the subject of argument to the contrary by your legal representative, quite properly in the circumstances I should say.”

The respondent’s sentences expired in 2017 and he has remained on a continuing detention order since then.

11. [11]
    The respondent’s sentences expired in 2017 and he has remained on a continuing detention order since then.

The first hearing under the Act

12. [12]
    At the first hearing under the Act, Brown J reviewed the psychiatric evidence in careful detail. Her Honour accepted the psychiatric evidence from Dr Grant that the respondent was suffering major psychotic symptomatology and had a poor level of cooperation (which made the assessment difficult); but based on the records and evaluations to date, the respondent presented with four conditions or diagnosis:^[11]

“Paranoid Schizophrenia

1. Mr Watkins has a clear history of psychotic symptomatology since at least 1999 and probably for some period before that. Psychotic symptoms have been observed and recorded in custody. He has had two admissions to hospital and he now describes and displays prominent symptoms including delusions, hallucinations, ideas of reference and passivity phenomena, these apparently being resistant to treatment. He indicates that there may be plans to readmit him to hospital and give him a trial of Clozapine in the future.
2. A Past History of Substance Abuse and Dependence particularly involving heroin and marijuana, currently in remission in custody.
3. A Personality Disorder with prominent antisocial traits and possible borderline traits. The presence of a Major Psychiatric Disorder, however, makes it difficult to be sure exactly to what extent that Personality Disorder is affecting his current functioning.
4. Paedophilia with an attraction to underage females, that being non-exclusive, in that he has had heterosexual relationships in the past. However, his sexual history is confused in that he has reported transgender issues and homosexual relationships in the past. He denies current paedophilic attractions but has reported them as being quite prominent in the past. Therefore, I believe a diagnosis of Paedophilia is appropriate.”

13. [13]
    Her Honour’s reasons for concluding that the respondent is a serious danger to the community in the absence of a Division 3 order and with reference to the matters set out in s 13(4) were expressed as follows:^[12]

“[68] The psychiatric evidence strongly supports the fact that the respondent needs to have his mental illness addressed and properly treated as a priority before consideration can be given to the respondent being released into the community under a supervision order with or without an involuntary treatment order. Dr Grant expressed the view, that the respondent needs to be placed in a high secure psychiatric institution for long-term psychiatric management and only when his mental illness is stabilised for a number of months could the question of a gradual transition to the community be considered under a supervision order. This view was supported by Dr Lawrence and Dr McVie. Dr Grant considered that such a gradual transition would need to be done through a combination of an involuntary treatment order in conjunction with a supervised order under the Act. That view seems to have some support from the views of Dr Lawrence.”

[emphasis added]

The last annual review

14. [14]
    After reviewing the psychiatric evidence tendered on the last annual review and in affirming the continuing detention order, Cooper J made the following relevant observations:^[13]

“[62]As to whether there is a propensity on the part of the respondent to commit serious sexual offences in the future, and the risk that he will commit another serious sexual offence if he is released into the community, the assessments undertaken by the psychiatrists suggest such a risk exists. Dr McVie considered the risk of the respondent committing such an offence if he was released without a Division 3 order to be high. Dr Beech considered that risk to be above average.

…

65. [65]
    The final relevant consideration is the need to protect members of the community from the risk that the respondent would, if released into the community, commit another serious sexual offence.
66. [66]
    The evidence before me, including that given by the psychiatrists on the question of the risk of sexual reoffending, is acceptable and cogent. On the basis of that evidence, and having regard to the matters set out in s 13(4), I am satisfied to a high degree of probability that the respondent is a serious danger to the community in the absence of a Division 3 order. As I have already noted (see [7] above), Ms Freeman, who appeared as counsel for the respondent, conceded that the evidence supports such a finding. That concession was appropriately made.”

[emphasis added and citations omitted]

15. [15]
    At the last review, Cooper J relevantly observed that the risk of the respondent committing a further serious sexual offence if he was to be released under a supervision order was “now somewhat less than was apparent on the evidence tendered on previous annual reviews.”^[14] This finding was supported by his Honour’s acceptance of four things:

    1. First: that there had been an improvement in the respondent’s behaviour since the previous annual review;
    2. Second: the respondent had demonstrated a willingness to engage in individual therapy with Dr Madsen and was more accepting of his circumstances including the need to continue to engage in future psychological treatment and to cooperate with further psychiatric evaluation to reduce the risk of his sexually re-offending;
    3. Third: that the respondent’s continuing detention was negatively affecting the impact of his treatment with Dr Madsen because of the limited opportunities in the high secure prison environment to learn the self-regulation skills which he required to sustain settled periods of behaviour and to gain the most from the therapeutical interventions; and
    4. Fourth: the respondent’s requests to be placed in the detention unit revealed he was capable of seeking out help when feeling unstable or unsafe and were additional protective factors.
16. [16]
    Despite these matters, Cooper J ultimately concluded that the Attorney General had satisfied the onus of demonstrating that (as matters then stood), the adequate protection of the community could not be reasonably and practically managed by a supervision order. In reaching this conclusion his Honour made the following relevant findings:^[15]

“[72]The improvement in the respondent’s behaviour in custody seems to be attributable in large part to his removal from sources of stress or frustration in the prison environment through his placement in the detention unit. A number of the medical witnesses referred to this as a coping strategy or safety valve which has been effective in reducing the impact of the respondent’s emotionally dysregulated behaviour. Even in that context, evidence of recent incidents (see [27] above) confirms that the respondent’s behaviour remains susceptible to deterioration at times of stress or anger.

73. [73]
    This raises the difficulty of the respondent living in the Wacol precinct, having regard to his severe personality disorder, in circumstances where he would not have access to the safety valve of being removed to something equivalent to the detention unit and he has yet to learn the self-regulation skills required to deal with the stresses and frustrations of such an environment without resorting to threats of violence or self-harm. Both Dr Madsen (see [32] above) and Dr Beech (see [48], [49] and [56](e) above) referred to the potential for a reasonably rapid deterioration in the respondent’s mental health in those circumstances and a resultant escalation in his risk of violence, self-harm and other destructive and threatening behaviours. Dr McVie’s recommendation that the respondent continue with individual therapy in custody, and demonstrate a longer period of behavioural stability in custody, prior to any release is also consistent with this assessment.
74. [74]
    Dr Beech’s evidence that the deterioration in the respondent’s behaviour, before he reached a state where he was offending against females, may not be obvious and that the ability to detect such deterioration is “a high level clinical skill” is, it seems to me, critical to the question whether adequate protection of the community can be reasonably and practicably managed by a supervision order. Although Dr Beech maintained his opinion that the likelihood of the respondent sexually re- offending would be reduced to moderate by a supervision order, the consequences if that risk eventuated could be a severe sexual assault.
75. [75]
    It is certainly true that a curfew condition made under a supervision order would act to restrict the respondent’s movements, particularly in the early stages of his release. Electronic monitoring would also permit QCS to know where the respondent travelled in the community, but not who he was with or what he was doing. Nevertheless, the risk that a deterioration in the respondent’s mental health in times of stress or anger might lead him to disregard the requirements of his supervision (as to which see Dr Beech’s evidence at [53] above), and the absence on release under a supervision order of the external controls such as the detention unit which have been used in the custodial environment to address the respondent’s emotionally dysregulated behaviour, satisfy me that the adequate protection of the community cannot be reasonably and practically managed by a supervision order. In those circumstances I must order that the

respondent continue to be the subject to the continuing detention order.”

[citations omitted]

17. [17]
    The following observations of Cooper J about the respondent’s future treatment in custody are apposite to the current review:^[16]

“[76]It is important to note the need for the respondent’s future treatment in custody to develop so that, to the greatest extent possible, the respondent is afforded the opportunity to learn the self-regulation skills he requires to maintain behavioural stability in times of stress or anger. Both Dr Madsen (see [34], [36](a), [37](b) and [37](c) above) and Dr Beech (see [52], [54], [55], [56](c) and [56](d) above) described what this future treatment might look like, with the objective of the respondent transitioning to a more open area of the prison. Mr Tannock indicated QCS’ willingness to engage in that future treatment program, subject to the security and logistical requirements of the prison. As Mr Tannock observed, whether the respondent’s future treatment follows that path will depend in large part on the respondent’s willingness to engage and persist with that future treatment pathway in circumstances which are likely to be challenging for him in light of the personality factors identified in the evidence of Dr Madsen and the psychiatrists.

77. [77]
    One final observation concerns the outstanding need for a comprehensive management plan prior to the respondent’s release on a supervision order. Mr Tannock confirmed in his evidence that, as at the date of the hearing, no such plan had been formulated. As the respondent submitted, his continued detention means he is unable to progress that matter.
78. [78]
    Dr Beech gave evidence as to the types of matters which that plan might address and the desirability of the plan being put in place during the respondent’s period in custody to confirm its effectiveness in avoiding or de-escalating the respondent’s emotionally dysregulated behaviour. Whether it is practicable for such a plan to be developed and implemented while the respondent remains in custody, and for that plan to be altered as necessary to account for changes upon the respondent’s eventual release under supervision, is ultimately a matter for QCS. It seems to me, however, that if the respondent is to progress towards release under supervision – which must be a goal of his continuing detention for the purposes of control, care or treatment – it is important for

any steps that may be practicable to be taken as soon as possible to progress the development and implementation of such a plan.”

[emphasis added and citations omitted]

Current review: medical evidence

18. [18]
    On this review, four expert medical witnesses gave evidence about the level of risk associated with the respondent’s various medical diagnoses in the context of his treatment and behaviour in prison. Their evidence is considered in the order in which it was adduced.

Dr Anthony Tie

19. [19]
    Dr Tie is a consultant psychiatrist, engaged by the Prison Mental Health Service to treat the respondent. In his report dated 19 April 2024, Dr Tie referred to the “consistent clinical opinions” that the respondent’s longitudinal history and presentation are inconsistent with a schizophrenia-like illness. Dr Tie was disinclined against a diagnosis of schizophrenia.
20. [20]
    Dr Tie last assessed the respondent on 13 March 2024 at which time the respondent presented in a euthymic mood with his thoughts relevant and organised. Dr Tie noted that the respondent told him that “Samantha” was “happy” with how he was progressing and that he was feeling “settled in a regular custodial unit”.
21. [21]
    In his latest report, Dr Tie described the respondent’s “self-reported and documented psychopathology” as better characterised as manifestations of a variety of not necessarily mutually exclusive underpinnings (depending on the scenario), as follows:

“• psychotic disorder not otherwise specified triggered by negative emotional states from stressors superimposed upon maladaptive coping mechanisms characteristic of a mixed antisocial and borderline personality disorder;

• externalisation of unacceptable and/or aggressive thoughts and impulses;
• retrospectively rationalising and displacing responsibility for his actions;
• pseudo-psychotic symptoms to elicit assistance and care from health services;
• potentially embellished or malingered psychotic symptoms.”

22. [22]
    Under cross examination, Dr Tie provided the following diagnosis:^[17]

“My working diagnosis for Mr Watkins is a mixed personality disorder, comprising of an antisocial and borderline personality structure with a vulnerability towards potentially psychotic episodes under sufficient duress.”

23. [23]
    Dr Tie also explained that the respondent was not currently under the Mental Health Act 2016 and was presently maintained on psychotropic medications which were attenuating the negative emotional states associated with his incarceration and interpersonal tensions with other prisoners.
24. [24]
    Dr Tie’s evidence was that if the respondent is detained, he will receive ongoing reviews from the Prisoners Mental Health Services and that if he progresses into the community on a supervision order the process would be that the respondent:

“…would be referred to the local mental health service [community mental health service]^[18] for continued psychiatric monitoring, support and treatment. The referral process would involve liaison with the intake personnel and district Forensic Liaison Officer of the local mental health service.”

25. [25]
    Dr Tie’s also gave evidence that if the Community Mental Health Service concluded that the respondent did not require his psychotropic medication, it could be prescribed through a General Practitioner, but that course would be “less than optimal”, and there would be very limited oversight of his adherence to medication.^[19]

Dr Lars Madsen

26. [26]
    Dr Lars Masden, the respondent’s treating psychologist provided two reports for this review.^[20] Dr Madsen is familiar with the respondent having now consulted with him on around 42 occasions. In the first of his more recent reports Dr Madsen noted the respondent continued to report the presence of auditory hallucination, particularly of “Samantha” but also observed the respondent to have developed a level of engagement that he characterised as “encouraging, especially considering the complexities of the prison environment and his personality”.
27. [27]
    In the 15 May 2024 report, under the heading “Function of Problematic Behaviours,” Dr Madsen provided some further insight into the respondent’s behaviour as follows:

“A more detailed examination of Mr. Watkins' institutional behaviour reveals that his adverse incidents predominantly consist of self-harm and verbal threats, with actual physical violence constituting only a minor portion. The common theme triggering many of these incidents seems to be his perception of being targeted or exploited, either by staff or other inmates. His reactions are typically overt and dramatic—such as loud verbal threats, superficial self-harm, and writing letters or messages with grandiose proclamations and threats. In one recent letter, he notably referred to himself as Satan, suggesting an element of psychological manipulation intended to provoke a specific response from the prison administration.

These actions appear strategic, aimed at invoking the prison's processes for managing disruptions, usually resulting in his removal to the Detention Unit (DU). Mr. Watkins has expressed that he feels 'safe' in the DU, indicating that his behaviour may serve a dual purpose. First, it allows him to distance himself from what he perceives as a threatening environment without the risk of physical conflict. Second, it helps him maintain a reputation within the prison hierarchy as a formidable and dangerous individual. This tactic protects him from harm and enhances his status among other inmates, playing into the complex dynamics of prison social structures.”

[emphasis added]

28. [28]
    Dr Madsen also outlined his more recent attempts (and frustrations) in treating the respondent and assisting with his reintegration “to a less restrictive context and eventually the community” as follows:

“Regarding treatment focus, within the individual treatment, I have attempted to focus on improving emotional dysregulation and reducing symptoms, including dysregulated behaviours (i.e. threatening others, violence etc). The eventual objective of this work is to assist Mr Watkins in developing the skills so that he can reintegrate from high secure units to a less restrictive context and eventually the community. This has, however, been challenging. Mr Watkins presents many of the typical problems experienced by individuals with severe personality disorder, adversely affecting his capacity to 'engage in' and 'benefit from' psychological treatment. These challenges are characterised by a pervasive pattern of instability and dysregulation involving unstable emotions, unstable and conflicted relationships, unstable sense of self/identity, unstable cognitive processes, and behavioural instability. For Mr Watkins, crises are common and typically experienced by him as a collage of anxiety, fearfulness, despair, sadness, anger, and rage. His thinking becomes disorganised, and he becomes paranoid and suspicious of others. During times of stress/emotional dysregulation, prisoner Watkins will become behaviourally dysregulated and act out in various ways.

What this ultimately means in terms of his therapy is that between sessions (approximately two weeks) things for Mr Watkins can change a great deal. These constant changes make it hard to maintain a 'therapeutic frame' (i.e., a specific and consistent focus upon an objective/purpose within sessions) as he frequently presents to sessions in emotional turmoil, is experiencing or has recently experienced conflict with others or acted out in some way (i.e., violence, threats, property damage, self-harm etc.). The implications of this means that the stressors and challenges that he experiences in his day to day are constantly changing between sessions.”

[emphasis added]

29. [29]
    In his oral evidence, Dr Madsen considered that the respondent would find it extremely stressful not having his own room at the Precinct and in his view it “would be a good idea for [the respondent] to have own room”.^[21] He had raised concerns about the respondent sleeping on the floor to the High Risk Offender Management Unit “very early on”, but the problem was a lack of resources.^[22]
30. [30]
    Dr Madsen described the change he had observed in the respondent’s recent response to treatment and confirmed that over the last year, the respondent had become “much more” open to the possibility of going to the Precinct than he had been in the past.^[23] On this issue Dr Madsen made the following positive observations about the respondent’s ability to cope in the Precinct:

    1. the respondent had softened his position with respect to residing with other sex offenders over the last 12 months;
    2. he maintained a level of confidence in the respondent being able to manage relationships with other Precinct residents;
    3. the respondent had recently become more amenable to taking on feedback with respect to his mental health and had taken on board advice that he needed to get better at managing his reactions to things;
    4. when the respondent’s mental health deteriorates, he is more amenable to reining it back in and “quickly” resetting;
    5. the respondent experiences less frequent auditory hallucinations and odd ideas^[24] which point to him being healthier psychologically and emotionally; and
    6. the respondent now also employs breathing and grounding exercises to maintain a sense of calm outside of their sessions together.
31. [31]
    Dr Madsen opined there would probably not be any difference with respect to the respondent’s treatment in the residential section of Wolston Correctional Centre as opposed to what he receives in the High Secure unit at the prison. With respect to what more can be done for the respondent in terms of treatment in custody, it was Dr Madsen’s opinion that “…they’re probably doing as much as they can” and “…if there was more that we could do, then I would recommend it, but I’m not sure what there is”.^[25]
32. [32]
    If placed on supervision, Dr Marsden said he would prioritise seeing the respondent at his Paddington clinic on a weekly basis.

Dr Ness McVie

33. [33]
    Dr Ness McVie is a consultant psychiatrist who interviewed the respondent at the Wolston Correctional Centre for 90 minutes on 6 April 2024 and provided a report dated 10 May 2024. Dr McVie is also familiar with the respondent, having provided reports on five prior occasions.^[26]

34. [34]
    In her latest report, Dr McVie observed the respondent’s increasing engagement with treatment since February 2023 whilst also summarising the complexity of the respondent’s clinical presentation and difficulties with treatment relevantly as follows:

“Though he has completed the High Intensity Sexual Offenders' Treatment Program, and the Maintenance Program for Sexual Offenders he continues to present with high treatment needs.

He continued seeing a psychologist for individual treatment commencing in 2020, but was considered difficult to engage in effective therapy. His sessions with the external psychologist were ceased from April 2022 to February 2023 due to his instability and behavioural problems in custody. He has been increasingly engaged in this therapy since February 2023.

He has continued to present with multiple incidents, mainly of self-harm, through that period.

His presentation is complicated by features suggestive of a serious mental disorder. He was first seen by a psychiatrist in 1998 and no evidence of psychosis was found. He seems to have first attracted a diagnosis of psychosis, possibly from about 2004, at the time he had developed an erotomanic attachment to a female psychologist, Samantha, who had been involved in his management in prison. He then spent two years in isolation in the Maximum Secure Unit.

His first inpatient assessment in High Secure was in 2008. His discharge diagnoses indicate he was considered to have primary severe personality pathology. Subsequently a diagnosis of schizophrenia has been considered. I note previous assessors including Dr Grant in April 2016, and Dr Lawrence in January 2017, considered him to have a severe chronic schizophrenic illness as his primary pathology and recommended secure hospital treatment.

He was last discharged from High Secure, The Park (HSIS) in March 2021. The current working diagnosis is that of a primary severe personality disorder.”

[emphasis added]

35. [35]
    In Dr McVie’s opinion, the respondent remains a high risk of committing a further violent sexual assault, but she also noted the respondent’s progress in engaging with individual therapy and his continuing attempts (and struggles) to address his maladaptive behaviours in the strict custodial environment, as follows:

“Mr Watkins presents a high risk of re-offending with both sexual violence and general physical violence, if released from prison without a supervision order.

He is currently progressing in individual therapy with Dr Lars Madsen, treating psychologist.

His behaviour in custody has been to deteriorate at time of stress including upcoming court cases and perceptions of being targeted by other prisoners for various reasons.

His behaviours had reportedly previously settled in the therapeutic environment of high secure mental health services and he was able to engage in appropriate rehabilitation programs in hospital. He may benefit by management with NDIS mental health supports and mental health supported accommodation. It does not appear that these supports have been considered necessary by his current treating mental health team in prison and they had recommended referral to a local health service for follow up, if he were to be released.

It is possible his presentation represents maladaptive behaviours secondary to his severe personality and borderline features which may settle once he is removed from the strict custodial environment.

I do note that the precinct can present its own set of problems due to the nature of the prisoners living in close contact, with breaches often due to substance use and sequelae of interactions with other residents.

Ideally Mr Watkins should demonstrate a longer period of stability in custody prior to any release. I would consider a six month period free of incidents, preferably with Mr Watkins in 'residential' should occur prior to any release to the precinct.

If released, I would recommend supervision order for a minimum of ten years, with conditions including prevention of contact with children under the age of 16 years and complete abstinence from alcohol, illicit substances and any medications of addiction such as opioid pain medications or opioid substitution treatment.

I would also recommend that any contact with x partner M or their daughter (now an adult in hr late 20’s) should not occur unless M, and/or B, give prior consent for this.”

[emphasis added]

36. [36]
    Under cross-examination, Dr McVie was asked whether “in general terms” the respondent’s risk of reoffending “has probably” diminished from last year. But she did not answer in the affirmative. Rather, her focus was the overseas studies and the general consensus that the risk of people released without supervision orders halves every five years they remain in the community risk free – but there was no clear evidence if that risk is halved with people on supervision orders.

37. [37]
    During her oral evidence, Dr McVie:

    1. confirmed her opinion that the risk posed by the respondent is high in the absence of a supervision order; and
    2. stated that (generally speaking) the respondent’s level of risk should diminish with time, and that the longer he spends in the community, the less of a risk he would be.
38. [38]
    The respondent’s submissions focussed on Dr McVie’s oral evidence that the respondent’s risk of committing a serious sexual offence could be reduced from high while unmodified, to moderate to low under the conditions of a supervision order. But this evidence needs to be viewed in the context it was given as is evidence from the following passage of the transcript:^[27]

“Very well. If a supervision order was imposed, what risk, then, would the respondent present?‑‑‑Theoretically, a supervision order could decrease his risk to moderate to low.

All right. It could be moderate to low; however, are there any difficulties in actually assessing the risk posed by Mr Watkins in terms of committing a serious sexual offence?‑‑‑For me, the difficulties with Mr Watson – Watkins is the fact that he’s been very difficult to manage in prison, and he’s very difficult to assess in terms of the way he interprets the world or the way he interpreters his past behaviours. So it’s difficult to get a very clear opinion of what he thinks his sexual offending was related to, and it would be much better if I was able to understand his view of his offending to further assess his risk, really going on a lot of historical material to assess his risk as high. He has at times talked about reasons for offending, but in more recent times he’s attributed his offending to hearing the voice of Samantha.”

[emphasis added]

39. [39]
    It follows that Dr McVie’s assessment of the risk of supervision being moderate to low (or low to moderate) under a supervision order was somewhat qualified and theoretical.
40. [40]
    During her oral evidence, Dr McVie also made the following relevant observations about the difficulties associated with the respondent sleeping on a trundle bed in a common area of a shared house at the Precinct if released on supervision (and her concerns about his release on supervision more generally):^[28]

“At the time I wrote my report, I wasn't aware that the only potential accommodation, the precinct, was a trundle bed. I don't think Mr Watkins would do very well in a trundle bed in the middle of a living room in a house with other offenders. As Dr Madsen said, I would agree that he nee — would need his own room in that space. I am perhaps more concerned that he hasn't been able to contain his behaviours in custody. Twelve months ago, when I assessed him, he'd gone through a period of nearly six months without any incidents, but between that assessment and when the court heard his case last year, he'd gone back to having more incidents in custody. I really think he needs to demonstrate at least six months incident free prior to a trial of transfer to the precinct, and I would certainly recommend that if he was transferred to the precinct, he should have his own room.”

[emphasis added]

Dr Michael Beech

41. [41]
    Dr Michael Beech, a consultant psychiatrist, interviewed the respondent at Wolston Correctional Centre on 12 April 2024 and provided a report on 13 May 2024.
42. [42]
    In his latest report, Dr Beech provides the following useful overview of the respondent’s trajectory and treatment in custody:

“In prison, he developed an erotomanic attraction to a prison psychologist, “Samantha”. In 2004 he was diagnosed with schizophrenia by the prison mental health services. He was held in the maximum security unit of the prison for two years. He was admitted to the high secure inpatient service of The Park in 2008, where he was diagnosed with a sever personality disorder. Despite that diagnosis, he was treated with trial of antipsychotic medication, which he ceased when the involuntary treatment order was revoked in 2016. He was re-admitted in 2017. The diagnosis has remained unclear, with medical reports indicating a persistent psychotic disorder akin to schizophrenia but with an alternative diagnosis of psychosis arising from a sever personality disorder. Mr Watkins’ behaviour in prison has been problematic. He has repeatedly required placements in the detention unit and on individual management plans.

Mr Watkins has repeatedly said that during the 1990 incarceration and his enrolment in a sex offender treatment program, he was exposed to paedophilic talk that led to thoughts that persisted. He has variously described the SOTP as some form of experiment or conspiracy that was followed up on release. Those thoughts in the community led to the 1998 offences. In 2013 he completed the high intensity sex offender program but when I interviewed him in 2023 he dismissed any benefit from it.

Risk assessments from 2016 onwards have confirmed the presence of some form of psychotic disorder (or other disorder), a substance use disorder in remission, and an antisocial personality disorder. He has also been diagnosed with paedophilia based on his description of this thoughts and his offending. His risk of committing another serious sexual offence has generally been assessed at moderately high. He has a Static 99R score of 5. On the RSVP v2, there are multiple dynamic risk factors especially antisocial attitudes, behavioural dysregulation, sexual deviance, mental illness, and personality disorder.”

[emphasis added]

43. [43]
    Under cross examination, Dr Beech:

    1. agreed that the respondent’s behaviour seemed to be a lot better when placed in the therapeutic environment of The Park;
    2. accepted that Dr McVie had raised a valid point about the respondent potentially being in the category of those who improve out of the custody, but he otherwise considered this proposition difficult to test; and
    3. plainly recognised and respected the experience of Dr Madsen as a clinical psychologist well acquainted with the respondent but he was unable to say whether the level of risk had been reduced from the previous year.
44. [44]
    Dr Beech also provided the following summary of his more recent interactions with the respondent:

“He remains a client of PMHS under Dr Tie. His medications are unchanged with risperidone and diazepam. His work with Dr Madsen has focused on his thinking associated with his offending. His description to me sounded like a form of cognitive therapy used to alter the justifications and cognitive distortions that had facilitated the offending. It appeared to concentrate on those issues rather than the sexual offending per se. There was also a focus on day-to-day stress management. Mr Watkins thought he had become less defensive.

Mr Watkins offered then that he had a digital radio and he listened to Pop Age, ABC Sports, and Arabic 24. He noted that sometimes the female radio presenters would "prod the male speaker" to get a response from the male presenter: "they're extremely skilled". They likely did this to get information from the man, without his knowledge. Mr Watkins said he can pick that information up at times because he understands a little Arabic, Korean, and Mandarin. To questioning, he confirmed that the presenters signal him directly but he did not want to say too much and "speak out of school'. He did not like to elaborate on the processes involved but he confirmed that the female radio presenters were speaking to him. They are messages "from the girls" [female radio presenters]. The messages are "purely information" and not instructions or commands. He did not think it was his role to explain it to me, As well, he said that despite his name he has German heritage and the German bloodline has come through. This meant there was likely a Nazi white supremacy trait in him but, "I'm proud of my heritage ... but I'm not going to act on it ... I've got Jewish friends". He confirmed he had no desire to act out his heritage.

Mr Watkins said he had daily contact with "Samantha". She instructs him on day-to-day chores, telling him things like to pay attention or to manage his hygiene. He used to see this as nagging but he now sees it as instructive. There are no instructions to harm people but "she preps me for confrontations". To further questioning, he said that "prep" was similar to statements in the Bible: "it's God who prepares a man's hands for battle for war". Sometimes Samantha gives him advance warnings [of confrontations] and "I'm the vessel' of Samantha's acts and instructions. She will tell him 'to stir it up". Dr Madsen has advised him not to listen to Samantha, but Mr Watkins felt he had no choice but to listen to her. He is aware though that this eventually led to his placement in the detention unit. The upside of that episode was that he came out a winner, because it led to his transfer to S 7. Samantha had told him he had to do something, so he had acted "and spat back at them".

Similarly, he "follows" his university studies and the Bible: “they lead, I follow”. He had been given a "wink wink" instruction to harm another offender. Mr Watkins did not want to elaborate on this. He confirmed he also received instructions from the television. The recent one was a female on TV, from Russia, who gave him a sign "and I just read the play ... I know how to read the play" and he acted. He believed that God had been acting through him when he did.

During the interview, as I let Mr Watkins talk uninterrupted, he expanded on a what seemed to be complex delusional content with referential thinking, talk of higher order beings, and a theme of acting out signals and instructions he has received. He said he could refuse those instructions, unless they were from Samantha; he has learned not to refuse her. There were grandiose, persecutory, and religious elements to his talk. Mr Watkins said, "I've got multi personality disorder" and he takes on the personality or beliefs of people he associates with. So, when he is locked up with child offenders, over time "that takes effect their thoughts...I can't get it out of my head'. He does not like the thoughts so he uses distraction. He offered, “I'd shoot myself” before he re-offended with a child.”

[emphasis added]

45. [45]
    Dr Beech’s evidence plainly reveal the ongoing delusional battles simmering within the respondent and the associated dynamic risk that emanate from this. But Dr Beech also made the following positive observations from his more recent interactions with the respondent:

“Mr Watkins appeared his stated age. He showed evidence of good self-care. He was settled for the interview and engaged in a cooperative manner. He did not try to dominate the interview process. His mood was in the neutral range. He maintained a stable affect. He did not appear particularly glib or shallow.

There was no formal thought disorder but he struggled to explain some issues. There were many themes of referential thinking, control, and a lack of efficacy. There was a repeated refrain of problems with his peers. I thought he held to his referential belief system unshakably, to the extent that it was a delusional belief system. Certainly, it was also a self-serving belief system. There were no indications he was responding to perceptual abnormalities.

He seemed of average intelligence. He was alert, orientated and able to process information.

There was some insight: he said he is "not normal like normal people. I have a different perception of the way the world works, that's why I'm on medication".

[emphasis added]

46. [46]
    Dr Beech accepted that, generally speaking, there is good evidence that supervision orders reduce the risk of offenders committing another sexual offence under the Act. But he also summarised his concerns about the adequacy of a supervision order in this case as follows:

“…Mr Watkins continues to describe referential thinking, persecutory ideation, auditory hallucinations, and associated instructions or commands. He reports that the sexual thinking, including deviant sexual thoughts, are relayed to him by other prisoners, although these days he tries to distract himself from them. At interview, I believe his presentation is consistent with schizophrenia on a cross-sectional basis. But his long-term treating psychiatrist conceptualises it as a severe personality disorder with a vulnerability to psychotic or quasi-psychotic states under stress. There are also indications that Mr Watkins also talks about these phenomena to displace responsibility or manipulate his environment. Certainly, there is at times a self- serving aspect to his symptoms.

His behaviour remains problematic. Mr Watkins continues on a long-term safety order and intensive management plan. There have been multiple incidents of concern over the past 12 months, several of which have led to placement in the detention unit. He has not progressed again from secure units to the residential unit. Instead, as I understand it, he has been transferred from one unit to another because he felt harassed. lntercurrently, his behaviour is reasonable but he isolates himself to manage his stress. Mr Watkins continues to report getting messages, signals, instructions and commands from others. He reports sexual thoughts related to children but blames them on the other prisoners. His predominant methods of dealing with stress appears to be isolation and distraction.

On a positive note, there are indications that he is compliant with psychiatric treatment and medication. He has engaged with a forensic psychologist and QCS clinicians. The focus though has been on self-regulation.

It is difficult to see if overall there a substantial improvement has been, but the treating psychologist believes there has been an improvement in self-regulation. Certainly, a review of the integrated offender management system records points to periods of relative stability, albeit on a safety order with a tendency to withdrawal. In the past, with others, Dr Madsen has been able to helpfully provide graphs that illustrate an overall improvement trend. It would be helpful if he were able to do that for Mr Watkins.

Mr Watkins has no outside supports. His plan is to reside at a prison precinct. He believes that he can manage stresses there through distraction and withdrawal, I think he bridles at the thought that he may be forced to associate with others on a day- to-day basis.

In my opinion, Mr Watkins either has schizophrenia and an antisocial personality disorder, or a severe personality disorder with a vulnerability to psychotic episodes. Neither diagnosis gives much comfort for his management in the community given the persisting difficulties with his behaviour in prison.

Static and dynamic risk assessment instruments place him in the group of sexual offenders who are at above average risk of community another sexual offence. In my opinion, Mr Watkins is in that above average (moderate high) risk group. The risk relates to his paedophilic thoughts (despite his denials), ongoing behavioural difficulties, and psychotic or quasi-psychotic symptoms despite long-term psychiatric and psychological treatment.

…

The difficulties Mr Watkins would face under supervision relate to his ability to manage his emotions and behaviour while dealing with the stresses and vicissitudes of residing at a prison precinct. Those difficulties would be aggravated by the lack of structure and routine on a precinct; the necessary association with sex offenders; the limited ability to isolate himself from others; and the lack of anything equating to a safety order, intensive management plan, and resort to a detention unit.

Compounding those issues would be the necessary transfer from the prison mental health services and prison medical services to community based general practitioner support and a referral to the local adult mental health service. Essentially, as I understand public mental health services, the PMHS would refer him to the community mental health services. The CMHS would make their own assessment and decide on treatment. The concern I have is if they decide Mr Watkins has a personality disorder, as distinct from a mental illness, the treatment approach might diverge from what he is receiving, He is prescribed oral medications. In the community, there would be no way of knowing if he was complying with treatment. Mr Watkins is a voluntary patient, which means that CMHS and QCS would have little control over his treatment adherence. Should his mental state deteriorate, there would be no access to a detention unit type placement.

Clinically, I believe that the risk of Mr Watkins committing another sexual offence would be reduced to at least moderate by a supervision order, simply because of the level of monitoring, movement restriction, and curfews placed on him. At the precinct, he would have access to illicit substances, but that might be detected with frequent testing. He would be aggravated, I believe, by the other prisoners but might be able to isolate himself in his room, if his accommodation allowed that. It is difficult though to see how he could in the short to medium term progress on the precinct given his inability to progress in prison.

If he were to commit a sexual offence, it could be a sudden decision by him, influenced by deviant thoughts, triggered psychotic or pseudo-psychotic commands, and facilitated by his externalisation of responsibility and his beliefs or self-serving self-statements that he was acting on the instructions of others. While there might be some evidence that his mental state has deteriorated, there would be limited avenues for intervention. I think the risk of harm is serious if he were to re-offend.”

[emphasis added]

47. [47]
    As can be seen from this passage, Dr Beech assessed that the risk of Mr Watkins committing another sexual offence would be reduced to at least moderate by a supervision order.
48. [48]
    During the following exchange with the court, Dr Beech clarified that in his view the risk was that the respondent would commit a serious sexual offence on a child (like the one he committed in 1998):^[29]

“Yes, your Honour. I think it's more likely that if he were going to commit a sexual offence, it's going to be like the 1998 offence. It's going to be impulsive, spontaneous, driven by emotional turmoil where he's decided to flee, but in the process get overwhelmed by paedophilic thoughts and commands or whatever, and he acts on them. Much less likely would he be engaged in the earlier offence where he breaks into a house and finds a wep — a victim.”

49. [49]
    In his oral evidence-in-chief, Dr Beech explained the reasons why he was not prepared to reduce his risk assessment any lower than below moderate, as follows:^[30]

“The difficulties are that he has problems with interpersonal communication with other prisoners. He doesn't get on with them. He doesn't get on particularly with sex offenders, and he's been very open about that in — in prison. He has developed several strategies to manage that. He — but particularly, he isolates and withdraws from those people. Up until the end of May, I think he was on a full segregation safety order. He has been placed in a detention unit in — he's on a sec — in a secure unit, and he can withdraw to his cell if there are difficulties. When those strategies don't work, he engages in self-harm, which I think facilitates his isolation from the unit. Failing that, he makes threats towards others, including staff. The — this occurs in a — a secure unit where there's routine, there's structure, there are prison officers around. On the precinct, he would have to necessarily associate with sex offenders, not just the prison population. The routine and structure would be absent. The presence of Corrective Services officers would be absent. And instead, he'd have to deal with living with sex offenders, and — from my experience and anecdotally — these are not the most stable or consistently agreeable people, generally. But what — importantly, he then doesn't have access to strategies that he has used. There's no place that he can go to — as I understand it, he can't even go to his own room now. So I think that he will become stressed, he will become overwhelmed. When he becomes stressed, he decompensates into some psychosis or quasi psychosis where he gets referential thinking, paranoid beliefs, hears the voice of Samantha, and things like that. And to that, I would add, the risk of paedophilic thoughts coming through, either as part of a psychotic phenomena or part of just a deterioration in his mental state. My concern is that — the way he would differ from other people on the precinct is that he has no escape from this because he's got no room to go to. They can't put him on a safety order. They can't isolate him. He can't go to his room. He can't lock the door. So his resort, if he gets overwhelmed, is that he will abscond. And I worry that he would be then within the same circumstances as he was in 1998. He felt things were getting difficult for him in New South Wales. He felt it was a hostile environment. He decided to flee to the North Queensland. But on the way, he got sexual urges to assault a young child.

Yeah?---So I think my worry is that he would then try to abscond from the precinct, and — you know, that would set off all kinds of alarms, clearly. Right? But in the process, his risk of committing another sexual offence will have increased. And that's a longwinded way of saying I think that supervision would reduce the risk below moderate, but I wouldn't go as far as saying low.”

50. [50]
    As can be seen, Dr Beech has assessed the respondent as being a moderate to high risk when unsupervised [Dr McVie’s opinion was the level of risk was high]. Although under cross-examination he categorised this risk to be reduced to at least below moderate by a supervision order. He could not “go lower” because “I don’t’ know how [the respondent] is going to react when he gets released.”^[31]

Other evidence about the custodial behaviour of the respondent

51. [51]
    Emma Wildermoth, the acting manager of the High-risk Offender Management Unit within Community Corrections Queensland Corrective Services (‘QCS’), gave evidence in the form of an affidavit. Her evidence is that since the period of last review, the respondent:

    1. has required periodic management under safety orders (which are dynamic in nature and involve separate confinement, usually no longer than a month, limited time out of the prisoner’s cell, and limited interaction with other prisoners) due to his unstable behaviour, self-harm incidences and aggression against staff and other prisoners;
    2. has required three intensive management plans;
    3. was involved in some 20 separate incidences in response to self-harm, threats against staff, threats against other prisoners and substance supply;
    4. was subject to an Elevated Baseline Risk Case Management intake interview on 19 June 2024, during which the respondent referred to hearing auditory hallucinations, homicidal in nature; and
    5. in the follow up Case Conference on 3 July 2024, the respondent continued to report perceptual and emotional disturbances of a commanding impulsive violent and homicidal nature.
52. [52]
    The evidence from Ms Wildermoth was that because of the matters outlined above, QCS:

    1. continue to hold concerns that the respondent has not yet evidenced a pro- longed period of stability in custody – in line with the psychiatric recommendations;
    2. have actively engaged in open discussions with the respondent about what he needs to do to progress to residential accommodation in custody; it was not entirely clear what this residential accommodation entailed; and Ms Wildermoth was not specific exactly what the discussions entailed but it is reasonable to assume from her evidence and that of Mr Wilson discussed below, that at least one requirement was that the respondent has a longer period of stability);
    3. could not provide a timeline regarding the respondent’s progression to a residential unit now because that depended on the respondent’s behaviour compliance – but that the High-risk Offender Management Unit would continue to engage with Centre staff regarding the respondent’s progress in custody; and
    4. holds a concern that a supervision order cannot be reasonable and practicably applied to the risks posed by the respondent.

53. [53]
    There was some tension in the evidence about where any management plan linking the respondent to mental health services in the community would come from. Ms Wildermoth said it would be from the Prison Mental Health Service and that it was her understanding was that the respondent would need to be in a position where his release was imminent before connections were made between Prison Mental Health and a community mental health service. But contrary to this, the Manager of the Wolston Correctional Centre Mr Wilson’s evidence was that such a plan would come from the High-Risk Offender Management Unit. Mr Wilson was aware of the respondent’s mental health needs, and as a result of his position, his evidence was that he had “…more knowledge of Mr Watkins than most”.^[32] From Mr Wilson’s view, the only way to ensure the respondent’s smooth transition into the community, was to simply have him continue to attempt to comply with the conditions of the secure unit at the Wolston Correctional Centre.
54. [54]
    Mr Wilson did not know the details of any management plan, was not aware of any discussions regarding such a plan, and was not familiar with the psychiatric evidence in the preceding annual reviews of this matter. When asked in cross-examination as to whether someone within the Centre or QCS was in a position to assist in getting the respondent ready for release beyond making him subject to safety orders, Mr Wilson stated:

“To answer your question, I think those – compliance with those orders is – is the plan.”^[33]

55. [55]
    It follows that rather than there being a comprehensive or intensive management plan to ensure the respondent’s release to a supervision order is at the very least underway, the only plan seems to be to have the respondent attempt to comply with safety orders and intensive management plans so that he can progress from the from the secure unit of the prison to residential accommodation in custody. It was not clear on the evidence what that latter accommodation entailed.
56. [56]
    Ms Wildermoth produced a general policy document prepared by QCS entitled “Key aspect to a supervision order”, which supplemented by her other evidence, painted the following broad picture of what a supervision order would look like for the respondent:

    1. the respondent would be released to reside at the Wacol Precinct (as he has no suitable alternative accommodation);
    2. at the Precinct the respondent will not have a room to himself but rather a trundle bed in the living room of a precinct house (which are shared between three to seven other individuals managed under the Act); and he would have to join a waitlist for a room of his own upon release (it apparently not being possible to be on a waitlist until after his release);
    3. upon his initial release he would be subject to a 24-hour curfew, whilst necessary QCS assessments are completed and reintegration supports organised;
    4. the respondent would be subject to electronic monitoring through a global positioning system tracking device;
    5. whilst some initial support is offered on a case-by-case basis, offenders are expected to live independently and are responsible for their reintegration activities in accordance with the requirements of their order;
    6. the Precinct is not a secure facility so the respondent will eventually be able to freely access the community;
    7. the Precinct, unlike the prison, is not equipped with a medical centre and medical staff so if there was a need for a rapid response or a medical emergency, the Queensland Ambulance Services would have to be called;
    8. QCS could not make an application on behalf of the respondent to access a package under the National Disability Insurance Scheme but could help the respondent make an appointment with a General Practitioner to obtain a referral; and
    9. there would be no impediment to having Dr Lars Madsen attend the Precinct to treat the respondent (beyond Dr Madsen’s schedule).

Consideration of relevant matters [s 13(4) of the Act]

57. [57]
    Section 13(4) of the Act lists the matters the court must consider in deciding whether a prisoner is “a serious danger to the community”. The first of these [s 13(4)(a)], concerns the reports prepared by the psychiatrists under s 11 and the extent to which the prisoner cooperated in the examinations by the psychiatrists. The respondent co- operated with both Dr McVie and Dr Beech. The relevant parts of their reports are set out earlier in these Reasons.
58. [58]
    The second matter [14(4)(b)], is other medical, psychiatric, psychological or other assessment relating to the respondent. There was an abundance of material in this category which I have referred to above: including references to various reports prepared for earlier reviews, the report from Dr Madsen and the assessments and plans contained in the affidavits of Ms Wildermoth and Mr Wilson. As was the case at the last review before Cooper J, the material contains a divergence of opinion as to whether the respondent meets the diagnostic criteria for schizophrenia.^[34] I too accept the Attorney General’s submission that the respondent meets criteria for psychopathy, Anti-Social Personality Disorder, Paedophilia (heterosexual, non-exclusive) and Persistent Psychotic Disorder.
59. [59]
    I have discussed the two further reports from the respondent’s treating psychologist, Dr Madsen, in some detail under that heading above. I accept Dr Madsen’s insight and that from his perspective, the respondent has recently demonstrated an encouraging level of engagement in therapy, particularly considering the difficulties surrounding his personality and the complexities of engagement within the prison environment. I also accept Dr Madsen’s view that the respondent has taken other important steps forward in addressing the myriad of issues he faces upon release into the community (see [30] above). But the improvement in the respondent’s level of engagement in therapy remains a real work in progress, particularly given the respondent’s continued stays in the Detention Unit and being subject to safety orders and integrated management plans. In this context, I accept Dr McVie’s view that the respondent should demonstrate a period of six months free from incidents, preferably in the residential section of the prison, prior to release from custody.

60. [60]
    The third matter [s 13(4)(c)] is whether there is a propensity on the part of the respondent to commit serious sexual offences in the future. It is convenient to address this issue with the risk that the respondent will commit another serious sexual offence if released into the community [s 13(4)(h)]. The actuarial and dynamic assessments administered by the psychiatrists, which I accept as cogent and reliable, are that such a propensity exists and that there is a real and serious risk of the respondent committing further serious sexual offences: Dr McVie assessed this risk as high and Dr Beech as above average.
61. [61]
    The fourth matter [13(4)(d)] concerns considering whether there is any pattern of offending behaviour on the part of the respondent. I have considered the circumstances of the 1990 and 1998 offending as recounted earlier.
62. [62]
    The fifth and sixth matters [ss 13(4)(e) and (f)] concern the efforts by the respondent to address the causes of his offending, his participation in rehabilitation programs and the effect of rehabilitation programs on him. Dr Madsen observed (see [28] above), that the respondent has many of the typical problems experienced by individuals with severe personality disorder which adversely affect his capacity to engage in and benefit from psychological treatment. It is also relevant to note, and as Dr Beech observed (see [44] above), the need for treatment intervention to focus on reducing the respondent’s dysregulated behaviour patterns means that there has been a concentration on those issues rather than the respondent’s sexual offending.^[35]
63. [63]
    It is, however, readily apparent from all the material, that despite his struggles and the fact that the respondent continues to present with high treatment needs (see [34] above), the respondent has made an impressive effort at rehabilitation and that he continues to access help and complete relevant courses. I accept that the considerable steps taken to date by the respondent have generally led to longer periods of stability in his behaviour which is a positive thing.
64. [64]
    The seventh matter [s 13(4)(g)], requires a consideration of the respondent’s antecedents and criminal history. These facts are canvassed in the reports of the psychiatrists and in the other material including the judgment of Brown J when the continuing detention order was made.
65. [65]
    The final relevant matter [13(4)(i)] is the need to protect members of the community from the risk of the respondent committing another serious sexual offence. The risk in this case is that the respondent would commit an impulsive spontaneous serious sexual offence on a child – like the one he committed in 1998. There is an obvious need to protect the community from such a risk.
66. [66]
    It follows from the above analysis of the matters set out in s 13(4) as underpinned by the evidence, that I am satisfied to a high degree of probability that the respondent is a serious danger to the community in the absence of a Division 3 order. The concession from the respondent’s counsel was properly made.
67. [67]
    The decision made by Brown J on 6 February 2017 is affirmed.

Appropriate Order to bemade

68. [68]
    The respondent’s submission that the adequate protection of the community can be ensured by releasing him to a supervision order of ten years is underpinned by three broad notions:

    1. First: there has been considerable and sufficient improvement in the respondent’s ability to regulate his behaviour in custody.
    2. Second: the respondent has hit a brick wall in custody.
    3. Third: the respondent’s risk of re-offending in the community with a supervision order in place is now at an acceptable level.
69. [69]
    Each of these matters are addressed in turn.

Encouraging improvement of behaviour in custody

70. [70]
    As discussed earlier (see [59] above), the evidence of Dr Madsen demonstrates an encouraging level of engagement in therapy by the respondent within the custodial environment – albeit in the secure unit. I accept Dr Madsen’s view that the respondent has taken other important steps forward in addressing the myriad of issues he faces upon release into the community (see [30] above). But this improvement in the respondent’s level of engagement in therapy remains a real work in progress, particularly given the respondent’s continued stays in the Detention Unit and being subject to safety orders and an integrated management plan. It is also complicated by the fact that the psychiatrists are not able to fully understand the respondent’s sexual offending to further assess his risk. In this context, I accept as sensible Dr McVie’s view that the respondent should demonstrate a period of six months free from incidents, preferably in the residential section of the prison, prior to release from custody. This finding is consistent with that of Dr Beech (see [46] above) that the respondent’s behaviour remains problematic, and he has not progressed again from secure units to residential units.

The Brick Wall

71. [71]
    The effect of the evidence of Mr Wilson and Ms Wildermoth was that any previous discussion of the implementation of a management plan to reintegrate the respondent into the community prior to his release from custody, have not only not been implemented, but due to the internal workings of QCS, cannot occur. I accept the respondent’s submission that the evidence revealed that any plan to see the respondent linked with a community mental health facility, or to ensure that he has something as basic as a room of his own within the Wolston Precinct, will not be implemented before his release to a supervision order is imminent.
72. [72]
    This evidence is troubling, particularly given that at the last review before Cooper J, his Honour made express reference of the need for a comprehensive management plan prior to the respondent’s release on a supervision order. His Honour also referred to the fact that at the date of the last hearing no such plan had been formulated and that the respondent’s continued detention meant that he is unable to progress that matter. To that end, Cooper J observed relevantly as follows:^[36]

“Dr Beech gave evidence as to the types of matters which that plan might address and the desirability of the plan being put in place during the respondent’s period in custody to confirm its effectiveness in avoiding or de-escalating the respondent’s emotionally dysregulated behaviour. Whether it is practicable for such a plan to be developed and implemented while the respondent remains in custody, and for that plan to be altered as necessary to account for changes upon the respondent’s eventual release under supervision, is ultimately a matter for QCS. It seems to me, however, that if the respondent is to progress towards release under supervision – which must be a goal of his continuing detention for the purposes of control, care or treatment – it is important for any steps that may be practicable to be taken as soon as possible to progress the development and implementation of such a plan.”

73. [73]
    As set out earlier in these reasons (see [55] above), the only plan in place seems to be to have the respondent stay out of trouble. But I do not accept this is well described as a plan – rather it is a goal, which needs to be underpinned by some identifiable supports and processes. Whilst I note at this review Dr Madsen said that he could think of nothing more that could be done in terms of treatment while the respondent remained incarcerated, it cannot be overlooked that the regular sessions the respondent has had with Dr Madsen have produced positive outcomes (see [30] above). These sessions should continue. I also note that at the last review, Dr Madsen and Dr Beech gave some description of what the future might look like with the objective of the respondent transitioning from the secure unit to a more open area of the prison.^[37] I found Dr Madsen’s evidence that there was probably not any difference between the two surprising, simply as a matter of practical common sense. At the last review, Cooper J also relevantly accepted (as I do on the evidence before me) that the respondent has little opportunity in the high secure environment to adequately learn the self-regulation skills which he requires to sustain settled periods of behaviour. Again, this finding supports the need for the respondent to be given the opportunity to move to residential accommodation in custody.^[38] And particularly given that the evidence of the psychiatrists (which I accept) was that a move to residential in custody was a positive steppingstone for the respondent.
74. [74]
    At this review, Dr Beech also identified steps that may assist in the respondent being able to move out on supervision as follows:

“It would be helpful if prison mental health services were able to liaise with community health services to provide a management plan for Mr Watkins in the community. That could then be provided to Queensland corrective services so that they would know how to access immediate assessment and treatment should they become concerned by any perceived deterioration of Mr Watkins mental state.

Ultimately, I am still very concerned about Mr Watkins' ability to tolerate placement in a prison precinct. There is a worry that his mental state would deteriorate and he could not be contained by the strategies that are implemented in prison. As his mental state deteriorated, there is a risk that he would become psychotic and act on his perceived instructions. Those commands could include an escalation in sexual thoughts to assault a child.”

[emphasis added]

Risk of re-offending on a supervision order

75. [75]
    Dr McVie’s opinion was that the respondent’s risk of committing a serious sexual offence under the confines of a supervision order would be reduced to “moderate to low”, and Dr Beech’s evidence was that the risk was “at least below moderate.” I accept both assessments on the basis that they were qualified and cautious (see Dr McVie’s evidence at [38] and Dr Beech’s evidence at [49]).

Conclusion as to appropriate order

76. [76]
    Both Dr McVie and Dr Beech retained a genuine and realistic concern about the respondent’s ability to tolerate placement in the Precinct: the concern being that his mental state will deteriorate quickly with the respondent becoming psychotic and acting on his perceived instructions from Samantha or someone else. Those commands could include an escalation in sexual thoughts to the serious sexual assault of a child.
77. [77]
    I accept that the proposed curfew condition would act to restrict the respondent’s movements at the start and that electronic monitoring would permit QCS to know where the respondent was in the community more generally (though, of course, not who he was with or what he was doing). But the evidence remains that the respondent has not shown a consistent capacity to be able to address his emotionally dysregulated behaviour in times of stress or anger for any longer than a month or two. And even then, it has been within the confines of a secure and monitored environment. Although Dr McVie and Dr Beech maintained that the likelihood of the respondent sexually offending would be reduced to “moderate to low” and “at least below moderate”, the consequences if that risk eventuated could be a severe sexual assault on a child.
78. [78]
    In these circumstances, the Attorney–General has satisfied the onus of demonstrating that, as matters presently stand, the adequate protection of the community cannot be reasonably and practically managed by a supervision order.
79. [79]
    I therefore order that the respondent continue to be subject to the continuing detention order.

Orders

80. [80]
    I order that:

1. Pursuant to s 30(1) of the Act, the decision made by Brown J on 6 February 2017 that the respondent is a serious danger to the community in the absence of an order pursuant to Part 2, Division 3 of the Act, be affirmed.
2. Pursuant to s 30(3)(a) of the Act, the respondent continue to be subject to the continuing detention order made by Brown J on 6 February 2017.