Mur­der shifts fo­cus on the men­tally ill

The Weekend Australian - Travel - - Health - LEANNE ROWE

LAST month, in the Supreme Court of Vic­to­ria, a jury de­clared that Samuel Ben­jamin was not guilty of the mur­der of doc­tor Khu­lod Maarouf-Has­san, by rea­son of men­tal im­pair­ment. Un­for­tu­nately, his case adds to the sta­tis­tics around the over­rep­re­sen­ta­tion of peo­ple with se­ri­ous men­tal ill­ness in the crim­i­nal jus­tice sys­tem.

Af­ter the case fol­lowed a tor­tu­ous course through the courts over the last 21 months, we fi­nally un­der­stand the sys­tem fail­ures which con­trib­uted to Khu­lod’s death.

My friend and col­league was bru­tally stabbed in her Noble Park gen­eral prac­tice dur­ing busy of­fice hours on June 16, 2006.

Khu­lod had been per­sis­tent in try­ing to gain ac­cess to spe­cial­ist ser­vices for Samuel Ben­jamin about nine months be­fore her death. Samuel Ben­jamin then fell through the gaps of the frag­mented health sys­tem, de­spite his de­te­ri­o­rat­ing men­tal state which he de­tailed in his diary.

Over this time, he des­per­ately tried to con­vey his psy­chotic delu­sion about a grand con­spir­acy by the med­i­cal pro­fes­sion to kill him to many or­gan­i­sa­tions, in­clud­ing the Vic­to­rian Health Ser­vices Com­mis­sioner.

The per­pe­tra­tor did not have an ap­point­ment with Khu­lod on the day of the stab­bing and she had no warn­ing of the threat against her. Since then, the Has­san fam­ily, in­clud­ing Khu­lod’s three young daugh­ters, have en­dured a long, lonely process through the court sys­tem be­cause of the de­fen­dant’s para­noid in­sis­tence on rep­re­sent­ing him­self.

A psy­chi­atric re-as­sess­ment of the de­fend- ant was rec­om­mended by the mag­is­trate af­ter six very con­fus­ing com­mit­tal hear­ings, and when the court process failed to pro­ceed. Af­ter be­ing di­ag­nosed as psy­chotic, the de­fen­dant was trans­ferred to the high se­cu­rity Thomas Em­bling Psy­chi­atric Hospi­tal in Melbourne, seven months af­ter be­ing de­tained in prison with­out men­tal health treat­ment.

When the case was fi­nally re­ferred to the Supreme Court, the hear­ings were ad­journed on three fur­ther oc­ca­sions, pend­ing fur­ther psy­chi­atric as­sess­ments of the de­fen­dant.

Far from be­ing an iso­lated event, or out of the blue as many peo­ple have sug­gested, Khu­lod’s death is at the tip of the ice­berg of some deeply con­fronting na­tional trends. Vi­o­lence against doc­tors, nurses and other health pro­fes­sion­als is com­mon and re­flects the es­ca­la­tion of vi­o­lent crime in the wider Aus­tralian com­mu­nity. Some stud­ies have doc­u­mented that two out of three gen­eral prac­ti­tion­ers were sub­jected to vi­o­lent be­hav­iour from pa­tients in the pre­vi­ous 12 months.

GPs re­quire the sup­port of the wider health sys­tem to care for pa­tients at risk of vi­o­lent be­hav­iour, but over­worked fam­ily sup­port ser­vices, men­tal health ser­vices and drug and al­co­hol ser­vices are usu­ally un­able to pro­vide the as­sertive multi-dis­ci­plinary man­age­ment re­quired. As a con­se­quence, peo­ple like Samuel Ben­jamin com­monly end up in the crim­i­nal jus­tice sys­tem.

Samuel Ben­jamin is Su­danese. There is no ev­i­dence to sug­gest that Su­danese refugees, many of whom are strug­gling with their new en­vi­ron­ment af­ter flee­ing the long­est, dead­li­est war of the later 20th cen­tury, are more likely to of­fend or to ex­pe­ri­ence psy­chotic ill­ness than peo­ple born in Aus­tralia. They are, how­ever, more likely to have their crimes promi­nently re­ported in the me­dia, and less likely to re­ceive treat­ment for men­tal ill­ness.

We should no longer tol­er­ate a sys­tem that al­lows the most vul­ner­a­ble in our com­mu­nity to fall through gaps in health and wel­fare ser­vices and end up in prison. The over­rep­re­sen­ta­tion of peo­ple with se­ri­ous men­tal ill­ness in the crim­i­nal jus­tice sys­tem is a hu­man rights is­sue and change re­quires greater com­mu­nity ac­tion.

But it ap­pears that vi­o­lence has be­come so en­trenched in our com­mu­nity, it rarely stirs the pub­lic con­science. As an ex­am­ple, the Supreme Court out­come in the case of the mur­der of a bril­liant doc­tor, who ded­i­cated her life to car­ing for dis­ad­van­taged peo­ple, hardly stirred a pub­lic re­ac­tion.

Dur­ing our ca­reers as med­i­cal prac­ti­tion­ers, we ex­pe­ri­ence many tragedies. For me, the sad­dest mo­ment was look­ing into the sea of more than 1000 griev­ing faces, as I gave the eu­logy for Khu­lod be­side her open cof­fin, on be­half of the med­i­cal pro­fes­sion, in my then po­si­tion as chair­man of the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers in Vic­to­ria.

In the time of im­mense grief in the past 20 months, per­haps the most poignant mo­ment was the si­lence in the court af­ter the young Su­danese man fin­ished an in­co­her­ent rant­ing with the state­ment: ‘‘ No one is help­ing me.’’ Be­cause, trag­i­cally, his car­ing, com­pas­sion­ate gen­eral prac­ti­tioner was dead, and he was right. Ad­junct As­so­ci­ate Pro­fes­sor Leanne Rowe AM is a rural gen­eral prac­ti­tioner and was a friend of doc­tor Khu­lod Maarouf-Has­san.

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