24 The offender continued under the care of Dr Ali from late 2002, until late October 2005. The clinical records produced under subpoena by Dr Ali reflect a somewhat haphazard course of treatment during that period of time. However, there is no evidence that the offender's schizophrenic condition, which had been diagnosed in August 2002, was in remission at any stage between that time and the date of his arrest on 8 November 2005. On the other hand, there is evidence that during the period, the offender was prescribed with Risperdal, Luvox, Zyprexa and Avanza. These are medications that are used to treat schizophrenia and are used in the treatment of depression and like conditions.
25 The material produced on subpoena also established that during that same period there were, in addition to the diagnosis of schizophrenia, further diagnoses of depressive anxiety disorder and major depression, for which he was prescribed Tramol, an analgesic medication used for severe pain.
26 The clinical notes produced by Dr Ali under subpoena contained little detail and there was little in the way of reports from him to the offender's general practitioner during the period of treatment. However, included in the material produced was a report of Dr Ali dated 12 August 2004. This was provided in association with the offender's appearance before the Burwood Local Court on driving charges. Dr Ali observed:
"Mr Sharrouf has a history of psychotic symptoms over the past few years and has been diagnosed to be suffering from a schizophrenic illness. His main psychotic symptoms have included: auditory hallucinations, some delusional ideas of a persecutory nature, and occasional bizarre behaviour. The onset of symptoms was several years ago and they have been fluctuating in intensity. He has been on antipsychotic medication for some time and has also had brief depressive symptoms which are part of the symptomatology of schizophrenia. I note that he has done irrational things in the past, but sometimes he is impulsive and he does things and is not able to appreciate the consequences of his actions."
27 Further, an additional report was produced under subpoena prepared in association with the same Local Court proceedings by Natasha Langovski. Miss Langovski's conclusions, following her examination of the offender, included the following:-
"Based on the information provided by Khaled during this assessment, he presents with symptoms of psychotic illness. This is in line with the findings of his treating psychiatrist, Dr Ali, who is treating him for schizophrenic illness. His illness is evident in symptoms such as distorted reality, perceptional disturbances, auditory and visual hallucinations and the presence of paranoia. In addition to this, he also presents with symptoms of depression. In relation to the impact on his general functioning, his apparent cognitive impairment is of concern. Cognitive impairment is a devastating symptom of psychotic illness with wide-reaching consequences; impaired memory, difficulty in thinking logically and difficulty in solving even the most straightforward problems can have an enormous impact on everyday living. As previously mentioned, a noted feature of psychotic illness is the presence of impaired insight. With such an illness, a diminished ability to think logically and sequentially directly affects one's ability to make rational, appropriate judgments."
28 There is one further report which documents the offender's mental condition at or about the time of commission of the offence, namely, the report of Dr Nielssen dated 22 September 2005. This report had been provided for medico-legal purposes at the request of the offender's then solicitor for use in conjunction with another appearance by the offender before a Local Court on a charge of possession of a knife in a public place. It included the following observations:-
"Mr Sharrouf was unable to say why he was taking the tablets or the name of the illness for which he was receiving treatment. However, he agreed that he had experienced hallucinations of voices which he said began around the age of 18. He said that he attributed the voices to people outside the house and had often gone outside the house to look for the sources of the voices. Mr Sharrouf said he did not know who might be behind the voices."
29 Having examined the offender's mental state Dr Nielssen continued:-
"His affect was lacking in emotional range rather than depressed. His hearing was thought to be normal but he had difficulty registering questions and frequently asked for questions to be repeated in a way that was typical of people with impaired concentration due to mental illness. He gave brief uninformative answers that were lacking in explanatory detail. There was no evidence of disorganisation of speech of a kind often observed during acute mental illness. He denied experiencing hallucinations at the time of the interview and did not offer a delusional explanation for his reported experiences. However, he did not appear to recognise that the experiences were a symptom of mental illness. Mr Sharrouf's attention was impaired as was his ability to register and retrieve information."
30 Dr Nielssen eventually arrived at a diagnosis of schizophrenia. In doing so he observed:-
"He appears to have a fairly disabling form of the illness in that it has resulted in significant impairment in his intellectual performance confirmed in psychological testing performed last year. He has a disabling mental illness and it appears that fluctuations in his mental state may have contributed to his offending behaviour."
31 The evidence I have set out above serves to document the offender's mental health as it was at or about the time of the commission of the offence. The Crown agrees it supports the conclusion that at that time he was suffering from a mental illness. The Crown does not point to any material which contradicts the diagnoses which were made or the opinions which were expressed as outlined above.
32 In addition to the production of the offender's treating medical records relating to the period prior to his arrest, Justice Health produced other records pertaining to his treatment following his arrest on 8 November 2005. Those records disclosed that on 17 November 2005, only nine days after his arrest, the offender was assessed by Dr Allnutt, a consultant psychiatrist. No written report of Dr Allnutt was included in the material produced on subpoena. His clinical notes however, were included and recorded the following history:-
"He has in the past heard voices. He last heard a voice a few months ago. Can't recall what. Used to hear things outside and thought they were people. Used to run out with a bat but unable to hear properly. Thought they were saying negative things. Onset about 6 to 7 years ago. Began to use acid LSD about 6 to 7 years ago in one hit. After that began to think that people were after him. At the start, not sure, freaked out because started thinking that it may be his family, thought everything that they told him was a lie. Thought his family were planning to harm him. Began to affect his sleep. Kept waking up. Believed someone outside of his house. On occasions he went out with a bat but wife has never heard the sounds. Recalls telling his mother and father that people were following him. Around this time also had feelings of depression, appetite decreased, saw Dr Ali, followed up by Dr Ali, saw him every few weeks. Thought people would read his mind and control his thoughts. Used to be highly contemplative about what people meant when they were talking to him. After he realised he had a problem, he began to hang out with Muslims. They always reminded him of God. Began to hang with people in the mosque. Attended each time prayers were on. This relaxed him. He found that every time he felt paranoid, the thought of God would relax him. Used to attend as often as he could. Began to attend the mosque frequently after he got married about four and a half to five years ago. At that time he was recovering from his paranoia."
33 This history was generally consistent with that recorded by other medical practitioners, including Dr Nielssen. Moreover, it was sufficient, in combination with evidence obtained from other sources, including the treating records, for Dr Allnutt to arrive at the same diagnosis as had been made by Drs Ali and Nielssen, namely schizophrenia. The clinical notes of Dr Allnutt and his diagnosis are indeed consistent with the treating medical evidence. In circumstances where the offender was examined by Dr Allnutt only a matter of nine days after being taken into custody, only one month following the commission of the offence which is the subject of the plea, the records produced by Justice Health provide ample support for the conclusion that the offender was suffering from a schizophrenic condition at the time of the commission of the offence.
34 In November 2007, Dr Nielssen came to the view that the offender was unfit for trial. This opinion was confirmed in a further report of Dr Nielssen on 23 February 2008. The opinions of Dr Nielssen were generally supported by Dr Westmore, who examined the offender on behalf of the Crown for the purposes of determining whether or not he was fit to stand trial. In his initial report, Dr Westmore expressed the following opinion:-
"I would note early in this report that based on his clinical presentation Mr Sharrouf is not fit to stand trial. He appeared to be perplexed and confused throughout the assessment and he also appeared to be responding to auditory perceptual disturbances. In a forensic context and following a single cross-sectional interview, the question of malingering or a factitious disorder need to be considered. I would indicate, however, that I think that those diagnoses are less likely. It is probable that he is suffering from an acute psychosis."
35 Having set out his finding on examination, Dr Westmore went on to say:-
"This man appears to have an acute exacerbation of the illness schizophrenia. His presentation suggested that he would not be able to understand the nature of the proceedings or to follow the course of the proceedings. Again, based on his clinical presentation, he would not be able to understand the substantial effect of any evidence that may be given in support of the prosecution, nor could he make a defence or answer the charge."