H. Psychiatric and other consultations
- Mr Fitzgerald developed a mental illness as a result of the accident.
- Dr Anthony Durell, a psychiatrist retained by the plaintiff in June 2016, diagnosed Mr Fitzgerald with major depressive disorder and post‑traumatic stress disorder.
- Dr Robert Lewin, retained by the Nominal Defendant in September 2017, found evidence of "enduring irritability and some mild post‑traumatic symptoms of the anxiety" and also "evidence of a Chronic Post Traumatic Stress Disorder now in partial remission and a Major Depressive Episode, also in partial remission". [56]
- The partial remission which Dr Lewin diagnosed has occurred without any psychiatric or other counselling. Dr Durell had advised monthly psychiatric, general practitioner, drug and alcohol counselling for five to ten years, monthly family therapy counselling for three to five years, and twice monthly psychological sessions for five to ten years and an inpatient post‑traumatic stress disorder program for two to three weeks. [57] None of this has occurred, apparently due to Mr Fitzgerald's reluctance to have counselling. Mr Fitzgerald gave no evidence of any reason why no counselling had occurred, apart from an apparent general reluctance. In cross‑examination it was put to him that if some funds were set aside for counselling would he have it, and Mr Fitzgerald agreed.
- It seems to me that Dr Lewin's evidence is the only reasonably current evidence of Mr Fitzgerald's need for counselling, and in respect of counselling I must bear in mind that an award is only appropriate if the treatment is to be undertaken. The past conduct of Mr Fitzgerald indicates that anything more than a limited level of counselling would be unlikely.
- Dr Lewin stated:
"Mr Fitzgerald was advised by his general practitioner to undertake mental health treatment. Mr Fitzgerald reported that he had put this advice to one side. It was only after repeated encouragement from his wife that he agreed to take antidepressant medication. He had not accepted advice to undertake psychological care. He said that his general practitioner had explained the reasons for this but he decided not to proceed. I agree with Dr Durrell that there are unmet mental health treatment needs. Treatment provided so far has been confined to the use of antidepressant medication. This was both reasonable and necessary, because that treatment is consistent with published clinical data and treatment guidelines. It would be appropriate for Mr Fitzgerald to undertake further treatment. However, he repeatedly said that he is unwilling to undertake this. In my opinion, in these circumstances, a limited program of intervention designed to improve functioning and to persisting with problem-solving tasks is indicated. Mr Fitzgerald should be referred to a consultant psychiatrist. Between 12 and 18 outpatient treatment sessions are indicated. The bulk of the treatment would be provided within the first three months and treatment would be undertaken over a twelve-month period in total. An allowance for antidepressant medication costing between $60 and $120 per month is indicated for a twelve-month period. Mr Fitzgerald presented as a gentleman who was not psychologically minded. I think it is doubtful that he would benefit from a more intensive treatment program based upon psychotherapy. He does not appear to be a person who reflects upon his own inner experience. For example, I noted that he maintained even in the face of recent discussion that the problems identified in regard to interpersonal relationships and irritability in the workplace were problems independent of his own thoughts, feelings and functioning. He considered that there may have been some relationship problems, only when pressed. I think it most unlikely that he would engage in a program of psychotherapy which requires a number of things. Capacity to reflect upon inner experience the capacity to tolerate considerable distress and integrate this without emotional decompensation and the capacity to sustain a therapeutic relationship over a prolonged period of time are some of the reasons for this. In my own clinical experience, I would not be recommending the intensive program of treatment described by my colleague." [58]
- I accept the more current evidence of Dr Lewin and the proposed treatment that aligns with Mr Fitzgerald's reluctance to have counselling and the current status of his condition. Thus, $5,700 for future counselling and treatment for a 12-month period should be allowed. I would, however, allow an additional $5,000 as a buffer in circumstances where Mr Fitzgerald's reluctance changes as a result of some successful counselling, bearing in mind the other more extensive programs once recommended by Dr Durell.