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Mental Health

History of Attempts to Visit Saeed

History of Attempts to Visit Saeed Dezfouli

20th April 2009

Report provided to mental health legal representative, who was told to wait three weeks to gain approval to visit:

We've followed this up and contacted the Forensic Hospital.

 

The position is:

The 3 week period you mentioned can be substantially shortened if requested.  In particular, anyone who has been permitted by DCS to visit a patient in the old prison hospital will automatically be permitted to visit the patient in the Forensic Hospital.  Although it is not relevant to you because you have been previously approved, the sole criteria they use to assess whether someone should visit is whether the visit is 'in the clinical best interests of the patient'.  To determine that, amongst other things they will ask the patient whether they want to see the visitor.

Visits take place from Monday to Sunday. Allotted times are:

                  9.30 - 10.30

                  11 - 12

                  1.30 - 2.30

                  3 -4

There are 5 wards and one person is permitted to visit in each ward during each allotment of time.

Once you are approved as a visitor you need to book a time the day before to enable the guards on the front gate to be aware of your intended visit;”

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Denial of Visiting

Community Access to Mental Health Patients (read as pdf)

Denial of Visiting

From April 2009 until September 13, 2011, several dozen citizens of good character including psychiatrists, lawyers and other people of goodwill were blocked access to visit and help Saeed Dezfouli after nine and a half years locked in a closed hospital. This is one of many issues dealt with by Saeed. An issue, which is so significant, that it was raised before the NSW supreme court. The Mental Health Review Tribunal was also asked to intervene. Nobody responded.

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Timeline of Saeed’s Case

1958

  • Saeed Dezfouli born in Iran. 

1983

  • Migrated to Australia. Immediately began studying a Bachelor of Arts, majoring in political sciences. 
 1986
  • Saeed became a citizen of Australia, and began working as a court interpreter for the Ethnic Affairs Commission NSW,

2001

  • Throughout 2001, Saeed received death threats. Decided to take action, and thus warned authorities on his concerns prior to committing the crime. He was accused of setting fire to the foyer of the Community Relations Commission (formerly the Ethnic Affairs Commission) at Ashfield by using a container of petrol. He was taken to Burwood police station where he was insulted, assaulted and unlawfully interrogated by the NSW Police. He was subsequently charged with several offences.

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About Saeed

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“I am a patient with patients’ rights, an inmate with inmates’ rights and a human being with human rights. These rights have been fundamentally and severely violated by unprofessional and sadistic state government employees in the positions of psychiatrists, psychiatric nurses and prison officers. They are required to go by the law, regulations, policy and procedures, codes of conduct practice and ethics, but they don’t.”

- Saeed Dezfouli

INTRODUCTION 

 

The NSW Health Department’s mental hospital is getting exposure through the window of patient Saeed Dezfouli. His case significantly highlights the issue with government bureaucracies dealing with challenging people at the individual level, lacking compassion, concern, or rational behaviour.

 

HISTORY 

 

Saeed Dezfouli was born in Iran in 1958 and came to Australia in 1983. Upon arriving in Australia as a refugee, he earned a degree in Bachelor of Arts and majored in political sciences. In 1986 he became a citizen of Australia and was working as a court interpreter for the Ethnic Affairs Commission NSW. Throughout 2001, he became fearful of his life and safety and stated that he had been receiving death threats. He felt that he was constantly under surveillance. He said that he warned the authorities by sending them letters about his concerns for 5 months prior to the offence.

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The Treatment of Saeed Dezfouli

History of Treatment


In February 2002 Saeed was transferred to Long Bay Prison Hospital and in 2004 he was found not guilty due to mental illness. Since that time he has been held indefinitely and subjected to continuous abuse. His mistreatment by the staff of Justice Health and the department of corrective services at Long Bay hospital can be seen through the following examples.

  • A number of times they kept Saeed naked in a solitary confinement cell for days to "break him down".
  • The first time, when they forced medication into him by injection they broke two of his ribs. The second time they left him bruised all over and in severe physical pain for days.
  • Twice they left him in a cell without toilet paper for four (4) days.
  • DCS Officers broke a number of his bones in LBH-1.
  • In January of 2005 Saeed got brutally assaulted by DCS Officers and as a result got a permanent back injury. Saeed was taken to Prince of Wales Hospital Emergency Room for the injuries inflicted upon him by DCS Officers.
  • Saeed now is suffering from heart condition, ulcers and diabetes as a result of the side effects of anti-psychotic medications combined with going through a daily oppressive and suppressive regimen.

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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...)."

 

 

Victory! Malcolm’s Forced Medication Stopped: August 2018

IMG 0910On 16 August, Malcolm Baker won his case at a hearing before the Mental Health Review Tribunal. He will no longer be forcibly medicated.

In the past, Justice Action has appeared with Malcolm before the Mental Health Review Tribunal on six separate occasions to fight for his right to refuse medication. His last hearing took place on 28 June, but was adjourned without decision as Justice Health had failed to produce the medical certificates that were required as evidence.

Malcolm was supported at his 16 August hearing by two members of the Justice Action team, whilst another two members were refused entry despite previous arrangements.

A new psychiatric report provided by Justice Health was revealed, contradicting previous assessments of Malcolm. Previous psychiatrists had commented that Malcolm’s beliefs are “abnormal to the point of delusional”, concluding that he therefore had a “chronic psychotic illness.” However, the leading psychiatrist of the team now said, “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.”

Under s 16 of the Mental Health Act 2007, a person cannot be considered mentally ill merely on the basis of a particular philosophy, political beliefs, or opinions. Malcolm’s personal beliefs therefore cannot constitute a mental illness, and do not justify the use of forced medication.

“My own examination currently does not find true delusional ideation in his thinking,” stated the leading psychiatrist. According to him, medication would not have any impact on Malcolm’s personal beliefs, which had been the causes of controversy with previous treatment teams. The psychiatrist also noted that Malcolm has had no behavioural issues and has never displayed aggression, threats, or a “need to control him.”

Therefore, upon inspection of the evidence, it became clear that Malcolm did not meet the requirements articulated in s 14 of the Mental Health Act, which allows involuntary treatment in situations where a mentally ill person poses a serious risk of harm to himself or others.

As a result, Malcolm will be taken off the medication. He will remain in the hospital at Long Bay prison for the next three months whilst the medication is gradually discontinued. A psychologist will be allocated to Malcolm for cognitive behavioural therapy, which the leading psychiatrist says will allow him to “develop interpersonal skills and strategies that enable him to cope better.”

Justice Action is also applying to find Malcolm a job and educational opportunities. The psychiatrist agrees that work, education and socialisation is “very important” for Malcolm’s long-tem care and safety. 

His next hearing will take place in three months’ time, and will determine his future resettlement and a long-term strategy for care, treatment and control.

Forced Medication For Management Purposes

Contrary to the evidence presented, we lost the latest hearing into whether Malcolm Baker could be forcibly medicated.

Malcolm attended the Mental Review Health Tribunal on the 19th of April 2018 with the support of three members of the Justice Action team. Justice Health brought its team of psychiatrists who were committed to forcibly medicating Malcolm, with no evidence to support the risk of serious harm to self or others as required by the law. It was obvious that they thought they didn’t need any. Also, Malcolm was clearly suffering from side effects of the medication, drooling and unable to form full sentences. The Tribunal agreed that he was in bad shape and expressed their sympathies, however they still gave the order to continue the treatment for another 3 months. 

When the chair asked the psychiatrist for the worst-case scenario if they were to stop medicating him, they responded; “he could become difficult to manage.” It was a clear admission that Justice Health saw its responsibility to help manage the prison rather than to look after the health of its patient. The side effects of the medication were horrendous – clearly poison to his system. 

The culture of mental health in prisons meant that the Tribunal almost always agrees to Justice Health’s requests regardless of evidence. Justice Health agreed that they couldn’t enforce the order in Silverwater prison and would need to move Malcolm back to Long Bay to continue forcibly injecting him.

Justice Health tried to justify its desire to forcibly medicate Malcolm with a misleading 10-page statement suggesting that he had a long history of proven mental illness. Malcolm’s team dissected it and showed that not only did the two psychiatrists at his trial in 1992 say he was not psychotic, they also said he would not be a danger to the community in the future.

In addition, Malcolm demonstrated a successful resettlement in mainstream Nowra prison in 2014, and for long periods before and after without being forcibly medicated. This was for a period of 3 years between 2012-15, 14 months between 2015-16, and just under 2 years from 2016-2018. He had also been held for fifteen years in virtual solitary confinement in Goulburn SuperMax with no stated justification; however, he survived with good humour and stoicism, remaining in contact with his family and Justice Action.

On several occasions Malcolm has been forcibly medicated with varied justifications, such as that others were attacking him, or he had attempted to write a letter to a Senator.  

In three different cases before February 2018, Malcolm was taken before the Mental Health Review Tribunal who proceeded to reject the application by Justice Health for a Community Treatment Order. These cases occurred on 7th August 2012, 30th April 2015, and most recently 24th July 2016.

Before Malcolm’s tribunal hearing on 1st February 2018, the head of his treating team admitted that Malcolm had not attacked anyone nor harmed himself during the 26 years of his imprisonment. No evidence has ever been produced to suggest otherwise. He is a non-violent prisoner.

After the hearing Malcolm gave each team member a warm hug goodbye. He then said, “now I’m just going to go back to my cell, and they’re going to inject me.”  The Justice Action’s team felt their heart break for Malcolm in the wake of this disappointing result.

Malcolm Baker’s case demonstrates the inhumane culture of mental health in prisons. Justice Action will certainly appeal to the Supreme Court. We began the process the next day by requesting the audio transcript of the hearing. 

Malcolm Baker Index Page

Latest summary on Malcolm Baker tribunal hearing

Malcolm Baker's hearing was lost on the 1st of February 2018,the Mental Health review tribunal determine that Malcolm should continue to be detained at Long Bay Prison hospital.  Placing a halt on a series of three previous victories in 2010, 2015 and 2016, whereby MHRT found no justification for continuing Malcolm’s forced medication. Given Malcolm’s previous record of non-violent behaviour, the lack of consensus regarding his mental diagnosis, and the absence of any evidence that he was a threat to other inmates, it was surprising, if not completely outrageous, that the MHRT arrived at the decision that it did.

During the hearing, Malcolm was represented and advocated solely by the Justice Action team. The tribunal allocated time for Justice Action to make Malcolm’s case, cross examine health authorities and suggest viable alternate treatment options. Two main legal arguments were presented to the tribunal.

  1. The requirements for involuntary admission, detention and treatment under s 14 of the Mental Health Act 2007 were not met.

Malcolm’s health debate has been disputed for a long period of time. The two most recent medical certificates presented before the Tribunal did not provide a consistent diagnosis. However, Justice Actions main contention was that there was a failure to establish a causal relationship between Malcolm’s mental illness and his two recent assaults. Section 14 of the Mental Health Act 2007 States that there must be ‘reasonable grounds for believing that care, treatment or control of the person is necessary for the person’s own protection from serious harm, or for the protection of others from serious harm’. On one of the medical certificates, it was stated that Malcolm had threatened to harm others. A request was made on the 24th of January asking Justice Health to provide evidence of this. However, the request was ignored and no evidence was provided.

  1. There had been a breach of the Principles for Care and Treatment of Mentally Ill Persons under s 68 of the Mental Health Act 2007.

Requirements under section 68 embrace that people with mental illnesses ‘should receive the best possible care and treatment, the prescription of medicine should meet the health needs of the person and not as a punishment or for the convenience of others.’. In particular, Justice Action drew attention to the side effects of the medication. It was reaffirmed that Malcolm was in blatant opposition to the treatment that he was receiving. Yet, his alleged failure to meaningfully engage with medical practitioners formed the basis of Justice Health’s recommendation that Malcolm should remain at Long Bay Prison Hospital for several more months to ensure that the medication had any “real effect”.

Following the last hearing with the mental health review tribunal on the 1st of February 2018 to which ruled that Malcolm was to continue to forcibly be medicated against his will, Justice Action has consistently engaged in the lobbying of the 12 leading legal and mental health organisations for support for Malcolm’s case. Also maintaining regular contact with Malcolm for updates on his situation. Next hearing with Mental Health Review Tribunal to consider forensic Compulsory Treatment Order scheduled Thursday 19th April 2018 at 12.45pm, at Long Bay Hospital.

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