COURT: The defendant was charged with the murder of his wife. He admits to killing her but claims he did so while suffering from schizophrenia. Relying on the defence of diminished responsibility, he pleaded guilty to her manslaughter. This plea has been accepted by the prosecution in satisfaction of the indictment. Having read the medical reports prepared by both the defence and the prosecution, I am satisfied that the plea should be accepted.
The Summary of Facts which the defendant has admitted for the purpose of his plea reveals that he believed that his wife was being unfaithful to him. At around 11 am on 28 November 2018, the defendant quarrelled with her over his perception that she was having an extramarital affair. When she was cooking in the kitchen, the defendant took out a knife and stabbed his wife once in the back, and it was this wound which caused her death.
He reported the case to the police at around 2.55 pm and admitted to them that he had stabbed his wife on impulse and in a moment of rage.
The Summary of Facts also sets out the procedural history of the case and the psychiatric assessment of the defendant. When he appeared before the Magistrates’ Court on 30 November 2018, the court requested a psychiatric examination of him. This revealed that he was then unfit to plead as he had fluctuating moods, indulged in self-muttering and had auditory hallucinations. Furthermore, the defendant did not believe that his wife was dead and he did not seem to be aware of the present charge against him.
On 9 January 2020, after receiving antipsychotic treatment at the Correctional Services Psychiatric Centre at Siu Lam over a period of 12 months, the defendant was regarded by a psychiatrist as fit to plead.
On 16 June 2020, Dr Robyn Ho at the request of the defence conducted a mental state examination of the defendant. Dr Ho noted that the defendant had been abusing alcohol for a long period of time and that he had been reducing his daily dosage of medication since 2017. As a consequence, he had begun to grow suspicious that people around him were planning to harm him and he had started to suspect that his wife was cheating on him. A few days before he killed his wife, he had begun hearing non-existent voices commanding him to punish his wife by stabbing her for her infidelity. At the time of the offence, these voices commanded him to stab his wife and he then impulsively did so.
Dr Ho expressed the opinion that the defendant had started to suffer from schizophrenia since early 2018 and that the major cause was his self-reduction of his antipsychotic medication. Dr Ho concluded that the defendant was suffering from a relapse of his schizophrenia that was largely precipitated by his poor drug compliance.
In May and June 2021, Dr So Wai-lam, a visiting psychiatrist at Siu Lam Psychiatric Centre, compiled psychiatric reports on the defendant. Dr So also concluded that the defendant was suffering from a relapse of schizophrenia at the time of the offence and she expressed the opinion that his abnormality of mind substantially impaired his mental capacity for his acts at the time of the offence.
The defendant has been known to the Hospital Authority since 2003 as a person who is prone to suffering from delusions of persecution and aggressive behaviour, especially after consuming alcohol. He has been admitted to hospital for treatment of his mental illness in 2003 and on two occasions in 2011. He has been on antipsychotic prescription medication since 2003.
The background to the offence is fairly typical of schizophrenia murders but that does not make it any the less tragic. The defendant, on his own initiative, started reducing the dosage of his medication. As he did so, his mental illness returned and he was observed by those around him to be muttering to himself, behaving strangely and exhibiting delusional signs. It seems that those close to him were aware that he was not taking his medication and that this was responsible for his behaviour, but it also seems that no one anticipated that this might result in him behaving in a violent way.
I have received a number of medical reports on the defendant. They are unanimous in concluding that the defendant’s conduct was due to his mental illness and to his failure to control it by complying with the directions given to him in respect of his medication, exacerbated by his consumption of alcohol.
I have before me the reports of two registered medical practitioners under the Mental Health Ordinance, Cap 136, Dr So Wai-lam and Dr S H Lui, both visiting psychiatrists at Siu Lam Psychiatric Centre. In her report dated 7 July 2021, Dr So expressed the following opinion:
“Law suffers from schizophrenia with a background of alcohol dependence and a history of alcohol-induced psychosis. He was noted to be easily irritable with irrelevant speech, auditory hallucinations and morbid jealousy on admission to SLPC in December 2018.
While his mental condition has partially improved with treatment, he continues to have suspicions regarding details of his wife’s death and has a limited insight towards his mental illness. In view of his partial remission, limited insight and risk of violence under psychotic influence, further inpatient treatment is necessary for stabilisation of his condition and rehabilitation.
If the court sees fit, I would respectfully recommend a hospital order for an unspecified period under section 45 of the Mental Health Ordinance for treatment of his mental illness. He could serve the hospital order at Siu Lam Psychiatric Centre. His progress and release in the future would subsequently be regularly reviewed by the Mental Health Review Tribunal. He is mentally fit to plead.”
In his report, Dr S H Lui concluded that the defendant is suffering from paranoid schizophrenia and that although his mental condition is stabilised, he does not impress as giving much thought to his mental illness. Dr Lui then said:
“Hospital treatment is indicated, given his self-centredness, lack of insight into his problems and uncertain social support. As there is no telling when it will be safe for him to be discharged, I would recommend to the court if it sees fit that Law be committed to the Siu Lam Psychiatric Centre under section 45 of the Mental Health Ordinance for an unspecified period. His future release then will be regularly reviewed and to be determined by the Mental Health Review Tribunal.”
Dr Lui also confirmed that the defendant is fit to plead.
I am satisfied that the defendant is a mentally disordered person as that term is defined in the Mental Health Ordinance. Given all that I now know about this defendant, I am satisfied that the recommended course of action, that is the making of a hospital order, is the most suitable method of disposing of his case. I say this because it is clear that what the defendant needs, above all else, is medical treatment but this must be done without imperilling the interests of the public.
I believe that making a hospital order achieves the correct balance of addressing the needs and interests of the defendant, and at the same time protecting the public.
Under the Mental Health Ordinance, I am required to decide two matters relevant to the terms of the section 45 order. The first is whether the defendant should be admitted to and detained in the Correctional Services Psychiatric Centre, in which case he is treated as a prisoner lawfully confined in a prison, or whether he should receive treatment in the mental hospital either as an outpatient or as a detained inpatient. The second matter I have to decide is whether I should make the order for a specified or unspecified period of detention.
A number of matters concern me about the defendant’s illness and his ability to take charge of it in a responsible way. The defendant knew he suffered from mental illness and he must have known that properly managing it required him to take the medication that was prescribed for him and that he would have to be on the alert to symptoms of it returning. Over a period of time, he deliberately reduced the dosage of his medication, ultimately robbing it of any effectiveness.
He has shown by his conduct that he still lacks a proper appreciation and understanding of his mental illness and of the symptoms that can manifest should he not take his medication. I also regard his attitude towards taking his medication as reflecting a lack of judgment and a certain degree of irresponsibility. He reduced the dosage of his medication primarily because he disliked the adverse impact that it had on his sexual potency. Aligned with this is his inability to control his consumption of alcohol. He knew that alcohol could affect his mental illness detrimentally and he deliberately kept from his wife his consumption of it. The adverse impact of alcohol upon him was compounded by his reduction in the dosage of his medication.
Both his reduction in the dosage of his medication and his continued consumption of alcohol were for selfish and self-indulgent reasons. He does not present as an offender who can be relied upon to adopt a responsible, mature, and consistent attitude to the taking of his medication. It seems to me that he needs to be in the disciplined and regimented environment of a secure setting in order to ensure that he takes his medication in the dosages and frequency prescribed by those treating him in order for him not to be a danger to the community.
For this reason, I am satisfied that the defendant should be admitted to and detained in the Correctional Services Psychiatric Centre. For the same reasons, it is not possible for me to determine how long it may take for the defendant to develop a proper appreciation of the seriousness of his mental illness and of the importance of him complying with the directions of his doctors. These are both necessary prerequisites to him developing the ability to responsibly manage his mental illness.
The potentially disastrous consequences to the community of me making unrealistic assumptions about these matters compels me to order that his detention be for an unspecified period.
I am satisfied that arrangements have been made for the admission of the defendant to the Correctional Services Department Psychiatric Centre. I therefore make an order under section 45 of the Mental Health Ordinance, Cap 136 that the defendant be admitted to and detained in the Correctional Services Psychiatric Centre for an unspecific period of time.