This is the report ordered to establish if I could represent myself because Legal Aid refused me a lawyer for over a year. I only go through it without huge distress and terror because of something my friend Malcolm said. He is part of the Lake Alice group who were tortured and has fought for many years for compensation and services. He told me when he gets a really bad report full of lies he is really pleased, cause it means he has more ammunition to fight them with. I havn’t yet done my complaint to the Medical Council about all the lies and assumptions in the report but I will in the next few days. So you will see just how bad it is, if you can’t work it out already its so full of BS.
I am sure people who understand what has been happening to me and how bad the mental health services are, will see the incredibly corrupt, unprofessional and bias he has shown in this report. NOTE: I havn’t smoked pot for years to deal with my disorder, that was in a report done about 15 years ago by the nut job ACC psychiatrist Anne Walsh (she was the lover of that psychiatrist down in Dunedin who tried to kill his wife) only person who would pay her is ACC and she does exactly what they want. I know for a fact she has dozens of complaints through the Health and Disability Advocacy Service.
If you remember I had my care illegally removed in 2009 by ACC and they have refused to reinstate it since that time – even though I have won two reviews. My mental health has only worsened in that time after years of valid written and polite complaints that were ignored. This report was done based on 1hr 20min meeting with a psychiatrist that has been an architect of abusive, oppressive and elitist mental health legislation in New Zealand.
DR NICK JUDSON, MBBS MRCPsych FRANZCP Dip.HSM
4 September 2019
PRIVATE and CONFIDENTIAL
Tel: (04) 918 2471
Fax: (04) 918 2477
PO Box 50-233
4 September 2019
The Presiding Judge
Re: J E R……
Dob: xx January 1965
NHI: APQ 3050
Charges: Wilful Damage
Failure to Answer District Court Bail
Use of offensive Language/suggestions (x2)
Offensive/Disturbing Use of a Telephone (x4)
Obscene Language (x3)
Causing Harm by Posting Digital Communication (x3)
Use of Offensive Language/Suggestion
Psychiatric report pursuant to Section 38 of the Criminal Procedure (Mentally Impaired Persons) Act.
The Court has sought a report for the purpose of assisting the court to determine whether the defendant is unfit to stand trial or would have a defence of insanity within the meaning of Section 23 of the Crimes Act.
I met with Ms Routhan at the Masterton District Court on Thursday 29 August 2019 for the purpose of this report. At her request, a court security guard nominated by Ms Routhan sat in the interview, and a tape recording of the entire interview was made. I agreed to this recording on the basis that the recording would be held by the court. As the court will be aware, there had been some difficulty in organising an appointment that was acceptable for Ms Routhan and after some negotiation the terms of this assessment finally proved acceptable to her.
I have been supplied with the Summary of Facts for the various charges and a Summary of Previous Criminal and Traffic Offending. With Ms Routhan’s verbal consent I have accessed previous reports for the court prepared by Dr Justin Barry-Walsh in March 2014 and March 2019 and Dr Caroline Holmes dated May 2014 as well as a report prepared for ACC by Dr Alan Doris dated November 2008. Ms Routhan was specific in her verbal consent that these were the materials that she would permit me to access. I did not obtain written consent, as she had made it clear early in the interview that she found any ‘forms’ to be traumatic for her and I did not feel that it would be appropriate to ask her to sign a written consent form for access to the material.
With her permission, I have also spoken with her daughter P. M. and with her friend S. S. as well as briefly speaking to her lawyer, Mr Alisdair Ross. Ms Routhan had an understanding of the purpose of the assessment and was aware that my report would be sent to the court. She somewhat reluctantly agreed to participate in the interview.
I subsequently received an email from Ms Routhan sent via the office of the Director of Area Mental Health Services, which has added further useful information.
The interview with Ms Routhan was an extraordinary experience, particularly notable for the continual stream of personal abuse directed at the assessor. The interview was largely unstructured and was allowed to remain so, as any attempts to provide some structure to the questioning seemed to provoke even more levels of distress for Ms Routhan. She was quite clearly distressed and highly aroused by the interview situation and at times she had to pause to sit with her hands pressed to her temples to try and compose herself when her distress became too overwhelming. Her mood throughout the interview varied between anger, with invective and vicious personal abuse directed at the interviewer and at services and professionals in general, to quite marked distress and brief periods when she seemed reasonably calm for short periods and with some ironic humour. There were short periods towards the later part of the interview when she seemed to calm and almost seemed to gain some rapport with the interviewer around the issues of what may be beneficial in terms of a potential health support package. However this did not last very long and she returned to her previous pattern of angry and frustrated abuse.
As the court may be aware, if a transcript of the interview was accessed the abuse was continual and direct, with repeated, almost stereotyped phrases sauch as: “I hate you”, I hate your fucking guts, you piece of shit”, “you piece of garbage”, “you sick fuck”, “you elitist maggot”, you fucking elitist neo-liberal piece of shit” etc. She also directed statements about her beliefs of the Mental Health and Justice systems at the interviewer. It was evident that although these were directed towards the interviewer, they were in fact directed towards the interviewer as a representative of the system about which she feels so angry and frustrated. For example: “I know you are a murderer”, “you are dragging people into the justice system”, “you are raping those people that you lock up”, that the Mental Health system is the cause of suicides and therefore that I was murdering people and that I was personally responsible for the deficiencies in the Mental Health system.
She referred frequently to her views that the ‘system’, characterised by professionals, elites, foreigners, rich people, the justice system and the Police is systematically abusing poor people and actively taking pleasure in the sufferings of poor and disabled people. She expressed anger against foreigners who were moving to the country buying up property and displacing poor people like herself. She referred frequently to the traumas that she had suffered and her frustration with ACC and Mental Health Services, who had not provided her with the services that she feels she requires on terms that are acceptable to her.
She referred to her own very high levels of anxiety and inability to cope when faced with any situation that may remind her of her personal experiences of abuse or trauma, or that of other people in a similar situation. These may include for example, seeing police, people with tattoos in rememberance of a suicide, any kind of forms to complete, or any contact with Police, mental health professionals or the like. Her views on professionals, elites, foreigners and Government agencies systemically abusing poor and traumatised people were expressed with a vehemence and inclusiveness that suggested a quite paranoid flavour, though there were no specifically delusional beliefs.
She referred to feeling constantly suicidal and said that she was unable to function effectively. She agreed that when frustrated, when her pleas for help were not met or taken seriously she “lost the plot”. She referred to this as ‘going Tourettes’, by which she meant that it seemed that her stream of abuse occurred without her necessarily intending to do so, and that this was something in the nature of an involuntary compulsive behaviour or tic. However she also talked about her behaviour as being genuine protest against Police, Government agencies and other actors in the system and seemed to have great difficulty in understanding that her behaviour was effectively self-defeating. When I tried to explore what she was trying to actually achieve with her protests this produced higher levels of anger and distress more intense abuse. She did however appear to acknowledge that her protests were more an expression of her anger and frustration than designed to achieve any specific end, though she did hope to access to suite of ACC funded services.
As regards the issues concerning the court, she appeared to have a good understanding of the charges in general, though I did not go through each of the charges in detail. She had a very clear view of her plea options and the defence that she wished to run. She insisted that her behaviour is justified by being political protest rather than criminal action. When attempts were made to explore her understanding of the potential consequences of the criminal charges, her response was merely that she did not care about the consequences. I was unable to ascertain to what extent she actually did have any factual understanding of the potential consequences of these charges.
She initially was dismissive and somewhat disparaging about her lawyer, but when asked specifically about the role of the lawyer in representing her in court she appeared to understand his role and expressed an intention to let her lawyer run her defence in the courtroom and to try and not intervene directly in the court process. She felt that, even despite the anxiety that she knew she would feel in the court situation she would manage to maintain sufficient composure to allow the lawyer to conduct the process on her behalf.
Ms Routhan subsequently sent me quite a lengthy email, which was articulate and much more reasonable in tone. In this she acknowleged that the abuse she had expressed was not appropriate and almost apologised: “even though I want to write those words I just can’t”. She referred to how the abuse was not intended: “…what came out wasn’t what I expected either”, and that the abuse was not personal, but was an expression of her overall frustration and rage: “What happened was you copped a lot of my unresolved rage at injustice perpetrated by other psychiatrists and mental health workers who had hurt me, discredited me, rejected me etc. Please don’t take it personally.”
The current offences, 18 in all, cover a period between January 2018 and June 2019. The various offences are characterised by her abuse directed at representatives of various agencies whom she contacted in person or by telephone and by behaviour such as chalking swastikas. The charge of wilful damage arose when she threw paint over a White Ribbon banner at the police station because she objected to its comment about speaking out about violence, which she felt was hypocritical and inappropriate – she described her behaviour as ‘artistic expression’. I did not go through all the offences in detail and the court will be fully aware of the details of all the offences she is currently facing.
Background and Mental Health History
I will summarise her background and mental health history briefly as this has been well documented in previous reports.
Ms Routhan appears to have been a well-functioning and reasonably well-adjusted woman prior to an episode in 2002 when she was raped when asleep and intoxicated. She had had some previous mental health contact for some irritability, but no serious psychiatric problems prior to that. Following the incident of rape she developed symptoms suggestive of post traumatic stress disorder and received some mental health support funded by ACC. It appears that in 2009 she was receiving a package of care that she found particularly helpful, but for reasons that are not clear to me this was discontinued by ACC. Since then she has been increasingly angry, frustrated and despairing about mental health and support care that she has been offered, or that has been denied. I understand that numerous attempts have been made to engage her by various therapists through mental health services and ACC funded providers, but for various reasons these attempts to provide care have been unsuccessful.
Ms Routhan is noted to have developed high levels of anxiety, eating disorder, chronic suicidal ideation and anger, compounded by effects of cannabis use that she used to manage her mental health. She was diagnosed as suffering from a profound and enduring personality change due to the trauma of the rape. Diagnoses have varied as to whether this is PTSD, anxiety, personality change or mood disorder but however characterised there seems no doubt that this was provoked by the original episode of rape trauma and has been compounded by repeated frustrations and difficulties in her engagement with ACC, mental health and other helping agencies. Her own account is that she has been increasingly unable to function, unable to face the anxiety provoking contacts with any agencies that can support her. She gave as examples of this her inability to fill in any forms required by agencies such as Winz or ACC because of the trauma this causes her. Her friend S.. noted she experiences high levels of anxiety when she receives any communication by mail and is unable to open her mail.
Both her friend S.. and her daughter P…. describe her functioning as appearing to be relatively unimpaired for much of the time. However, when she has any experiences, contacts or thoughts that remind her of many of the traumas that she finds particularly anxiety provoking this can produce an overwhelming episode of anxiety which then triggers her angry response and inability to cope with the situation in which she finds herself. This may include contacts with mental health or other statutory agencies, or if she sees an item on the television or in the newspaper that reminds her of any of the issues that she is so preoccupied about. Ms Routhan has been unable to obtain any kind of employment and attributes this to lack of services and the anxiety and trauma that she experiences, further compounding her difficulties. She told me she now has only one friend and has very little other social contact.
Ms Routhan is currently not receiving any mental health or ACC funded services. She has made it clear that she does not wish to receive any kind of medication. She currently has no GP. She told me that this was because the GP had imposed conditions on her behaviour that she was unable to maintain without a mental health worker and that she now requires medical intervention for physical health issues.
I note that Ms Routhan has two previous convictions for graffiti in December 2017 and one of wilful trespass in May 2014. As far as I can ascertain from the records, the pattern of offending behaviour seems to have escalated in frequency and intensity over the last couple of years.
In summary, Ms Routhan displays a picture of a woman who was reasonably functioning and relatively unimpaired in terms of her mental health and behaviour prior to an episode of rape in 2002 age 37. From this event she developed high levels of anxiety triggered by the trauma, leading to an escalating pattern of distress, mood disorder and constant preoccupation with injustices, both her own and those of society as a whole, leading to her continual episodes of ‘protest’. Her protests bring her in conflict with Police and other agencies due to her pattern of escalating abuse, which is clearly distressing and may be frightening to those who are the recipients of her abusive verbal invective.
- Mental Disorder within the Meaning of the Mental Health Act 1992
Ms Routan has developed a chronic mental disorder characterised by very high anxiety, volatile mood and preoccupations with systemic abuse and exploitation which border on the delusional. There are also issues of impaired volition, in that she appears by her own admission and the observations of others, to be unable to control the stream of verbal abuse when she is triggered by rejection or an event cue that heightens her anxiety. Although she calls this a type of Tourette’s syndrome (a neurological disorder characterised by compulsive verbal and other tics), it is unlikely that this would be a diagnosis. However there is a very stereotyped pattern of abuse that characterises her tirades when her anxiety and frustration is triggered beyond a certain point. It appears that she effectively loses control and is unable to exercise any real voluntary control over her anger and verbalisation once she passes a certain trigger point. It would be reasonable to say that the first limb of the test of mental disorder, as an intermittent disorder of mood and volition, is therefore met.
The second limb of the test for mental disorder requires that she poses either a serious risk to others or a serious risk to her own health or safety, or is seriously diminished in her ability to care for herself. In terms of serious risk to others there is little evidence that any of her individual actions in themselves would pose a risk to another person, however it seems clear that the episodes of her abuse can lead to the victims of her abuse becoming upset, frightened and quite scared of her. I myself, an experienced psychiatrist, was taken aback by the abuse I experienced and for a lay person, particularly when caught by surprise, this is likely to be an extremely distressing and traumatic experience. Although each event in itself may not meet the criterion of seriousness, the accumulation of less serious events could be interpreted as being a serious risk to other people.
Secondly considering the issue of serious risk to her own health or safety, although she claims chronic suicidal preoccupation I am not aware that there has been any suicidal behaviour, and in that sense do not think that she poses a serious risk to herself.
However she does put herself in situations where others react to her in a manner that may endanger her safety. For example she complains that Police have physically hurt her when restraining her, due to her behaviour when she has been highly aroused. In addition, her preoccupation and inability to resist the urge to pursue her protests and express her frustrations causes her to come up against the very triggers that re-traumatise her and heighten her anxiety and the consequences of these create a vicious cycle, steadily worsening her own mental health. This is in itself could be seen as a serious risk to her own health if the situation is maintained. She is also reckless as to the potential consequences of her repeated protests, which also may be seen as a risk to her own health and safety. Lastly considering whether there is a significant diminished of capacity to care for herself. The accounts of her daughter and her friend suggest that she is able to care for herself in practical, day-to-day issues when she is calm and functioning reasonably well. However her life situation has clearly deteriorated during the years that she has been suffering from this mental disorder. She has gone from a relatively successful and stable person to one who is living by her own account on the margins of survival, with little money and preoccupied by the injustices of her own situation and that of others. Due to this her function is in many aspects of her life seems quite seriously impaired. Issues such as her inability to deal with the agencies that she needs to help her manage her situation, her inability to complete forms, to open her mail or to attend interviews and appointments that are necessary to make some progress in her life, all suggest that there is a significant diminution in her capacity for self-care.
Putting this all together, it is my opinion that she does meet the definition of mental disorder as defined in the Mental Health Act and that she would potentially be eligible for compulsory intervention if this was considered to be the most appropriate step in alleviating her distress. However, her intense distrust of any aspects of the mental health system would make a compulsory intervention potentially counterproductive, re-trigger many of her traumas and enhance her sense of mistrust, with a significant risk of worsening her situation
- Fitness to Stand Trial
The criteria for fitness to stand trial are that she is able to plead, to understand the nature, purpose and possible consequences of the process, and to communicate adequately with counsel.
- Ability to Plead: She understands the charges and can indicate clearly what is her preferred plea and why. However the defence that she is relying on may be unrealistic, in that she seems to dismiss the reality of the criminal behaviour and seems to regard her behaviour as entirely legitimate. On balance I consider that she is fit to enter a plea.
- Ability to understand the nature of the process: I do not think this is impaired.
- Ability to understand the purpose of the process: the answer to this would be yes in a simple sense, in that she understands that she is going to court charged with a range of offences. However her view is that the whole societal structure is one of oppression of the poor and marginalised by the elites, the professionals, Government systems etc, so that her understanding of the purpose is heavily influenced by her view that the legal process is yet another attempt to deliberately victimise her. Her full understanding of the purpose may therefore be impaired.
- Ability to understand the possible consequences: It is very difficult to assess this given her attitude is that she does not care about the consequences. It is probably that she does understand the consequences, even if she does not accept this. Her refusal to consider the realistic consequences may affect her fitness to stand trial.
- Ability to communicate adequately with Counsel: This is in my view the most tricky area for her in terms of her fitness to stand trial. The quality of her communication is so coloured by her distress, her anger and her frustration that it may be impossible for her to have any calm, rational discussion with her counsel about these issues. Although she is accepting at this stage the role of her counsel, and insists that she is allowing him to conduct her defence on her behalf, her volatility and impulsivity is such that she is likely to find it very difficult to maintain her composure and her stance of non-intervention in the court room.
In summary then my view is that there is some doubt over her fitness to stand trial, particularly given her firm insistence that she is not criminally responsible because her actions were a legitimate protest and because her ability to interact with the court as the process unfolds is likely to be impaired due to her ability to contain her distress and impulsivity during this stressful process.
Previous reports have not considered there to be an issue of insanity, though I would suggest that this a more nuanced judgement. Section 23 of the Crimes Act states that a person may be considered insane if they are suffering from a disease of the mind which makes them unable to understand the nature of the action or omission, or to understand that it was morally wrong.
Firstly does she have a disease of the mind? She is clearly suffering an entrenched mental disorder characterised by PTSD, mood disorder and some personality change, and also exhibits what appear to be compulsive urges to verbally abuse, as well as some degree of paranoid mood in relation to the persecution of herself and others in a similar situation. This mental disorder can be defined as constituting a disease of the mind.
In terms of her understanding of the nature of the action I do not consider that she would be impaired in this regard. However, does she understand that it was morally wrong? She seems to understand that the level of intensity of abuse that she allegedly perpetrates goes beyond acceptable. Her characterisation of this is “going Tourettes” indicates that she believes she cannot help herself when her anxiety reaches a certain point and that she knows that she goes beyond rationality and reasonableness with the stream of abuse that emerges when she is triggered by rejection, frustration and trauma issues. At the time these behaviours occur however, her capacity to reason or to understand the morality of what she is doing is likely to be completely overtaken by the level of personal distress and impulsive expression of her anger and frustration that she experiences. An argument can therefore be made that at the time that these behaviours occur she is incapable of understanding that her actions are morally wrong.
It should also be noted that she regards her actions as being legitimate behaviour and therefore justified. On this basis she argues that it is not morally wrong. Whether this is considered to be due to mental disorder is debatable. It is difficult to see any coherent strategy from her so called ‘protest’ and her view of the injustices seems to be heavily coloured by a quasi-delusional interpretation of the malign intent of the various groupings of professionals, Police, Government agencies, and therefore can be interpreted as being a direct result of the mental disorder.
I would therefore suggest that the question of an insanity defence cannot be entirely ruled out in this case.
Comments on Disposition
The Court has sought advice only on the questions of fitness and insanity, however I think it would be appropriate for me to make some comments on disposition. I am very much aware that Ms Routhan finds any psychiatric assessment to be extremely distressing and anxiety provoking and anything that can be done to avoid her having to attend further psychiatric assessment is likely to be helpful for her and for the Court.
Ms Routhan herself suggests that she needs a package of support to assist her to manage the distress and high levels of anxiety that she currently experiences. She has at least some idea in her mind of what this would constitute. It would ideally involve mental health and support professionals who could support her in various areas of her life to manage the trauma and anxiety experiences and to enable her to get herself back into some sort of functioning occupation. She has been dismissive of the idea of any psychological input or of any medication as part of this. In order to stand any chance of successful intervention, it would be necessary to have support from a coordinated team of mental health professionals including psychiatrists, psychologists, occupation therapist, community support worker and possibly others working together to manage the various strands of her disability. I have no doubt that as part of any intervention, medication would be an important tool in alleviating the high levels of anxiety and impulsivity that occur, but this would need to be embedded in a comprehensive support package that would be acceptable to Ms Routhan and would also necessarily include some psychological work to address her Complex PTSD. To put together such a package of care would be a challenge, and to set up a package that would be acceptable to Ms Routhan would be an even more tricky challenge. In addition, it would require the mental health workers to be able to endure the kind of abuse that she would inevitably exhibit during at least the initial periods of engagement. This may be able to be tolerated if it can be conceptualised as a compulsive or tic- like behaviour that is beyond her control, and therefore not perceived as being personal abuse directed towards the therapists or care workers themselves.
One can see that this would be a difficult task to achieve but in my view would be the best way of ultimately being able to intervene to relieve the distress that Ms Routhan suffers. If successful such intervention may enable her to moderate her behaviour, to maintain any protests within socially acceptable boundaries and avoid the ongoing contact with Police and the Justice system. The question of compulsory intervention will inevitably need to be considered. It may be at the end of the day that compulsory intervention cannot be avoided. However any compulsory intervention by the mental health system would compound her distrust and feelings of trauma and victimisation by a system that she regards essentially abusive and should only really be considered if all other avenues to provide the care that she requires are exhausted.
I trust that this report is helpful to the court.
I have read and complied with the Code of Conduct for Expert Witnesses contained in Schedule 4 of the High Court Rules.
I confirm the truth and accuracy of this statement. I make this statement with the knowledge that it is to be used in Court proceedings. I am aware that it is an offence to make a statement that is known to me to be false or intended to mislead.
DR NICK JUDSON