The psychiatric evidence
25Reports of the treating psychiatrist Dr Roxanas, the treating psychologist Dr Pollicina, as well as reports of the forensic psychiatrists Professor Greenberg and Dr Nielssen, who had both conducted psychiatric assessments of the accused, were in evidence. All of their reports confirmed that the accused was suffering from a serious mental illness at the time of Mr Amore's death. None of the doctors were required for cross examination.
26It is convenient to first refer to the most recent report. It was the Crown which led evidence from Professor Greenberg. In his May 2011 report, Professor Greenberg's diagnosis was that the accused suffers from a chronic schizophrenic disorder with treatment-resistant residual symptoms. He then assessed that the accused understood the nature of the charge which he faces. While the accused had told Professor Greenberg that he intended to plead not guilty by reason of mental illness, in the Professor's opinion the accused did not understand the consequences of such a plea, even though he did understand the difference between a guilty and not guilty plea. The Professor was of the view that the accused was not then able to explain the purpose of these proceedings; he would have difficulty appreciating the substantial effect of evidence; in giving instructions to his legal counsel; or in deciding what defence he should make. The accused could not give a version of the facts and if required to give evidence, could not do so. On the balance of probability, he remained unfit to stand trial.
27Professor Greenberg noted that the accused remained unable to give any account of his version of events, at the time of the alleged offence. Given his history of severe mental illness in the two to three years prior to the alleged offence, the Professor was of the view that on the balance of probabilities, the accused's mental illness played a significant and major role in his behaviour at the time, with the result that he was likely to have a defence of mental illness.
28In his March 2010 report, Professor Greenberg also noted that the accused was then unable to remember the events of 13 May 2009; whether he was then using illicit drugs or alcohol; or taking psychiatric medication. He was also unsure if he was then experiencing hallucinations or paranoid or somatic beliefs. When asked if he had murdered his stepfather, he said that his mind was blank. The accused was vague about his history since diagnosis some 15 years ago, with schizophrenia. He was uncertain as to whether he suffered from a mental illness and was unsure why he took medication. He reported no conflict with his stepfather. He did not answer most questions asked and most frequently replied 'I don't know', when he did answer. Professor Greenberg found the accused's insight into his mental illness then to be grossly impaired.
29Professor Greenberg referred to the accused's medical history, including a 2008 report to his GP, Dr West by his treating psychiatrist Dr Roxanas, in relation to his diagnosis of schizophrenia and psychotic delusions that people were following him and trying to harm him; his past substance abuse, which was not ongoing; and his pre-occupation with delusions about his mother and brother. There was a history in 2008 of delusional beliefs about his brother's influence on his life, despite psychiatric medication, as well as preoccupation with people entering his house suspiciously and moving items around his house. It was noted that in 2008 and 2009 a psychologist had noted strained relations with his brother and stepfather. Professor Greenberg's opinion was that the accused's condition had been deteriorating since 2006, with the result that he had come before the court on various criminal charges.
30Professor Greenberg also noted the treatment which the accused had received in custody, but observed that the accused's cognitive functioning remained impaired, as was his general ability to interact and communicate with people. There had to that point, in his view, been a further deterioration in the accused's chronic illness.
31In his March 2011 report, Dr Nielssen n oted that he observed the accused pacing the ward, not interacting with other patients, suffering from a tremor and involuntary movements which were the side effects of potent anti-psychotic medication which he was taking. I interpose to note from my observation of the accused in Court, he visibly continues to suffer those symptoms.
32The accused gave Dr Nielssen brief and uninformative answers to open ended questions. He knew that he had been found unfit for trial and that a plea of not guilty on the grounds of mental illness would be entered. He could not remember stabbing Mr Amore, whether he had a pair of scissors that might have been used in the attack, or whether he had any reason to kill him. The accused asked Dr Nielssen for advice in response to several questions, his expression was observed to be blunted; and his answers markedly impoverished and required prompting, to provide even basic information.
33Dr Nielssen spoke to the accused's treating doctor, who had observed some more lucid moments, but the accused's impairment was considered to be consistent with severe schizophrenia. There was no evidence that the accused was exaggerating or feigning the extent of his intellectual impairment. Dr Nielssen's diagnosis was that the accused was suffering from severe treatment resistant schizophrenia, with significant impairment in all areas of his intellectual function.
34Despite the absence of clear explanation of the relationship between the symptoms of his illness and his behaviour, Dr Nielssen was of the view that the defence of mental illness was open to the accused. He concluded:
"However, despite the absence of a clear explanation of the relationship between symptoms of mental illness and his behaviour, I believe Mr Tarantello has the defence of mental illness open to him. He has a severe form of schizophrenic illness which in its more severe forms is a progressive neuro-degenerative disorder. Schizophrenia produces a pattern of abnormality of mind that is recognised in law to be a disease of the mind. Mr Tarantello's mental illness gave rise to a defect of reason that is most evident in his poverty of thought and impairment in a range of domains of intellectual function including the registration and retrieval of information and his capacity for abstract and logical thinking. Mr Tarantello also has the well-documented chronic delusional beliefs that his health had been tampered with, that people had broken into his home, that people used telepathy from the eyes to send him messages and that his actions were controlled by external forces. Those beliefs were chronic in nature and unresponsive to treatment with conventional anti-psychotic medication, and were almost certainly present at the time he attacked his stepfather. In the absence of any rational motive for the attack, I believe that on the balance or probabilities, Mr Tarantello was acting on the basis of his bizarre delusional beliefs. The severe impairment in his capacity for logical thinking arising from his illness deprived him of the ability to consider that his beliefs were delusional, or to understand that his actions in killing his stepfather in response to those beliefs was morally wrong.
Unless there is significant improvement in his condition, Mr Tarantello will require indefinite treatment in a secure hospital.
35In his January 2010 report, Dr Nielssen had noted changes in the accused's treatment, since his August 2009 report. He then diagnosed chronic treatment-resistant schizophrenia. There had in his view been no improvement in the accused's condition, to the contrary Dr Nielssen was then of the view that there had been a deterioration since he had last seen the accused, which might have reflected a reduction in the effective dose of medication which the accused was receiving. The accused had declined some alterations proposed in his treatment.
36Dr Nielssen was also then of the view that the accused was unfit for trial and that his under treated mental illness would prevent him from following any proceedings in a meaningful way; understanding legal advice; or providing reliable instructions to his legal representatives. Dr Nielssen then believed that with treatment in hospital, there was a reasonable chance that the accused's mental state would improve within 12 months, so that he might then be fit for trial. I note that this hope has not materialised.
37In his August 2009 report, Dr Nielssen noted that he had twice interviewed the accused, the second time after the accused had been given legal advice as to the purpose of the interview and the need for a written report as to his condition to be prepared. Still his answers were very vague and in some places seemed evasive. He often answered 'I don't remember', but confirmed previous convictions for assault occasioning actual bodily harm in 1988; serving three and a half years for armed robbery and two convictions for indecent exposure. There was also a conviction for cultivating cannabis, but the accused was evasive in his responses about past substance abuse. He denied smoking cannabis.
38When asked about the alleged offence, the accused confirmed where the events occurred, but could not remember details. He did recall an incident four years previously, where his stepfather had hit him, but denied having held any grievance from that incident, or having any reason to dislike his stepfather.
39When referred to symptoms described in Dr Roxanas' report, the accused agreed that he believed that his stepfather had used telepathy to affect his health, and that an argument with his stepfather had followed, after he had accused him of doing so. He also agreed that he believed that other people had forced him to expose himself and that his sexual organs had been damaged, but denied believing that people were breaking into his house. When asked how he intended to plead to the charges, he said that 'I don't know what to say', but when asked if he would prefer to plead not guilty on the grounds of mental illness, he said 'possibly, ... I would prefer it'.
40Dr Nielssen noted Dr Roxanas' report of the accused's long history of non compliance with treatment and ongoing delusional beliefs. Dr Nielssen noted that the accused was made a forensic patient, because of initial refusal to take medication. He had refused food and drink because of concerns about its content and believed that other inmates planned him harm. Hallucinations and a belief that he was not mentally ill were also noted. Dr Nielssen then diagnosed chronic treatment-resistant schizophrenia, because the accused continued to experience symptoms, despite receiving adequate doses of antipsychotic medication given in reliable form of long acting injections. Dr Nielssen was of the view that his history of convictions reflected a deterioration in his mental illness, with a direct connection between his symptoms and a recent serious assault offence.
41On the balance of probabilities, Dr Nielssen was then of the view that the accused had a defence of mental illness. He did not recognise the symptoms of his illness and was unable to recognise that any action on the basis of his delusional beliefs would be directed against an innocent person and would be morally wrong. During the acute phases of his illness he was also affected by irrational anger, probably in response to his illness and he was unable to reason with any measure of composure, about the likely consequences of his actions.
42A report from Dr Roxanas of February 2009, prepared in relation to other proceedings, was also in evidence. Dr Roxanas referred to an 18 year history of delusions and hallucinations preceded by the use of LSD and cannabis. The doctor referred to complaints that the accused's life and the world appeared to be a dream and that some of his exhibitionist behaviour had been related to a phenomena of 'passivity feelings', where he was instructed by outside forces to perform those acts'. In September 2008, Dr Roxanas had seen the accused in relation to 'telepathically inflicted pain'.
43Dr Roxanas noted a long history of non-compliance with treatment, but with improvement after fortnightly injections and daily oral medication were introduced. The doctor then assessed that the accused was unlikely to improve with hospital admission, but that he did not then present as a danger to himself or others. Community treatment was assessed to be appropriate. It was noted that he had been compliant with appointments and treatment.
44In 2009 the accused had been referred to a psychologist, Dr Pollicina, for counselling. On 4 May 2009, Dr Pollicina reported that the accused had completed a course of 12 counselling sessions, but that further counselling was recommended, because of the chronic nature of the accused's condition. Dr Pollicina was of the view that a chemical imbalance was causing the accused's symptoms, which may have originally been drug induced and that the early loss of his father and his social isolation had added to his negative state. From March 2009, Dr Pollicina observed the accused's state to have been variously 'flat' or depressed. The last session took place on 1 May, with the accused then expressing a desire to continue counselling, in the long term.