THE PRESS FRIDAY, SEPTEMBER 2, 1983. Care of dangerous patients

Press, 2 September 1983, Page 12

THE PRESS FRIDAY, SEPTEMBER 2, 1983. Care of dangerous patients

Putting constraints on an individual’s liberty in the name of the community at large is always a serious step. In recognition of this, the law is first the guardian of freedoms and only subsequently a procedure that can lead to confinement. When the law is applied to criminal prosecutions, in the great majority of instances the steps by which people are deprived of their liberty are taken in full public view. Not all of the people detained in New Zealand are behind the walls of penal institutions; many are confined in psychiatric institutions under the terms of the Mental Health Act in the interests of their own safety as well as the safety of the community. The law and psychiatric medicine are often uncomfortable bedfellows. In many court hearings, an accused’s state of mind, his sanity, the extent of mental disorders from which he may or may not suffer, are the source of divergent — even contradictory — arguments from experts called to give evidence for the defence and for the prosecution. Such instances in the courts highlight the difficulties of assessing psychiatric illness. The report of the Commission of Inquiry into the circumstances of a patient’s release from Porirua Hospital, his subsequent arrest, and further release on bail was tabled in Parliament this week. The report shows that, when it comes to the detention of potentially dangerous psychiatric patients, the workings of the law are not yet adequate. Perhaps no system that attempts to balance the rights of individuals on the one hand and the rights of society on the other can ever resolve the conflict to the satisfaction of everyone. As the commission’s report shows, however, the present system of rehabilitation, release on trial, and the ultimate discharge of potentially dangerous psychiatric patients can be improved. In the case that the commission investigated, a former patient of the maximum security wing of Lake Alice psychiatric hospital was found dead in a booby-trapped car after being suspected of killing another man in Wellington. The former patient was on trial leave at the time of his death, as well as being on bail in connection with another offence. During his period on trial leave, he had also been convicted of sexual offences, yet on no occasion had his trial leave been ended. Two principal shortcomings of existing practices were exposed. One is that neither the prison system nor the mental health system-can cater adequately for some people who are accepted as being potentially dangerous to themselves or to others. Doctors .considered

that this particular patient was mentally disordered, but not suffering from a condition that fulfilled the precise requirements of the Mental Health Act to continue his detention. Nothing more could be done to treat the patient, who was still not well; but the doctors had no authority to continue to detain him. Had some other mechanism been available, the patient and another man might be alive today and a young girl might have escaped sexual molestation.

The other shortcoming revealed by the tragic case is that no means exists of rapid identification of pertinent psychiatric information about people brought before the courts. The commission found that on the last occasion that the patient had come before a court, the court had not known of his mental history. The commission has recommended that police files on special or potentially dangerous patients should be marked in such a way as to indicate that such people have a history of mental illness. The psychiatric information on such a person would not be stored on the police files; but the police would be alerted to the offender’s background and they would then have to seek the details through the proper channels. The proposal would seem to overcome the problem of doctor-patient confidentiality; an offender’s rights to privacy would still be protected to a large degree, and the community would have been given a warning signal. To get round the problem of releasing potentially dangerous people, the commission has recommended that there be a new category of “restricted” patients, who would receive more control and supervision than other psychiatric patients in the course of their rehabilitation, release, and discharge. A twotier, independent panel would be responsible for these patients; a review panel and, in particularly difficult cases, a national advisory committee, would decide on releases. The advisory committee would also decide who should be classified as a restricted patient in the first instance. The need is to identify a highrisk group without placing unnecessary restrictions on a far larger number of patients who are no actual or potential danger. The commission’s proposals might not meet the approval of everyone. They might not overcome all the shortcomings in the present systems that have given the commission — and the community — such cause for concern. They are, however, a step in the right direction and should not be simply filed and forgotten.