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9780522862317This sensitive account of a family tragedy details the terrible consequences when the mental health system fails. 

How’s this for a great horror/who-done-it plot?

Nick Waterlow is a world-renowned art curator, past director of the Biennale, with an Order of Australia medal. He is an Englishman of noble origins, who migrated to Australia and is the next in line for a baronetcy. His deceased wife was the daughter of the wealthy Australian who started the Breville electronic goods corporation. His present partner, Juliet, is the granddaughter of the first chairman of the board of BHP.

Nick organises a dinner for his son, Anthony, at the home of his daughter, Chloe, who is an attractive and achieving mother of three young children. Anthony is Jesuit- and university-educated, usually charming, a would-be actor with matinee-idol good looks.

Before the dinner is served, Anthony has brutally stabbed his father and sister to death and seriously injured his young niece. He takes off, goes bush, and is not apprehended for three weeks. The funerals of the deceased are conducted by a family friend, a priest named Father Sinn, and attended by various Sydney A-listers, including family friends Jane Campion, the film director, and the actress Rachel Griffiths.

As a consequence of Nick’s death, Anthony is now the first in line to the baronetcy, and will be entitled to be addressed as Sir Anthony in the fullness of time.

When Mark Twain said that truth is stranger than fiction, he could have been writing about this book, which is the thinking reader’s true crime. Like most homicide trials in Australia, this is not a who-done-it but a why-did-he, and the author goes about answering this in a most lucid, thorough, sensitive and readable manner. The thoroughness includes researching various detailed court exhibits, transcripts and medical records as well as a trip to England to meet Nick’s family and to research earlier episodes of Anthony’s aggressive psychosis.

The result presents the personal histories of all the principal players in a way that allows readers to feel that they actually know them. The book also provides an excellent picture of the somewhat difficult tensions and dynamics which exist in most families, and which did in part contribute to the horrific killings. It also documents the terrible stresses on family and friends of living and dealing with a close family member and friend who is suffering with serious untreated mental illness.

The author interviewed various experts in mental health and thoroughly researched the illness of schizophrenia. One of the best aspects of the book is its excellent description and discussion of this illness, its symptoms and the way it should be dealt with. For instance, Burton emphasises that the sufferers are at much greater risk of harm to themselves through misjudgement or misadventure or even suicide, than they are of harming others. The book also gives an excellent analysis of a breakdown of an essentially effective, if under-resourced, mental health system. Most importantly, the author details the terrible consequences that can flow when mental health professionals do not properly apply the law that allows them to treat a mentally ill person against his or her wishes.

So is there a villain in this true-crime book? Anthony hardly fits this bill. When he is well, he is charming and personable, and he is now incarcerated in the psychiatric hospital in the grounds of Long Bay prison, dealing with the facts that he has killed two of the people he was closest to, is estranged from the family whose approval he sought so much, and does not know when or if he will ever be released.

However, those who come out worst in this book are the various mental health professionals who, over a four-year period, failed to take the action that they could have to hospitalise and treat Anthony involuntarily. These include the mental health assessment team in London in 2006, who failed to section him after he tried to seriously harm his English relatives; the psychologist his GP referred him to, who persisted with behavioural therapy (counselling) when medication was the obvious tool; and the Caritas Centre at St Vincent’s Hospital in Sydney.

The family’s unfortunate experience with Caritas is fully explored. Caritas was ironically named from the Latin word for love and compassion. Happily it closed a few years ago, after the Waterlow killings, and not before time.

I often presided over hearings of the Mental Health Review Tribunal at Caritas and it was probably the worst psych unit I ever attended. It comprised an historical 150-year-old house where confusion reigned, with an often unresponsive staff and a lot of patients milling around small and confined common areas. It was the only one out of many such units where I felt the need to keep most alert. The room where the hearings were usually held was devoid of pictures or any decoration and smelt either of urine or damp, I was never sure which. The patients were among the most challenging, being mostly young, homeless and drug users who came from the Kings Cross/Darlinghurst area.

For many years monies were spent on various of St Vincent’s centres of excellence and their showcase, St Vincent’s Private Hospital, but never on the psychiatric unit for mentally ill public patients. After Caritas closed it was replaced by a modern public psychiatric unit nearby. A year or two after that an additional and luxurious psychiatric ward was opened in the private hospital for treating the wealthy mentally ill. The old Caritas building is currently being converted into expensive inner-city apartments.

The book charts, on my counting, twelve occasions over a 28-month period when the doctors at Caritas refused to schedule Anthony at the request of his family and friends. Each of these refusals  immediately followed a violent or threatening episode. Amazingly, on one of those occasions, the views of Dr Olav Nielson, a prominent Sydney forensic psychiatrist, were not accepted. Eventually the family just gave up on the psychiatric profession.

It is hard to understand how such consistent and worrying information could be provided by so many credible, educated members of Anthony’s family and friends, on so many occasions, over such a long period, about threats and actual instances of violence, and for it to be ignored. On each such occasion, the psychiatrists to whom this was reported sent Anthony away with advice to take his prescribed anti-psychotic medication, in spite of the fact that he always made it abundantly clear that he had no intention of ever doing so.

When assessing many seriously psychotic persons, a few minutes’ conversation will easily demonstrate the need for an Involuntary Patient Order. However, a minority of sufferers will present as prima facie normal, although a good psychiatrist or forensically experienced lawyer should be able to work it out if a good history is available and detailed questioning can be undertaken. Anthony was in this latter class, being clever and capable of coherently denying the allegations of threatening or violent behaviour, often involving knives, that always preceded his contact with mental health authorities. This was often facilitated by the fact that the worrying behaviour occurred after drinking and his subsequent psychiatric presentation occurred when he was sober.

The question arises whether Anthony would have benefited from a compulsory admission to the Dickensian Caritas. The answer is almost certainly yes, as in spite of its considerable shortcomings, it would at least have been able to ensure that he took the medication that he had always previously refused. It is noteworthy that as a result of the medication he has been forced to take since his arrest, he has became well, gained insight into his illness and accepted the necessity of maintaining the medication regime. There can be little doubt that if he had received compulsory hospitalisation, followed by discharge with a properly administered community treatment order, it is very likely his father and sister would be alive today.

There also seems to be little doubt that in Anthony’s case, on all the evidence, the relevant criteria for scheduling as set out in the Mental Health Act should have been satisfied; that is, that he suffered from hallucinations or delusions or serious thought disorder or disturbance of mood which required care, treatment or control, in order to protect him or others from serious harm.

After Anthony’s trial, Kevin Humphries, the New South Wales Minister for Mental Health, supported public demands to amend the law to allow decisions by a hospital – such as St Vincent’s – to refuse to schedule a patient – such as Anthony – to be appealed to the Mental Health Review Tribunal.

The Tribunal usually sits with a panel of three: an experienced lawyer, a psychiatrist, and another mental health professional. At present the Tribunal only reviews patients who have previously been scheduled. The proposed appeal process would provide an additional check in the event of errant frontline professionals.

Yet nothing has happened in the 18 months that have passed to implement any such change in the law. Rumour has it that allocation of additional funds has been the hurdle. Any such reform without the necessary funding will create as many problems as it may resolve, as other patients may be prematurely discharged to provide a bed,  and patients who do not need to be scheduled may be detained unnecessarily, if the Tribunal is not resourced so as to be able to hear any appeal very quickly.

In October the government announced a review of the Mental Health Act to report in the New Year, and this proposed reform is now being considered by those conducting this review. No doubt many people, including the remainder of the Waterlow family, will be very interested in the recommendations arising from it.

Pamela Burton The Waterlow Killings: A Portrait of a Family Tragedy, Melbourne University Press, 2012, 272pp, $29.99

Tom Kelly was an Official Visitor to Rozelle Psychiatric Hospital in the 1970s and President of the New South Wales Psychosurgery Review Board in the 1980s. In 1985 he established the Mental Health Advocacy Service within New South Wales Legal Aid Commission. He has been a legal member of the New South Wales Mental Health Review Tribunal for the last 15 years. He was consulted by the author on legal issues during the writing of this book.

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