In the months before a psychotic 25-year-old woman stabbed her father and sister to death and seriously wounded her mother, her psychiatrist, Yolande Lucire, had prescribed 25ml of Largactil a day -- a dose so small it used to be recommended as a treatment for hiccups.
Last week in the NSW Supreme Court, judge Michael Grove found Pamela Willings (not her real name) not guilty by reason of mental illness.
But the treatment she received has created a furore in psychiatric circles.
In a report tendered to the court, forensic psychiatrist Bruce Westmore said: "Unfortunately she appears to have been ineffectually treated or under-treated and as a result her psychotic illness persisted."
Dr Lucire, the partner of former Labor senator Bruce Childs, is well-known for her conviction that anti-psychotic medication can aggravate or cause psychosis and depression rather than cure them. A psychiatrist for about 30 years, she is often called as an expert witness in legal cases.
Justice Grove noted that in this case, two other psychiatrists had complained to the NSW Medical Board about Dr Lucire's assessment and treatment of the accused.
The judge said the court had been given a copy of the complaint by doctors Richard Furst and Michael Giuffrida, consultant forensic psychiatrists for Justice Health who have been involved in the woman's care and treatment since the week after the homicides on July 5 last year.
The first reports of the shocking family tragedy in the Sydney suburb of Revesby, where Ms Willings lived with her parents and five siblings, said she had been denied treatment for her mental illness because some members of her family were members of the Church of Scientology. Scientologists reject psychiatry and claim psychiatric drugs "create insanity and cause violence".
Yesterday, Dr Lucire told The Weekend Australian: "The wrong drug or combination can cause side-effects which fill psychiatric units with (people in) toxic states.
"Psychiatrists do not want to know, so they defame me at every opportunity."
Sydney psychiatrist Olav Nielssen, who was retained by Ms Willings's lawyers to assess her state of mind, is one of the authors of an article in the British Journal of Psychiatry last month that showed the number of "homicides due to mental disorder" in England and Wales had fallen by more than two-thirds since the 1970s because of better treatment of mental illness -- and the increasing use of anti-psychotics.
"Ninety-nine out of 100 psychiatrists would have prescribed an effective dose of anti-psychotic medication in this case," he told The Weekend Australian.
It emerged in court that Ms Willings's 55-year old father, a Scientologist, had approached Dr Lucire.
Other members of Ms Willings's family had observed signs of her psychosis for two years.
In August 2006, when she returned to the family home after a few months elsewhere, "her mother became aware that she harboured a thought that she was possessed by an evil spirit", Justice Grove said.
Her mother contacted police. Within days, Ms Willings had been taken to a mental health unit in Bankstown, Sydney, for assessment, diagnosed as schizophrenic and "scheduled" -- which means involuntarily held for psychiatric treatment -- after a visiting magistrate ordered that she be detained for 14 days.
She was treated with the atypical anti-psychotic medication -- administered in fortnightly injections so it is not left up to a patient to take the medicine every day.
Two weeks later, the case was reviewed by the visiting magistrate, in this instance acting magistrate Craig Thompson, who has since retired.
The community mental health team and the hospital had applied for a community treatment order that would have meant that Ms Willings could return home if she received an injection of the anti-psychotic medication every two weeks for six months. This was opposed by Dr Lucire, Justice Grove said.
Documents show the psychiatrist wrote to the magistrate saying Ms Willings "has not recovered and will not recover on this medication ..."
The magistrate ordered immediate discharge and did not impose the treatment order.
Dr Lucire's handwritten notes, seized by police on the night of Ms Willings's arrest, were mentioned in psychiatric reports tendered to the court.
The notes made by Ms Willings's physician, also seized by police, reveal that the prescriptions were for 25ml of Largactil and 10ml of the antidepressant Tofranil, also a minuscule dose.
Her parents took her to the psychiatrist's office in Edgecliff. According to the judgment, Ms Willings, who was delusional, was afraid that there was a bomb in the carpark and started beating her mother with her fists.
Dr Lucire took Ms Willings to a nearby coffee shop, but then told her parents she could not make a diagnosis without a consultation in her rooms and advised them to take their daughter home and to return the following week.
Asked why she had not scheduled Ms Willings, Dr Lucire told The Weekend Australian: "She was neither suicidal nor violent when I saw her last."
By October, three months after the homicides, Ms Willings had again been treated with potent anti-psychotic medication; her doctors noted "a substantial sustained improvement in her mental condition".
In November, the professional standards committee of the NSW Medical Board reprimanded Dr Lucire, after disagreeing with a diagnosis she made in another medical case that had come before the courts.
The board placed conditions on her registration.
