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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Professor John Dwyer, Immunologist and Emeritus Professor of Medicine at UNSW

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