'Grey area’ in the mental health law

Press, 28 June 1983, Page 8

'Grey area’ in the mental health law

PA Wellington Psychiatric hospitals must discharge patients who are not clinically mentally ill even if the patients clearly intend to go out and commit serious crimes, the Commission of Inquiry into the release of a murder suspect, lan David Donaldson, was told yesterday. The Director of Mental Health, Dr Basil James, said problems of “mad or bad” were a grey area not adequately covered by criminal law. He said that the legal categories of sane and insane were inadequate to cover the wide spectrum of psychiatric disorders and there appeared to be an urgent need for a review of the Crimes Act and the Criminal Justice Act. Dr James said habitual offending was not necessarily related to mental disorder, or at least to treatable mental disorder. That was where the “mad or bad” problem arose. The Health Department took the view that if a patient was not clinically mentally ill his psychiatrist would have to discharge him even though the patient had given an unequivocal indication of intent to commit a serious crime. “As an example, if a patient is not mentally ill,

he must be discharged even if he is threatening to go out and kill his wife,” Dr James said. If an immediate and serious risk to life existed, or if serious injury was likely to follow threats, the psychiatrist should assume the responsibility of any citizen and inform the police. Dr James said the problems arose because while in some patients there was a clear presence of psychotic illness, such as schizophrenia or mania, others involved more difficult judgments. Some patients showed no symptoms such as delusions, hallucinations, or severe mood disorders and were capable of knowng right from wrong, but still had a history of repeated offending arising from preverse impulses which they seemed unable to control. In such cases, neither punishment nor conventional treatment appeared to have much effect on future behaviour, he said. Prison sentences were not only ineffective in such cases but exposed the community to risk when the prisoner was eventually released. Committal to a psychiatric hospital could only be justified after general agreement that the person concerned was “ill” and

even then there was little effective treatment. Dr James said the irresistible impulse to commit crimes was often untreatable, and was considered to be a mid-way point between mental illness and normality. Referring specifically to the Donaldson case, and the decision to release him from special patient status and transfer him from Lake Alice to Porirua Hospital, Dr James said it was not inevitable that patients would eventually be discharged regardless of safety. “There is a high degree of awareness of the safety factor within the mental health service and problems occur not from indifference or carelessness but from more profound issues of a philosophical kind reflecting not only the dilemmas of psychiatry but of society as a whole,” he said. The Donaldson case was notable for the degree of care exercised and the wide process of consultation involved before the decision to grant the leave was made. “Therefore change to the system as a whole would have been unlikely to have affected the outcome of this particularly tragic case,” Dr James said.