Murder shifts focus on the mentally ill
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.