Taranaki District Health Board's management of a mental health inpatient comes under fire by judge

The Taranaki District Health Board has come under fire by a district court judge. Photo/Tara Shaskey.

A district court judge has slammed the Taranaki District Health Board's mental health service for its "mismanagement" of an inpatient, saying the man was released too early and innocent people were assaulted by him as a result.

"You have not been properly looked after," Judge Tony Greig told the man, who is a paranoid schizophrenic, in New Plymouth District Court.

"I have met you so many times since I have been a judge here for the last two years. It's not – well part of it is your fault because you keep abusing substances – but it is the fault of the people who let you go."

Jo Woodcock, defence lawyer for the man, echoed Judge Greig's comments, saying it was clear her client, and the community, had been let down by the Taranaki District Health Board (TDHB).

But the TDHB said it is "confident in the care and treatment our services provide".

The 41-year-old man has an extensive history of offending, influenced by his complex mental health issues, and Judge Greig said it had recently escalated.

In September he appeared in court on a raft of charges including assaults on female, hospital staff, and other members of the public.

The man was found unfit to stand trial and under the Mental Health Act an inpatient order was made for him to reside at Te Puna Waiora, TDHB's mental health unit, for treatment.

Defence lawyer Jo Woodcock said the man has been let down by the Taranaki District Health Board. Photo/Tara Shaskey.

But the following month, he was out, having been released by his treating clinicians.

"In other words the hospital deemed him safe to be released far too quickly and as a result these other people have been offended against," Judge Greig said.

"The circumstances of these assaults, anything could have happened, it could have gone so badly wrong."

Shortly after he was back in the community, the man visited Te Puna Waiora on October 27 to receive his medication.

When he was asked to leave, the man became agitated and told a worker he would "smash him another day".

He then picked up a bottle of disinfectant and threw it at the worker before walking outside to the car park where he threw a large stone at a parked vehicle.

A later incident, on November 24, saw the man loitering outside a New Plymouth law firm, leading a woman to ask if she could help him.

He demanded to speak with her colleague and refused to give his name. Without provocation, he became agitated and told the woman he would "f*** her up".

The woman tried to lock the sliding door to shut the man outside, but he stepped inside before she could.

Inside, he knocked items out of the woman's hand and then shoved her, pushing her backwards.

On December 15, the man rode his bike along Tukapa St and passed a woman pushing a pram with her baby in it.

"You f****** b****," he yelled at her, as he closed his fist and forcibly punched at her head.

The woman, who was not known to the man, was able to protect herself and her baby by quickly ducking out of the way.

Following the spate of offences, the man was taken into custody.

Outside of court, Woodcock said it was evident her client had been released from the inpatient order too early.

"I think the proof is in the pudding isn't it, in the sense that very quickly after being released he's committing offences."

She said the man is mentally ill, vulnerable and is deserving of care and empathy.

"The difficulty is, and I appreciate it, is that the nature of that illness makes it difficult to care and have empathy for people who are abusive but that's part of the illness."

Wendy Langlands, TDHB's mental health manager, was unable to discuss the man's case due to patient confidentiality.

But she said a court order does not influence the length of time a patient stays in the ward.

"Unfortunately, we cannot control all the stressors one would face in the community, but this is taken into account before discharge."

Patients subject to the Mental Health (Compulsory Assessment and Treatment) Act undergo regular formal reviews of their status, she said.

"Prior to discharging a compulsory patient, we ensure a community mental health keyworker is in place, routine follow up occurs with their community psychiatrist and keyworker, social and accommodation supports are in place and treatment oversight is maintained."

At a court hearing on Thursday the man appeared, flanked by two police officers, on charges of male assaults female, common assault, assault with a blunt instrument, wilful damage and two of speaking threateningly.

He was again found unfit to stand trial.

Judge Greig said the incidents would have been traumatising for the victims.

But the man, too, was a victim, he said, referencing a report from Dr Kumar, of the Midland Regional Forensic Psychiatric Service.

"What I read into this report is implicit acknowledgement that [the man] has not been treated with the degree of attention that he should."

The man's diagnosis of chronic paranoid schizophrenia dates back more than two decades and is complicated by a raft of other issues including antisocial personality disorder, polysubstance abuse disorder, a transient lifestyle and poor treatment adherence.

The report said without proper oversight and intervention, the man was a danger to the community.

To manage his future risk of violence, he needed to receive adequate psychiatric treatment, initially in an inpatient setting, the report recommended.

But Judge Greig was apprehensive.

"What I don't want to do is to sentence [the man] to an inpatient order and have his case mismanaged, as is clear Dr Kumar feels has happened," he said.

But Dr Kumar had contacted the service manager of the TDHB mental health and addiction services who has advised that the service is aware of the man's complex needs, Judge Greig said.

"The director has given her commitment that mental health services will ensure that the man is treated adequately and that his symptoms are controlled before he is placed in a community facility."

As a result, Dr Kumar recommended that again an inpatient order be imposed instead of a special patient order which would see him released only by the mental health review tribunal.

Judge Greig adopted the recommendation and made the inpatient order.

"But you and everyone else needs to understand that if you are now released at a time when you are unwell and you offend again you run the risk of being made a special patient which could mean further confinement," he warned.

"It will mean further victims and it will mean the further victims, and you, should look to the Taranaki District Health Board for other remedies."