JOHN DWYER. Punishing and jailing the mentally ill.

A 37-year-old Sudanese woman has been sentenced to 26 years in jail for murdering three of her children by deliberately driving her car into a lake. The story is a tragic one and has nothing to do with criminal behaviour. It raises, yet again, the appalling way in which we treat those with a seriously mental illness who, while ill, break our laws. 

In the 70s I was a member of the medical faculty at Yale University in the US. The medical school was attached to Yale-New Haven hospital, a major teaching and research-orientated facility that provided a prestigious psychiatric in-patient facility. I became very friendly with a young architect with whom I played tennis regularly. He was 35 when I became concerned that he was developing a mental illness as he became increasingly agitated and displayed early signs of a developing paranoia. I knew the family well and his 75-year-old father and 70-year old mother would tell me of incidents that were suggestive of psychotic breaks and, despite his protests, I managed to convince him to undergo a psychiatric assessment. He was diagnosed with mild schizophrenia and commenced on appropriate medication but took it irregularly. A year into his treatment he was doing poorly and was so disturbed he was “scheduled” and forced to undergo in-patient treatment in the hospitals locked facility. Three weeks later he seemed much improved and was released.

One week later I received a phone call from a friend in the hospital’s ED to tell me that police had arrested my friend after he had strangled his frail father. He had become convinced that the voices that so tortured him would only stop if he killed his father. The police had brought him to the Emergency Department because he was experiencing gross physical symptoms. I raced down to see him and was confronted by my friend who was having what is called an “oculogyric crisis” which I had seen before but not to this degree. His eyes were paralysed in an extreme upward gaze, his mouth alternated between being open to a grotesque degree and snapping shut when he would puff out his cheeks to look like two little balloons. His breathing was erratic, he was flushed and his blood pressure was dangerously erratic. It is likely that his psychiatric agitation and the drugs prescribed had triggered this very physical crisis.

He was again hospitalised in the secure facility and responded to the treatment given. To cut to the chase he pleaded guilty to the murder of his dad and brought to court for expert evidence to be presented to the judge considering an appropriate sentence. All the experts agreed he was legally insane at the time of the tragic incident and the judge sentenced him to confinement in a Connecticut forensic psychiatric facility where he would stay at the “Governor’s pleasure”; an ancient term used to indicate that he would only be released when appropriate authorities agreed that to do so was safe and desirable. I visited him a number of times. While secure the facility was clearly a hospital not a jail. After six years he was released and now, more than thirty years later I can report that he has been living a normal life and enjoyed an outstanding career as a creative architect.

Contrast that to the way we are treating the Sudanese mother who is the catalyst for these comments. In brief she fled Sudan in 2006 after her husband was murdered with her three children to seek safety in Australia. The court was told that she suffered from depression and post-traumatic stress as a result of her ordeal in Sudan. In Melbourne she had an affair with a married man who has become her partner and fathered her four Australian born children. The court heard she had been ostracised by Melbourne’s Sudanese community because of her affair.

In his sentencing summary Justice Lasry seemed to provide mixed messages. He told her as he sentenced her to 26 years in jail “Your actions amounted to a horrendous crime on innocent children and a gross breach of trust and a betrayal by you of your obligation to protect your children,” but had noted that “her life was in turmoil on April 8, 2015, when she drove into Lake Gladman in Wyndham Vale with four of her children in the car, and that there was a connection between her disturbed mental state and the offending. He also acknowledged that she “had lived an “extraordinarily difficult life” and that cases such as hers tested the community’s compassion, as people wanted to understand how parents could kill their children.

“In my opinion your actions were the product of extreme desperation rather than any form of vengeance of a kind that has arisen in other cases of people killing their children,” So the community’s compassion was on display as it let her off with just 26 years in jail!

On the same day as this sentence was handed down a young man who ran over and killed a pedestrian then fled the scene, received a 7-year sentence and disturbed the judge, as “he showed no signs of remorse”!

Our community would surely welcome the possibility of displaying its compassion in the case of this Sudanese refugee by committing her to a safe psychiatric facility “at the Governor’s pleasure”. What on earth is to be gained by the community, let alone this desperately sick woman, by sending her to Jail? The community’s compassion will see her deported back to Sudan on release if she lives that long.

Like so many doctors who have had reason to visit prisons regularly I noted during the time I cared for HIV positive inmates at Long Bay jail, how much medical and psychiatric illness was on display. Any number of studies has reported that about 50% of those we incarcerate have a mental illness.

Nothing has improved since a 2013 report from Professor Allan Fels, then the National Mental Health Commission chair, highlighted the problem. He noted “Prisons have become the dumping ground for mentally ill people after the closure of asylums and the failure to provide adequate accommodation in the community. The criminalisation of people with a mental illness has never been right; it calls into question Australia’s international human rights obligations. The justice and prison costs associated with the mentally ill amount to $1 million per person per year. This is far more than it would cost to treat these people in properly serviced mental health programs in the community. Thirty eight per cent of the 29,000 people entering prison have a mental illness and one in three prisoners with a mental illness has been in prison five times or more”.

The only good that can come from the tragic story retold here would be a reinvigoration of the advocacy for compassionate, cost-effective management of those who offend because of severe mental illness. I hope that resources can be harnessed to mount an appeal to the useless application of current law that sees a Sudanese mother who should be in hospital in a jail instead.

Professor John Dwyer, Emeritus Professor of Medicine UNSW, Founder Australian Health Care reform Alliance and President of Friends of Science in Medicine. 

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3 Responses to JOHN DWYER. Punishing and jailing the mentally ill.

  1. Kathy Heyne says:

    Heart breaking but expected result. Poor, isolated, tormented, desperately ill Akon Guode. Her sentence isn’t about compassion, it’s about punishment and a mother who kills her children must suffer the harshest punishment of all, regardless of her mental health and history. Mothers who kill are seen as monsters, aberrations, subhuman; they terrify the community. The thought that anyone of us might break like that is unthinkable, so we lock these evil mothers up and throw away the key, out of sight, out of mind.

    I’ve read elsewhere her inability to number how many children were in the car when asked by rescuers was characterised as lying, rather than freezing- the other “f” word response, like “flight” and “fight”, that is symptomatic of extreme emotional trauma.

  2. Bruce says:

    If, as you say John it costs far more to imprison people than to help them what are we doing? Both cases you cite indicate at least some degree of mental disturbance.
    Both cases have seen the community irrationally baying for blood. They are simple “law and order” cases. They are evil people, lock them up, not thinking of the consequent costs to us.
    The young man, after a minimum four years prison is not likely to come out as a good citizen. At the very least he will be a burden for the rest of his life, at worst he will be “educated” and will incur far more misery on the community. That “education” will have cost the community at least $1 million.
    Law and order campaigns cost more for incarceration and create more problems. Unfortunately, like the US we now have a prison system being privatised so that a corporation can make millions of profit by creating more problems. What logic makes us believe that a private business that gains substantially from recidivism will really discourage it.

  3. Jim Coombs says:

    I have been campaigning on this issue for nearly ten years : the absurdity and waste of tax-payers money incarcerating people whose offences have been substantially caused by their mental illness. Meetings with state attorneys and health ministers ( all saying, “Yes, yes”) have achieved nothing. Leading psychiatrists in NSW do not even answer my calls or emails. The leadership of our courts seems oblivious to the waste of resources in locking up the mentally ill, when treatment might well be effective and much much cheaper. 30% + of gaol inmates, according to BOCSAR, have a diagnosable mental illness, in NSW that amounts to over 3,000 treatable persons, there are 300 in-gaol places for treatment. The current law persists in allowing judicial officers to ignore this fact, allowing the “denunciation” and “deterrence” of offending behaviour even where caused by mental illness to lead to expensive and untreated gaol time

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