Rafe Pulley psychiatrist, Liz (Saeed’s primary nurse) Saeed Dezfouli, Douglas Holmes (consumer worker) and Brett Collins primary carer
The initiative for this meeting was an email sent 29/1/14 by Brett to Adrian Keller, the Clinical Director of the Forensic Hospital and Long Bay Hospitals to consider the use of consumer workers to assist Saeed in his future directions. (see under)
Douglas and Brett entered the Forensic Hospital and were escorted into Deewhy ward at 9.30am by Liz. The meeting began at 9.43am.
Rafe Pulley came in and we agreed for the four to talk first before asking Saeed to talk separately with Douglas and Brett, and then a meeting between all five people, and then finally a discussion with Douglas Brett and Saeed.
Pulley explained that Saeed had previously been in Eloura Ward which is the lower security section of the Forensic Hospital, and that he had been injected with clopixol (Zuclopenthixol) under the control of psychiatrist Mastroianni until Saeed had complained about the side effects and it was decided to change it to injected (depot) paliperidone in 2012. The injection was ordered, took a while to be delivered and meantime – in a two week delay, Saeed said he didn’t want it. Because he refused it, and the ward didn’t have any seclusion cell to force him to accept the medication, they moved him back to Deewhy where he has been since.
Pulley said they are now wishing to use the same medication he is taking orally, - paliperidone at 75mg/month as a depot injection to ensure his compliance before he could be transferred to a less secure hospital.
Pulley said that Saeed had ongoing delusions and he was mentally ill. He hadn’t talked with him since 2012 although he did talk with nurses and other staff. Whenever they talked about the fire Saeed used irrational responses to justify it, and didn’t see it as irrational. He continued to hold delusions shown in his letters where he approaches US Senators Democrats as if he had information “too hot to handle” and discussion about global warming, misinterpreting information that he was given.
Douglas said he could assist in communication, encouraging Saeed to start discussions with Pulley and cooperation with the Treating Team. He said he could put aside 2 hours a week over a month to do so, and that might help lessen the tension.
Saeed came in after they had left, and talked with Douglas and Brett for 20 minutes about what the problems were, what cooperation was possible and what Saeed’s hopes for the future were. He took a recovery bus and agreed to a proposal that would allow him to receive support and start to work with the Treating Team.
Pulley and Liz returned at 10.36am
Immediately Pulley said: “I have talked with Adrian Keller and we feel that we need to act today with the injections. It is in the best interests of getting you out of here. I want to let you know that.”
Brett said that he was really sad to hear that. We felt that we had a useful proposal and agreement with Saeed, but you haven’t listened to that and are just delivering a fait accompli, and forcing a confrontation. I think it is really disrespectful and it gets my back up. Why is there an urgency? Even as a layperson you can see in Saeed’s eyes that he is medicated. Why can’t you do a blood test? Pulley said that blood tests for this medication wasn’t available in Australia.
Douglas said he was flabbergasted. He said he was still available to help Saeed if he wants. Saeed said that it was all an attempt to get him out of the Forensic hospital. He wanted to go to Bunyah but knew that it would be 7-9 years after that before he was allowed to re-enter the community. Previously in 2010 they recommended he be in Morisset but Saeed had denied his mental illness and they didn’t like that so rejected him.
Pulley said that Saeed could pursue his legal rights, to challenge on fitness to plead and try to get a limiting term, but he could also progress through the system at the same time. That he had lost 18months in his recent reversal from Eloura Ward when he refused depot medication. Saeed said others aren’t forced to take depot and are let into medium security. Pulley said it depends on each case. Pulley said you may not agree with this, but we believe you have delusions and that medication is critical.
Douglas said that he would talk with Liz Roberts and others about bringing in some educational material to the Hospital. He gave to Pulley the box of Narrative Resources.
Saeed said that his decision is clear. “There is no clinical justification for injecting me. To move me to medium security isn’t a proper reason. I will cease all oral medication and not eat or drink. I would lose face or honour if I didn’t. I was hoping to come to an agreement but that’s the way it is. I realise that I’m risking my life but the medication has caused me to have heart problems.
Brett offered Pulley a copy of Mad in Australia on the issue of medication. Pulley refused it saying he already had a copy.
Pulley and Liz left. Douglas Saeed and Brett talked.
Saeed said: I feel really rocked by that. Crushed. We couldn’t penetrate at all. If I take the injection I am still in a hospital for 7-9 years and Pulley agreed that is the process. I feel that I have nothing left. The medication they have given me so far has caused diabetes, a heart condition, high blood pressure, weight gain, cramps and loss of concentration, restlessness and I haven’t had any sexual arousal for five years. I feel detached from life with no light at the end of the tunnel. I have lost hope.”
Douglas and Brett assured him of their continuing support. Brett agreed to bring it back to the MHRT as soon as possible, rather than wait until April 3rd.
They left the hospital at 11.30am
Saeed rang Brett at 4.15pm and said that he had been injected at 11.45am and had been lying on his bed since. He said that he felt totally dejected.
INITIATING EMAIL TO ADRIAN KELLER
Dear Dr Keller,
Justice Action is most concerned about Saeed's well being. We are trying to resolve the tension involving Saeed, following the decision of Lindsay J. on 17/01/2014 to lift the injunction preventing the hospital from forcibly injecting Saeed. After a wide consultation with stakeholders we have a proposal that could defuse the matter, and have been advised to approach you to help resolve it.
Saeed has told us, and we understand told your staff, that he will refuse all food, water, and even his heart medication if they hold him down and inject him with Zuclopenthixol. The advice we have is that, given his medical condition, this will rapidly be extremely dangerous. Though Saeed has not in the past rejected oral medication, he feels that the threatened injections will have much more serious side effects than he is presently suffering, and finds being forcibly injected extremely personally invasive. He trusts the psychiatrists who gave evidence before the Tribunal in September last year that the medication could do him harm, and has referred to Mad in Australia as supporting a better way, involving recovery principles. We see that Saeed is moving towards a very unpleasant confrontation, that will end, we understand, with him strapped to a hospital bed in the Prince of Wales Hospital with drips attached to keep him alive.
We are most worried about this situation and the risk of serious harm that could result from the hospital’s imposition of its preferences for his care, especially when he feels that he has already more than paid the penalty for the act he did, if he was treated fairly with a limiting term, or treated as a criminal as fit to plead. (NSW Law Reform Commission Report 138, para 0.28)
We have talked with Saeed and have his support to approach you for another way to deal with this, with the cooperation of your team. The proposal would be that we ask for the assistance of Department of Health employed consumer workers to visit Saeed urgently to give him their professional assistance.
In preparation for this intervention, Justice Action has approached the NSW Mental Health Consumer Worker Committee (CWC) and has secured an undertaking from Mr Tim Heffernan, Chair of the CWC, to assist Saeed by providing two of their workers – similar to Certified Peer Specialists – for support. This undertaking also includes later provision of assistance by Consumer Workers in a Community Mental Health Team.
We urgently ask you to address this matter. Please acknowledge this email upon receipt.
RESPONSE EMAIL FROM ADRIAN KELLER
Dear Mr Collins
I acknowledge receipt of your email.
I will provide no undertakings in relation to the proposal you have put forward.
Mr Dezfouli’s treating team will be discussing his future management plan with Mr Dezfouli and yourself, as primary carer. They will consult with myself and other members of the Forensic Hospital team as is considered appropriate.
Clinical Director | The Forensic Hospital & Long Bay Hospitals
Justice Health & Forensic Mental Health Network