Mental Health and Sole Parental Responsibility
The Husband’s mental health
- The husband has a long and involved history of mental health problems. The wife’s solicitors issued a number of subpoenas to various medical practitioners involved in the husband’s mental health care. I was provided with a folder of documents produced pursuant to subpoenae from (omitted) Health, Dr D, Dr A and Dr J. I was also provided with an index of the pages relied upon in the subpoenaed material. The subpoenaed material was tended by counsel for the wife.
- Ms L was also provided with the documents produced pursuant to the subpoenae. She prepared a review of the husband’s medical records, which is a Supplementary Report dated 24 September 2016.
Evidence of Dr A
- Dr A is the husband’s treating psychiatrist. He swore an affidavit on 14 October 2016, which was filed on behalf the husband. Annexure 2 to that affidavit is a report prepared by him, dated 6 October 2016. As referred to at paragraph 213 hereof, his records were also subpoenaed by the wife’s solicitors.
- Dr A gave evidence and was cross-examined. I found him to be a truthful professional and impressive witness.
- The husband was first referred to Dr A on 7 May 2003 by his then general practitioner, Dr C. However, the file of Dr A contains a letter from Dr P, consultant psychiatrist, dated 19 July 1999, to the husband’s then GP, Dr H. That letter refers to the husband’s noted depressive symptoms for the past five years and that the husband may well be bipolar disorder type II.
- On 22 May 2003 Dr A forwarded a letter to the husband’s GP, Dr C.  That letter summarised the husband’s condition as follows:
“In summary, he is a man suffering from a relapse of a depressive disorder on the background of chronic dysthymia. He has a history of a severe depressive episode which possibly consisted of psychotic symptoms in 1995. Also the episode of hypomania in 1999, suggests that he may also be suffering from bipolar 11 disorder (that is depressive episodes and hypomanic episodes) and may also have the potential to suffer from a full blown bipolar disorder. His current depressive episode is characterised by anxiety symptoms and does not seem to have any psychotic symptoms at present but I will continue to re-assessed for this.”
- The evidence of Dr A was that he continued to reassess the husband on a regular basis, every few weeks or so for two years between 2003 and 2005. The husband was medicated with both an antidepressant, which had been prescribed by his GP and a mood stabiliser.
- When challenged by the mother’s counsel, as to why his report annexed to his affidavit stated “but I have not definitively made a diagnosis of any form of bipolar disorder”, his evidence was that a diagnosis of bipolar 11 disorder was a fluid diagnosis, which would take many years to be definitive. Notwithstanding his lack of formal diagnosis of bipolar 11, his evidence was that the husband had experienced depression and some hypomania over the years. He agreed that the husband’s intermittent attendance on him subsequent to 2005 may have hampered his ability to make a definitive diagnosis.
- During 2006 the husband consulted Dr A nearly every month. In 2007 he consulted Dr A approximately every six months, and in 2008 on one occasion. He ceased Valporate, a mood stabiliser, in 2007.
- In April 2011 the husband had a brief admission to (omitted) Hospital, psychiatric unit.
- On 14 October 2011 the husband was again referred by his GP, Dr D. On 18 October 2011, Dr A reported to Dr D. That letter summarises the husband psychiatric history , and further states:
“Upon reviewing him when he was admitted to the (omitted) Clinic on 17 October 2010. It is clear there has been a very significant deterioration in his relationship with Ms Douglass over the past few years. As you describe in your letter this has reached a point of almost no communication, significant emotional manipulation on his part, according to Ms Douglass. His perception of this is that they have just grown apart and there is no intimacy.”
“I have planned to increase his Lexapro and get on top of his insomnia in the first instance and will proceed from here as an inpatient and subsequently as an outpatient.”
- The husband was an inpatient at (omitted) Clinic from 17 October 2011 until 21 October 2011.
- In November 2011 the husband attended Ms B, psychologist. Dr A was not involved in that treatment. Ms B wrote to the husband’s GP on 26 November 2011.
- The husband suffered a significant relapse in his mental health in July 2014 when he was admitted to (omitted), the psychiatric unit of (omitted) Hospital. Dr A was not involved in his care during that episode.
- The husband did not consult Dr A until 1 June 2016 in the course of this proceeding. He then attended again on 12 July 2016 and 4 October 2016, to enable a report to be prepared by Dr A. He had continued to take an antidepressant, Lexapro, since October 2011, when he was admitted to (omitted) Clinic.
- Counsel for the wife cross-examined Dr A about the husband’s personality issues, which were referred to in his report. His evidence was that the husband had a “Cluster B” type personality and that common traits of a “Cluster B” personality are mood instability, vulnerability to depressive episodes, significant fear of rejection or abandonment, perception of catastrophic events if a relationship fell apart, extreme focus on own needs, and can appear to be paranoid and angry.
- Dr A agreed that the husband would benefit from ongoing consultations and management by him, which would include ongoing psychotherapy with him rather than a psychologist to be arranged by (employer omitted), as proposed by the husband.
- In terms of the assessment of future risk, his evidence was that the husband would always be vulnerable to depressive episodes as he had a past history of significant episodes of depression and crisis. These episodes could be triggered by any significant emotional problem for the husband emanating from either work or relationship problems.
- His evidence was that the aim of psychotherapy was to develop insight and awareness of difficult periods in his life and have the tools and strategies to do something about it, in times of crisis. He agreed that he did not have complete confidence that the husband would self-refer in times of crisis.
- I propose to make orders that the husband immediately commence psychotherapy with Dr A and continue to abide by the treatment and recommendations of Dr A and that the husband authorize the wife to obtain all relevant information from Dr A. This will provide an appropriate safeguard for the children, in the event the husband suffers a relapse of his mental health. I do note however, that Dr A, when asked whether the husband presented as a risk to the children, responded that he had not assessed the husband as a risk and that it would be unlikely.
Husband’s admission to (omitted) July 2014
- The wife’s solicitors subpoenaed the husband’s medical records from (omitted) Health. The (omitted) Hospital discharge summary, dated 23 July 2014 was tended by counsel for the wife.
- The Discharge Summary states that the husband was admitted to the psychiatric unit on 19 July 2014 at 14.26. He was discharged on 28 July 2014. The principal diagnosis was Dysthymic disorder. The clinical synopsis diagnosis was, Dysthymic disorder, Hx anxiety and depression, cluster B personality traits, ETOH abuse, and stress and anxiety related to relationship and employment.
- Subsequent to his discharge from hospital the husband did not consult Dr A, however, he continued to consulted his GP, Dr D.
Evidence of Ms L family report writer
- During the course of the proceedings Ms L prepared three reports as follows:
- Ms L gave evidence and was cross-examined by both counsel for the wife and the husband. I found her to be an impartial, professional and impressive witness, who was prepared to make concessions when appropriate.
- In the family report her recommendations for the parenting arrangements for X and Y were that the children live with their mother, and during term time spend time with their father, from after school Friday commencement of school on the following Tuesday each alternate weekend. She also recommended that the children see their father after school in the intervening week for dinner or activity. She did not endorse the current arrangements of a split week with different arrangements for each child.
- During the course of the property proceedings it became apparent that Ms L did not have access to the husband’s significant medical records prior to preparing the family report. Arrangements were made to provide Ms L with the husband’s subpoenaed medical file and for her to prepare a further report.
- Her conclusions and recommendations, after reviewing the medical file are as follows:
“Mr Douglass need is to have close and ongoing time with the children. The children’s needs to have settled and predictable week (sic). The two regimes are in contrast to each other. On the best interests of the children’s perspective. The writer’s recommendations in the family report are considered to be in the best interests of the children.”
- As referred to at paragraph 151 to 155 hereof, the husband was particularly concerned that Ms L did not specifically address the children’s views in her family report or the supplementary report.
- An order was made on 3 October 2016 providing for the children to attend Ms L to ascertain their views and the preparation of a further report.
- The children’s views, as ascertained by Ms L, are referred to at paragraphs 158 to 161 hereof.
- Ms L during cross-examination, said that the children when expressing their views, did not look at what was in their best interests. Her evidence was that the children could not conceptualise any alternative arrangements, as the split week had been the reality for them since separation. She also said that the children had not been sufficiently sheltered from discussions with their father about his views of the arrangements.
- Her evidence was that if the arrangements differed from the existing, then the children would be able to adapt and accept the new arrangements. X stated to her that he could adapt and, upon reflection, she thought that Y had emotional needs to spend more time with her mother.
- She concluded that it would be beneficial for the children to have individual arrangements. In particular Y was aware that X was her father’s favourite and that it would benefit her to have individual time with her mother as a reprieve from both her father and the ongoing conflict with X. If this were to occur it would be helpful for the children to have the arrangements explained to them by an independent person, and she was prepared to assume that role.
- In clarifying the most appropriate arrangements for the children, her evidence was that X should spend four nights a fortnight with his father in a block, however, this should be implemented gradually. She proposed that as X would commence secondary school in 2017, he should spend a three night block with his father each alternate weekend from Friday conclusion of school until commencement of school Monday for the remainder of term four 2016 and for term one 2017. X’s time could increase from Friday to Tuesday each alternate weekend from the commencement of term two, 2017.
- In relation to Y, the most appropriate arrangements for her would be to commence spending time with her father for the remainder of term four 2016 and from the commencement of term one, 2017 from Friday conclusion of school until Sunday 5 PM, each alternate weekend. Y’s time could increase from Friday after school until commencement of school Monday each alternate weekend, from the commencement of term two, 2017.
- Additionally, the children could have a meal with their father in the alternate week, but such time should not be overnight.
- She agreed with the proposals for sharing the holidays.
- In relation to the husband’s mental health issues, and the impact on the children, her evidence was that Mr Douglass’ acceptance of his mental health was rationalised by him. For example he described himself as bohemian and eccentric, to excuse his mental health problems. She perceived that the husband had little insight to be able to manage his own responses to emotional highs and lows and he would have little capacity to see the impact of his behaviour on the children. The husband appeared focused on his own distress rather than considering the children’s perspective or indeed that of their mother. The husband sees his behaviour as different to the way others perceive him.
- Her evidence was that the husband had two primary responses to the breakdown of the family relationship, namely residual anger towards the wife for leaving the family, and secondly, feeling sorry for himself. That manifested in aggression, and maladaptive behaviour. The husband’s outrageous and bizarre response to the wife’s application for divorce was an example of deeply ingrained anger and aggression towards the wife.
- The children have also been exposed to, and impacted by the father’s responses. In particular, X’s anger and aggression and his sense of wanting to be fair and loyal to his father. She agreed that the impact on the children of their father’s behaviour would be greater if they are exposed to him every few days.
- Her evidence of the impact of long-term exposure to residual hostility and self-sympathy was that it was would be likely to affect their adult understanding of how relationships work and their ability to problem solve with their peers.
- She recommended that the children have some form of psycho education to enable them to be informed and understand their father’s mental health issues. It would also enable the children to identify a potential deterioration in the husband’s mental health and would function as a protective mechanism for the children. She agreed that it was imperative that the husband continue with therapy with a psychiatrist, such as Dr A and that the children should also have access to a counsellor to discuss both the issue of sibling conflict and the impact of their father’s mental health of them, as they develop awareness of it.
- I accordingly conclude that orders for the children to live with their mother and spend time with their father, in accordance with the proposal of the mother and the recommendations of Ms L, are in the best interests of the children.