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Analysis of Malcolm Baker's diagnosis (September 2018)

On 16 August 2018, the Mental Health Review Tribunal accepted evidence from psychiatrist Dr. Jeremy Resnick, that Malcolm Baker is not delusionsl and that his forced medication was to be stopped immediately. The psychiatrists' report challenged previous psychiatric assessments of Malcolm. In the past, Mr. Baker was diagnosed as having schizoaffective disorder, or a "chronic psychotic illness," primarily substantiated by the apparent persistence of delsional ideations.

Dr. Resnick's report concluded that Mr. Baker's alternative points of view were not delusions, and were instead based on "rational explanations to be found in research literature such as the Nexus magazine." The psychiatrist told the Tribunal that Mr. Baker will be gradually phased off the medication and will instead undertake cognitive behavioural therapy at Long Bay Hospital.

Although the Tribunal accepted that Mr. Baker did not suffer from delusions, they neglected to remove him from the mental health facility where he was kept. The Tribunal did not receive substantial evidence that Mr. Baker did not pose a risk of causing serious harm to himself or others, meaning that their decision not to remove Mr. Baker from the facility did not meet the requirements of s14(1) of the Mental Health Act. Health services have a duty to treat all consumers with respect and must provide assistance free of coercion. The health professionals' sudden backflip suggests an effort on their part to avoid confrontation with the Supreme Court. This raises serious questions about the quality of Mr. Baker's initial "diagnoses" and subsequent treatment and perhaps more frighteningly, how many others are suffering from similar abuses in the mental health system?

Below is the histroy of Mr. Baker's diagnoses and an analysis of the decision. Whilst it is important to celebrate this victory, the fight isn't over yet, and we ask for your assistance in preventing further abuses within the mental health system.

Diagnosis History of Malcolm Baker
Below are some relevant extracts from Mr. Baker's history of incarceration. Justice Action has appeared with Mr. Baker before the Mental Health Review Tribunal on six separate occasions to fight for his right to refuse medication. Justice Action believes that Mr. Baker was misdiagnosed, forced into a vicious cycle of medication and re-admission based on symptoms caused by the very treatment he received while incarcerated.

A timeline of Malcolm Baker's diagnosis history:

  • October 1992: Malcolm Baker sentenced to life after being declared fit to stand trial and free of mental illness by two separate psychiatrists.
  • 21 November 2007: Dr. Matthew Hearps: "There was a persistence of delusional material."
  • September 2009: CT brain scan, no abnormalities detected.
  • 20 August 2010: Dr. Jeremy O'Dea: "Mr. Baker was readily arouse and animated when discussing apparent systemised delusional thoughts re mind control." (p.3)
  • 18 August 2012: Mr. Baker was "irritable and expressed delusional ideas." (p.3)
  • December 2014: Evidence of psychosis on background of schizoaffective disorder per Dr. Dayalan (Psychiatrist at Nowra CC).
  • January 2015: Untreated psychotic illness per Dr. Chew.
  • May 2015 - May 2016: "He also appeared to have delusions of reference interpreting the actions of those around him as threatening." (p.4)
  • June 2015 - June 2016: Off medication and no behavioural issues.
  • 24 January 2018: "No formal thought disorder" but "poor insight into his condition."
  • 19 April 2018: "Remains insightless, hostile, suspicious; paranoid however did not display any dangerous ideation."
  • 28 June 2018: The Mental Health Review Tribunal Report summarised Mr. Baker's psychiatric histroy as having a 'long-standing diagnosis of schizoaffective disorder."

What is schizoaffective disorder?
Schizoaffective disorder is characterised by persistent psychosis (e.g. hallucinations, delusions) and mood episodes of depressive, manic, and/or mixed types. This disorder will likely affect a person's thought, emotions and actions. Additionally, it is reflective of two common psychiatric illnesses, namely schizoprenia and a mood disorder (major depressive disorder or bipolar disorder).

Is schizoaffective disorder reversible?
Currently, there is no cure for schizoaffective disorder. It is a life-long illness but its symptoms may be managed and controlled with treatment, especially medications.

The Relationship between Delusions and Schizoaffective Disorder:
Delusions are understood as 'fixed forms of belief that do not change regardless of evidence to the contrary.' The delusions appear to be false or not based on reality. Additionally, "delusions are deemed bizarre if they are clearly implausible and not understandable and do not derive from any ordinary life experiences." 
According to DSM guidelines, in order to meet the criteria to be diagnosed with schizoaffective disorder a person must experience an uninterrupted period of illness where a major depressive, manic or mixed episode is concurrent with 2 or more of the following symptoms for at least one month:

  • Delusions
  • Hallucinations
  • Disorganised speec (e.g. frequent derailment or incoherence)
  • Grossly disorganised or catatonic behaviour
  • Negative symptoms (e.g. affective flattening, alogia, avolition)

However, only one symptom is required in the case of delusions being bizarre. During the period of illness, delusions or hallucinations must persist in the absence of prominent mood symptoms. In order for this condition to be diagnosed, the symptoms experienced by a person must be not better explained by the use or abuse of a substance (alcohol, drugs, medications) or a general medical condition (such as a stroke).

Applying this to the case of Malcolm Baker
Malcolm Baker's diagnosis for schizoaffective disorder was fundamentally justified and substantiated by persistent delusions (as per the statements in the timeline, on dates 20 August 2010, 18 August 2012 and May 2015-May2016). This line of diagnosis has proven to be incorrect given the recent report by Dr. Jeremy Resnick. He is of the opnion that Mr. Baker's beliefs are "not delusional in a psychiatric sense" and "aside from his 'alternative views' discussed above, my own exmaination currently does not find true delusional ideation in his thinking."
Mr Baker's beliefs originate from rational explanations as summarised by Dr. Resnick (Mental Health Review Tribunal, 10/08/2018):

"Mr. Baker has for many years been fascinated by alternative points of view, which may sound bizarre and impossible. However, it appears for many of these ideas, there are legitimate, rational explanations to be found in alternative research literature such as the Nexus Magazine...Mr. Baker at times links these ideas with his own coincidental experinces in prison, drawing conclusions that are self-referential, paranoid and at time superficially delusional."

Dr. Resnick provided another alternative explanation to Mr. Baker's behaviour, particularly that of his mistrust for people which has been heavily impacted by his personal history:

"It is apparent...he remains affected by memories of his traumatic childhood in terms of emotions, attitudes and beliefs in relation to others and himself which could be described as paranoid (i.e. mustrustful/suspicious, fearful...hostile, angry and comabtive...)."

 

 

 

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