The history of the accused's mental state
25 The mental history of the accused was proved through the histories provided to the psychiatrists, Doctors Nielssen and Lewin, who examined the accused for the purposes of this trial, and also through the hospital notes which were tendered and which recorded previous incidents of mental illness of the accused.
26 I am satisfied that I should approach the histories provided to the psychiatrists, although admitted for the purpose of demonstrating the basis of their psychiatric opinions, as evidence of the truth of what the psychiatrists were told: s 60, Evidence Act 1995. Both counsel agreed that this approach was the correct one.
27 Mr Adam was born in a village in the western part of Darfur in the Sudan. His family earned its living through animal husbandry. They were cattle and sheepherders. He was the sixth of ten children, most of whom remain in the Sudan.
28 In the course of the extensive civil war in the Sudan, in 1999 or 2000, Mr Adam witnessed the murder of seven relatives. They were hacked to death, various body parts were removed with machetes, and he witnessed their burial in a mass grave just outside the village in which he lived.
29 As a consequence, he experienced recurrent images of the particular incident. He also witnessed other traumatic experiences before he was able to flee from the Sudan to Egypt in the north. He first travelled from Darfur to Khartoum, and then to Egypt in 2000. He lived there for six years before coming to Australia as a refugee.
30 In the Sudan, Mr Adam had four years of formal schooling. He has a limited ability to read Arabic, and is not able to read English. He is fluent in Sudanese Arabic but has only limited English.
31 Mr Adam sustained an onset of mental illness in 2000. In 2002, he was hospitalised in Egypt for a six month period and then attended weekly outpatient psychiatric clinics at that hospital.
32 When he was hospitalised in 2002, Mr Adam was symptomatic. He claimed that he had been subjected to witchcraft. He reported ongoing difficulties with sleeping. He reported hearing voices of various people (both alive and dead) which made reference to the killings in Darfur that he had witnessed. He experienced multiple male and female voices which at times spoke to him at normal volume, and at other times appeared to shout. He sustained a range of persecutory delusions, and disruption to his pattern of functioning. He was not at that point in time able to look after himself.
33 He was informed by his doctor in Egypt that he suffered from Schizophrenia. Whilst he was in hospital he was given injections on a fortnightly basis and also took oral medication. He experienced fluctuating symptomatology.
34 In 2005, Mr Adam met his wife Ms Kany, who was the daughter of a cousin. She came from a similar Sudanese background to him. Together they migrated to Australia in 2006. At the time of his arrival in Australia, Mr Adam was troubled by auditory hallucinations, delusions of reference with to the television set, and persecutory ideas. Those ideas were delusional. He was troubled by ideas about witchcraft and voices which told him to kill various members of his family, including a cousin, his brother and his wife.
35 Within days of arrival in Australia he attended at the Auburn District Hospital for psychiatric assessment. It is unclear precisely what happened in 2006 at the Auburn District Hospital.
36 However, during 2006 at some stage after being assessed at the Auburn District Hospital, Mr Adam attempted to commit suicide by taking an overdose of paracetamol tablets. He did that because the television told him to do so.
37 As a consequence of this overdose, Mr Adams was taken to Bungaribee House, which is the psychiatric unit attached to Blacktown Hospital. He was admitted there for a period of time.
38 On 14 September 2007 Mr Adam again attended at Bungaribee House. He was taken there by the police. The police became involved because his wife had taken him to the Blacktown Police Station seeking help and assistance. Upon his arrival at Bungaribee House, his private treating psychiatrist, Dr Karlim Attia-Soliman, was contacted. He confirmed that Mr Adam had a diagnosis of both depression and Schizophrenia and that, although he had been seen on 29 August 2007, he had reported at that time that Mr Adam had ceased to take any oral medication.
39 At Bungaribee House he was assessed. Reportedly he had had visual hallucinations and delusional thoughts. He did not trust anyone and it was thought appropriate to admit him as an inpatient. He remained as an inpatient at Bungaribee House until 11 October 2007 and was discharged, with a program of follow up consultations.
40 After that time, he had three further admissions to Bungaribee House, the last of which was from 17 October 2008 to 6 November 2008.
41 On 17 October 2008, he was taken to the Psychiatric Emergency Care Centre at Blacktown Hospital, having been brought in by his brother, in circumstances where had superficial lacerations to his arms and a deterioration in his mental state.
42 Upon examination it was observed that Mr Adam had a history of Schizophrenia, that he was non-compliant with medication, he presented with paranoid delusions, ideas of reference, auditory hallucinations, persecutory delusions, lacking insight. At the PECC, he refused initially to take his medication.
43 His wife had taken out an AVO against him before his admission. Whilst in the PECC, he was commenced on medication. He was transferred from the PECC to Bungaribee House on 20 October 2008 where he remained until 6 November 2008. On discharge he was in receipt of a Community Treatment Order which provided for his compulsory medication and attendance at specialist consultation.
44 He was seen by Dr K. Channi, a psychiatric registrar, on 20 November 2008. At that time it was noted that Mr Adam was in receipt of fortnightly intramuscular injections of Risperdal and daily oral medications, for both Schizophrenia and depression. He reported that he was compliant with his medication. Dr Channi formed the impression that Mr Adam then had a stable mental state.
45 Follow up consultations on 17 December 2008 and 14 January 2009 were uneventful.
46 In February 2009, Mr Adam ceased to take his medication which led to him consulting with doctors at the Bankstown Hospital on a couple of occasions. Medication was prescribed.
47 On 19 February 2009, there was a lengthy consultation. At that consultation, Mr Adam denied that he had ever been treated for Schizophrenia. He complained of disloyalty from and bizarre behaviour by his brother. He claimed that he had been subjected to physical violence by members of the police force and he gave a history of feeling unwell and feeling that there "….is something in my veins…" which he was unable to describe any further. He was provided with further medication and a good deal of social support.
48 He returned for consultation on 5 March 2009 and was seen by Dr Joshua, a consultant psychiatrist. He reported that his nightmares had decreased since he had been on his medication. He continued to complain of tactile hallucinations, namely that something was crawling under his skin. He gave an inconsistent history about his compliance with his medication regime. A follow up short appointment was booked for 18 March 2009.
49 On that day, he reported that he was hearing the voice of the devil encouraging him to go and obtain further medication. He reported delusional features in that he was wondering why other people were talking about him and generally seemed to be discontented.
50 On 30 March 2009, he attended and saw Dr Joshua. He reported that he was leaving Australia on the following day to return to Egypt for about two months. He was advised to continue to take his medication and was provided with a script to take with him.
51 He was next seen by Dr Pistilli, a psychiatric registrar, on 8 July 2009. He noted that upon his return from the Sudan, he had been jailed for a few days because of allegations which had been made against him by his sister-in-law of assault which allegedly occurred prior to his overseas departure.
52 He reported to Dr Pistilli that whilst in jail he had auditory hallucinations but that those symptoms had largely resolved. Dr Pistilli noted that the Community Treatment Order had expired in May 2009 and that compliance with his medication appeared to be difficult. He could detect no obvious signs of current relapse. He recorded that he observed a stable mental state with no acute risk issues.
53 On 26 August 2009, Mr Adam returned for further psychiatric consultation. It occurred at the Mount Druitt Community Health Centre and the consultation was conducted by Dr Gordon Sloss, a staff specialist in psychiatry. It was clear to the doctor that Mr Adam had ceased to take his medication, and that the duration of his non-compliance was unknown. He informed Dr Sloss that he was still intermittently hearing voices, usually of the devil, but that he had not heard anything for the past five days since the start of Ramadan. The doctor thought that although he was somewhat angry and irritable when talking about his past experiences, and hospital symptoms, he did not appear to be depressed or display any obvious signs of mania. The doctor concluded that his mental state did not appear to be markedly different from previous reviews, and whilst he continued to have concerns about his risk factors in the long term there was nothing special which he detected which could lead him to the view that there was an imminent risk of an adverse outcome.
54 The notes of Dr Sloss record that he received tangential responses from Mr Adam to his questions, that Mr Adam lacked insight into his mental illness as that was defined in the Australian culture, that Mr Adam had ongoing evidence of psychosis with suspicious irritability and that Mr Adam needed to continue to be monitored.