COURT: Defendant was originally charged with murder. She pleaded guilty to manslaughter on the basis of the defence provided for in section 3(1) and (2) of the Homicide Ordinance, Chapter 339, namely the defence of diminished responsibility. This plea was accepted by the prosecution in satisfaction of the indictment. In short, the defendant has admitted to taking the life of her son.
It was on or about midnight between 4 to 5 September 2020, whilst at the family home, the defendant used a plastic cloth and strangled her autistic moderate intellectual disability, epileptic and behavioural problem son, then aged 21, to death.
Her actions arose from her abnormality of mind as the defendant was suffering from a major depressive disorder and/or a moderate depressive episode and was diagnosed by two different psychiatrists, namely Dr Li Cheuk-wing, the defendant’s psychiatrist, and Dr Liu Ching‑yung, Amy, a government psychiatrist respectively.
In any event, the depressive illness was an abnormality of mind which substantially impaired the defendant’s mental responsibility for her acts.
After strangling her son, she intended to take her own life by cutting her wrists and took drugs prescribed for her son and sleeping pills. She left two suicide WhatsApp voice messages to her husband and her friend. She told her husband she had taken the deceased away and asked him to take care of himself and their two children, twins. She thanked her friend for her assistance and asked her to take care of her twins. Shortly after her failed suicide, she woke up her younger son and asked him to make a report to the police.
The defendant was sent to hospital and upon examination, she was found to sustain an approximately 3-centimetre long deep laceration on her left wrist and approximately 2-centimetre long superficial laceration on her right wrist. The wounds were repaired and the defendant was discharged from hospital on 7 September 2020. She was remanded in gaol custody.
The defendant is aged 49, she is married and has twins, a son and a daughter now aged 15. At the time of the commission of this offence, the defendant was aged 47. The defendant originally came from the mainland to Hong Kong to be with her husband in 2004. She trained as a nurse in China and gave up her job when the deceased was born to look after him and to use her medical skills to make his life more comfortable because he was a frail, sickly baby.
Prior to sentencing the defendant, I called for a probation officer’s report, a psychologist’s report and two psychiatric reports. The psychiatric report dated 10 May 2023 were from Dr Lam Ho-yin and Dr Amy Liu. Both psychiatrists recommended a hospital order under section 45 of the ordinance for a period of one year and for the defendant to serve her sentence at Siu Lam Psychiatric Centre.
Although both reports were detailed and thorough in regard to the background and the defendant’s medical condition, it was not clear from the reports whether the defendant suffered from any mental disorder within the definition of section 2 of the Mental Health Ordinance, Chapter 136. The sentencing hearing was adjourned with the direction from the court to the psychiatrists to state “whether the defendant suffers from any mental disorder within the definition of section 2 of the ordinance, and if so to identify the mental disorder and details of such”.
Subsequently, further reports were submitted by Dr Lam and Dr Amy Liu on 30 May 2023. Both psychiatrists stated the defendant suffers from recurrent depressive disorder, which is a mental illness under the definition of section 2. They have maintained their recommendation as stated in the first report.
Ms Crebbin, for the defendant, has today submitted a further psychiatric report from the defence psychiatrist, Dr Li Cheuk-wing, dated 1 June 2023. She places great reliance on this report, particularly that the defendant is a person who would benefit from assistance outside of Siu Lam. Dr Li’s opinion at paragraph 9 states that the defendant’s prognosis is good.
Ms Crebbin particularly relies on this fact that the index offence was precipitated by the acute stress of caring for the deceased at home. This unique and severe stressor is no longer present. Ms Crebbin says it is unlikely to therefore happen again. She further relies upon Dr Li saying that she has good insight and accepts psychiatric treatment and Dr Li’s opinion that her psychiatric conditions can be managed in an out‑patient setting and that a hospital order is not indicated.
At paragraph 10, Dr Li states that the defendant requires ongoing psychiatric medications, follow-up and psychological treatment to prepare for her return to society. He opines that her risks of violence and suicide are low. It is noted, he said, that her stay in Tai Lam Centre for Women had been uneventful apart from a mild exasperation of depressed mood two years ago.
Ms Crebbin urges this court with the support of Dr Li at his last sentence in paragraph 11, that if the defendant is remanded further and in Siu Lam, managing a stable patient in a stressful environment such as a psychiatric ward may not be beneficial to their recovery.
Ms Crebbin has urged me to take into account that the defendant has been in custody since September 2020, now that’s almost 2½ years and that is sufficient punishment for her, that the only stress factor in her life was her autistic son and she will no longer be under any further stress.
Ms Crebbin submitted this was not a premeditated crime. In effect, the defendant suddenly snapped due to the stress and exhaustion she was feeling at a time when the deceased was being noisy and behaving badly and after having had a disagreement with her husband earlier in the day about how to deal with the various childcare issues they faced.
It has been emphatically urged upon me by Ms Crebbin and the defendant that she wishes to be released so as to take up her duty and responsibility to care for her twins who are now aged 15. It is Ms Crebbin’s mitigation that the twins are in desperate need of their motherly love, care and assistance which they had been deprived of in the last few years. The twins who are now teenagers would clearly benefit, Ms Crebbin says, greatly from having the day-to-day support of their mother as they reach puberty.
Furthermore, Ms Crebbin relies on the numerous letters before me which speaks of the defendant being a very loving, caring and hardworking mother doing her level best to look after the children and her husband and keep the family together under very difficult circumstances, particularly when the deceased needed so much extra care and support.
As I indicated to Ms Crebbin in the hearing before me today, what I am concerned about is how best and what is the most appropriate sentence for the defendant. I fully accept that the defendant was a loving, caring and hardworking mother and doing her level best to look after her children and husband. I fully appreciate that her children and her husband and herself wish to reunite. What I cannot ignore is the defendant’s present psychiatric condition.
I have before me now the four psychiatric reports which two each are from Dr Lam and Dr Amy Liu from the government and another report from Dr Liu today which totals five. I also have a psychology report and a probation report. The probation report recommends probation provided certain conditions.
Let me first turn to Dr Li Cheuk-wing’s report. Dr Li examined the defendant on 25 May 2023 at Siu Lam Psychiatric Centre for a total duration of about one hour. His last report was dated 19 April 2022. In preparing his report dated 1 June, he had regard to the four government psychiatrists report, the psychologist report and probation report which I have already mentioned and his opinion on Madam Chen’s background, history, psychiatric history and diagnosis were also stated in his earlier report.
This report that Dr Li has compiled was compiled after he saw the defendant for one hour and in his report at paragraph 9, he mentioned that her prognosis was good and she had good insight and accepts psychiatric treatment. This appears to go somewhat against the other two psychiatrists.
Significantly, I would add here that Dr Amy Liu had a very close patient-doctor relationship with the defendant. In her report of 30 May at paragraph 3, she states she has been the psychiatrist for the defendant since she was transferred to Siu Lam Psychiatric Centre for psychiatric assessment on 9 September 2020. Up to the time of writing the 30 May report, Dr Amy Liu had conducted at least 39 interviews with the defendant. At paragraph 3 of her report, she went on to say:
“Longitudinal observations through repeated interviews, with the help from nursing observation at Siu Lam Psychiatric Centre, provides her, the undersigned, with invaluable and unique information on the comprehensive psychiatric assessment. This is particularly useful for a detailed observation and assessment on the personality, coping strategy, fluctuation in mental state in response to stress, and readiness for change, which could be difficult to be evaluated through cross‑sectional interviews.”
In her concluding paragraph 30, she states that the defendant is regarded to be in early remission of the recurrent depressive disorder, which is a state of mental illness which is very different from absence of illness. It is apparent from her conclusion that the defendant is at risk of relapse, suicide, and violence. Dr Amy Liu stated as follows:
“The treatment of depressive illness involves pharmaceutical treatment for symptom control and rehabilitative treatment involve psychological, cognitive, and behavioural therapy. All elements are necessary and are equally important. The defendant did not show any progress in the rehabilitative treatment and therefore the defendant can be regarded as only halfway through her treatment.”
As elaborated in her report, the risk of relapse, suicide, and violence is high in patients suffering from depression with homicidal act. On top of it, the defendant has a lot of unfavourable factors which would further increase the risks. I turn to paragraph 13 of Dr Liu’s report:
“Risk of violence in patients with diagnosis of depression and homicidal act, albeit appearing to be less harmful in presentation, should not be underestimated. Homicide is a rare event, even amongst mental patients. It is extremely rare in patients with depression. Scientific research has repeatedly demonstrated history of violence as one of the strongest predictor of future violence in mental patients. Treatment for mental patients with serious violence, in particular homicide, is inevitably to be different and unique from treatment with those without violence.”
In regard to the treatment needs at paragraph 24, Dr Liu states:
“The risk of relapse, suicide, and violence are the three most important treatment goals. The psychiatric treatment should never stop at the mere control of symptom by medication. Rehabilitation, which usually involves intensive psychological, cognitive, and behavioural treatment, is of major importance to reduce the risk of relapse and to minimise the risk of self‑harm or violence in case relapse unfortunately happens in the future. This is particularly important in treatment of mental patients with serious violence such as homicide. This is even more critical for patients like the defendant in which the risk of relapse, suicide, and violence being directly related to the way she deals with stress.”
Dr Lam Ho-yin was of a similar opinion as stated in his paragraphs 11 and 12 of his report dated 30 May. He stated at paragraph 12 that the defendant is suffering from a mental illness, namely recurrent depressive disorder. Her depressive symptoms at present are largely managed with pharmacological treatment. But on the psychological aspects, there are unfavourable factors identified for the defendant which poses the risk of recurrence of her depression.
I note here specifically her superficial insight also raises concern towards compliance to treatment in the community. He therefore comes to the conclusion that he recommends, as part of the intensive rehabilitation of her mental condition, in-patient treatment is recommended.
I turn now to sentence. This case is a tragedy. The family have been deeply affected. The young twins have lost the nurture and care of their main carer, their mother. The husband has had to quit his job as a taxi driver to look after the children and live on CSSA. As I understand, he is also seeking treatment for stress-related matters. Tragically, the family have lost a brother and a son. I have every sympathy with the pain that the defendant and the family have gone through and will continue to go through, particularly the defendant for the rest of her life, knowing that she ended the life of her son who she so deeply loved and at the same time, attempting to end her own life.
In manslaughter cases, there are a variety of circumstances which the offences are committed. There are understandably no guidelines or tariffs. The root cause of this offence was as result of the defendant’s depression. Stuart‑Moore VP, as he then was, said in the case of HKSAR v Chiu Yu To [2001] 3 HKC 186 at 192:
“Essentially, mentally disordered offenders, whether or not the disorder has been the root cause of the offence, are approached on the basis that the law, where possible, should facilitate treatment in hospital.”
Defendant, I acknowledge that you had been in custody now for some 2½ years. I have given anxious consideration to all the matters, the numerous mitigating letters of support before me. Upon weighing the matters, particularly those submitted to me by Ms Crebbin that you should be given a sentence to which you will be allowed to have psychiatric treatment in an open setting, on balance, I am satisfied that having regard to all the circumstances, including the nature of the present offence, the character and antecedent of the defendant, and to the available methods of dealing with the defendant, the most suitable method of sentencing you is by means of a hospital order.
I therefore sentence you, the defendant, to hospital order for a period of 1 year at the Siu Lam Psychiatric Centre under section 45 of the Mental Health Ordinance.