The Medical Assessments
Dr Lewin
48Dr Lewin provided a report in March 2011, having examined the accused on two occasions. He considered various of the material now in evidence, as well as Dr Nielssen's July 2010 report, the accused's medical record while under the care of Professor Owen and Dr Ilchef, outpatient psychiatric nursing notes, his Justice Health clinical file, and psychiatric assessments undertaken in prison, by a Dr O'Dea.
49Dr Lewin noted the accused's report of having first experienced mental symptoms in 2000 and an earlier extensive history of marijuana use, from age 14 years. He had tried ice in 2008, but had not used such drugs in 2009 or 2010. He also reported no marijuana use for two to three years before his mother's death, but Dr Lewin noted that there were other reports in the documents he had reviewed.
50The accused recounted that his first hospital admission was associated with marijuana use. He was then experiencing paranoia and hearing voices. After treatment in hospital for a month, he was discharged, without follow up. His marijuana use then continued intermittently. His attempts to resume work failed. He was unsure about the times of his later hospitalisations, but recalled that this had occurred after he had experienced violent impulses and had threatened his mother, who he thought was raping him and doing bad things. After discharge, he saw a Community Mental Health nurse monthly.
51The accused reported being treated with oral medication and by injection, with Dr Ilchef changing medications and dosages over time. In 2010, he described being delusional, hearing voices and instructions conveyed by Al Qaeda. He was being given instructions to harm people. He was discharged from hospital in early 2010, but he continued hearing voices on a daily basis.
52In the weeks leading up to Ms Watson's death, the accused claimed he was not drinking alcohol, and had ceased taking marijuana or other drugs. He was experiencing persistent phenomena, including believing that Ms Watson was not his mother; that she had hurt him before and had raped him in his sleep. When asked about his mental state in the days leading up to her death, he said 'I don't really know for sure. What I done, it was not a good thing. I should not have done it'. He described having had violent outbursts, which he attributed to his medication. He felt angry, believing '[p]eople were against ya ... everyone was against ya'. He explained that this included his mother and doctors. He believed that when he told them the medication was not right, the doctor just 'fiddled' with it.
53The accused also described voices making him do things, against his best interests, including throwing out things such as CDs or a belt buckle. He tried to ignore the voices, but sometimes followed the instructions. He also explained his use of the name 'Nostradamus' and his firm belief that his mother was not his real mother and that he had received visits from a couple, who identified themselves as his real parents.
54The accused had limited recollection of the events of the day of Ms Watson's death. He had no memory of a knife and could not remember his thoughts leading up to her death. He could recall ringing the police and telling them he had killed someone.
55The accused also had memories of taking medication in the preceding days, which he found uncomfortable and distressing. He described feeling angry and dizzy and remembered believing the medicine was wrong for him. He reported pacing and a general feeling of being unsettled all the time, and feeling compelled to move, being unable to sit still, with a compulsion to walk. Dr Lewin was of the view that this was consistent with a history of Akathisia, a common complication of the use of neuroleptic medication, often experienced as intensely distressing.
56The accused described similar symptoms on an ongoing basis over previous months, but reported that he had not described them to Dr Ilchef. What he told Dr Ilchef about, was his thoughts of getting off the medication, so that he would feel better and could fix up the house. He reported that in the months preceding Ms Watson's death, his thoughts were not directed towards hurting her and he had no plans to harm her. At that time he was attending all his appointments, endeavouring to reduce his medication, which he was taking regularly, as prescribed. Dr Lewin observed, however, that the accused was clearly unsure of the dates and the time sequence of important events.
57As to his mental state in March 2010, the accused recalled being violent in January and February, after he ceased receiving injections and transferred to oral medication. He reported sometimes telling Dr Ilchef about the voices he heard and his symptoms worsening, but said that sometimes he withheld the information from Dr Ilchef, because he feared the medication being increased. He wanted to get off it, believing that it did not help him and that he did not like the feelings it gave him.
58The accused also described the reduction in medication in the two days preceding his mother's death, as worsening his symptoms. Dr Lewin noted that there was no independent confirmation of this history, but that such a pattern of worsening Akathisia, was consistent with clinical experience.
59The accused said that while he was getting on well with his mother in the weeks before and had not had thoughts of violence, in the days before her death, the voices were hounding him constantly. Dr Lewin observed that the Community Mental Health Service Clinical notes recorded that his family were particularly concerned at this time, taking him to the appointment with the treating psychiatrist.
60The accused could not recall what he then reported to Dr Ilchef, but said that he did not approach him with a plan of trying to persuade him to stop the medication. His memory had become clearer since, with changed medication and he could remember 'crazy talk' when interviewed by police. He said the name 'Satan Nostradamus' had just come to him.
61Dr Lewin noted that with treatment while in prison, the accused described the voices having settled, feeling better overall, memory and cognition improvement and that he had no current persecutory, delusional ideas. Dr Lewin outlined the basis of his assessment that in March 2011, Mr Watson had sufficient capacity to be able to decide what defence he would rely upon and to make his defence and his version of the facts known to the Court and to his counsel.
62Dr Lewin diagnosed that the accused was suffering from chronic paranoid schizophrenia, against a background of polysubstance dependence. His opinion was that there was abundant evidence of delusional thinking, during the accused's two interviews, when he gave a description of elaborate and complex patterns of persecutory delusions in the past, which he appeared to repudiate, but a number of which he continued to cling to.
63Dr Lewin noted emotional blunting, poverty of thought, and a continuing acceptance of bizarre beliefs, including delusional beliefs about Ms Watson's identity and her repeated sexual assaults of him, which the accused found unremarkable.
64On Dr Lewin's diagnosis, in the period from discharge from hospital in May 2009 and March 2010, the accused had exhibited acute psychotic symptoms and objective signs of mental illness. His symptoms reportedly settled in late 2009 and early 2010, but he repeatedly complained of side effects of prescribed neuroleptic medication.
65In his report to Dr Ilchef three days before Ms Watson's death, the accused had reported being in good spirits, with no psychotic symptoms reported. A reduction in medication dose was then prescribed. The accused had no memory of his state on the day of Ms Watson's death, but was described by Dr O'Dea, several days later, as being acutely unwell.
66Dr Lewin concluded that at the time of Ms Watson's death it was 'more than likely' that the accused was acutely unwell. There was long term evidence that he was suffering from a chronic and severe mental illness, which was resistant to treatment. While the treating psychiatrist came to the conclusion in March 2010 that the accused's condition was then less than acute, that it was then acute was supported by the accused's long term abundant history of schizophrenia, including persecutory delusional ideas about his mother, the accused's behaviour at the time and Dr O'Dea's assessment.
67In Dr Lewin's assessment, on the basis of the accused's cluster of persistent delusional ideas about his mother, which included that she sexually assaulted him during the night, his understanding of his actions was impaired. He was of the view that the accused appeared to have been unable to recognise that his behaviour in stabbing his mother, was morally wrong. The accused had described the ability to resist other delusional beliefs and to resist command hallucinations at other times, as well as a longstanding struggle with symptoms of Akathisia, which became more intense with the reduction of medication. In Dr Lewin's opinion, this may have magnified the intensity of the accused's response to his psychotic symptoms. Dr Lewin opined that '[i]t appears that he was then unable to think rationally as to the reasons which might guide him in a decision to act'.
68Dr Lewin also noted that there had been improvement in the accused's condition, during a prolonged period of stable inpatient care at Silverwater, with use of antipsychotic medication and detoxification for marijuana and stimulant substances. In March 2011, he found that mild residual symptoms of his schizophrenia illness were evident, in a mild/subacute phase, at a time when the accused was not unduly sedated. Dr Lewin concluded, however, that the accused's severe illness had responded only partially to an 'energetic psychiatric treatment'; that he had made only a partial recovery and that he had gained only limited insight. In all of the circumstances, Dr Lewin was of the view that the accused had a basis for the defence of mental illness.
Dr Nielssen
69Dr Nielssen also reviewed various of the material reviewed by Dr Lewin. He interviewed the accused in July 2010 and then noted a similar, albeit less detailed history to that later taken from the accused by Dr Lewin. At that time, the accused still adhered to the belief that Ms Watson was not his mother; that he had met his biological parents; and that his beliefs were not based on his symptoms of schizophrenia. He also then persisted in a belief that he was affected by 'mind books'. He did accept that hearing voices was probably a symptom of a mental illness. He described the ineffectiveness of the treatment he was receiving at the time of Ms Watson's death, in stopping the voices, which had told him how he'd been wronged and had suggested that he kill his mother.
70The accused described a belief at the time of his mother's death, that she wasn't his mother and that she had arranged to have some blokes rape him, at a time when he had been in a trance. He had read the narrative in the police facts sheet and felt ashamed of himself and sorry for what he had done, but denied being related to his sister. He also denied any memory of the assault itself, although he could remember ringing the police and telling them things recorded in the record of interview. He explained his use of the name 'Satan Nostradamus'; his description of Ms Watson as 'a keep'; and his history of being at the Chisholm Ross Centre, after arguing with his mother.
71The accused also gave an account to Dr Nielssen of his mental illness after heavy marijuana use and experimentation with ice. He described ongoing hallucinations and lapses in awareness and insisted that he was not related to his sisters and was not sure if they were his biological siblings.
72Dr Nielssen described the accused as evidencing blunted reactions, consistent with chronic schizophrenia. He reported symptoms such as hallucinations, which were then decreasing in frequency, but continued expressing delusional beliefs. Impairment in intellectual function consistent with chronic mental illness was also noted. Dr Nielssen diagnosed that the accused was suffering chronic schizophrenia, based on his presentation and history.
73Dr Nielssen also noted that he was not thought to be acutely unwell by Dr Ilchef, three days before Ms Watson's death. While he was then taking a relatively low dose of medication, which was further reduced, the accused reported then experiencing chronic auditory hallucinations and bizarre delusional beliefs.
74Dr Nielssen was also of the view that the accused had a defence of mental illness, given his severe form of schizophrenia, a disease which produced a pattern of abnormality of the mind, recognised in law as a disease of the mind. The effect of an exacerbation of his chronic and largely treatment resistant form of schizophrenia meant that at the time of Ms Watson's death, he was unable to recognise that his actions were morally wrong. Nor could he reason with sense and composure about the consequences of his actions. Dr Nielssen concluded that the accused had only made a partial recovery and continued to express delusional beliefs.