Waterlow murders reveal cracks in the system
It was November 2009 in the late afternoon, a moment of tragedy. The gentlest of men, my partner, the art curator Nick Waterlow, OAM, was killed. So was his beloved daughter, Chloe Heuston. This happened in front of her three young children. The perpetrator of this frenzied knife attack was Nick’s eldest son, Antony, who suffers from schizophrenia.
Antony had been ill. He had a long history of psychotic symptoms and violent behaviour, but he didn’t believe he had a mental illness and refused to take his medication. Despite appeals from family and carers, he remained untreated. These murders might have been prevented. Antony should have been scheduled and treated.
At the inquest into the events surrounding Nick and Chloe’s deaths, Nick’s youngest son, Luke Waterlow, and I gave testimony. I told the court I had always believed Antony was dangerous, and two years before the murders, when I heard Antony was coming for lunch, I put all the kitchen knives in a beach towel and hid them under a bush in the garden. “Just in case,” I told Nick. We told the court what it was like to live in fear and how we were witness to Nick’s helplessness and the very real fear, which confused him, and might have paralysed him.
As the years went on, many friends noticed that Nick looked more and more haunted. I thought Nick was afraid of what Antony, untreated, was capable of. I think this fear confused him and overrode his fear of death. Fear is a terrible thing. It can make death invisible.
The inquest made public the notes, kept by Antony’s doctors, of his long history of mental illness and violent psychotic behaviour. They recorded Antony’s death threats to his family, and Antony’s belief that his family were part of a game on the internet and were responsible for the voices in his head, which he believed were controlling him and were out to destroy him. They noted Antony’s bizarre behaviour: that Antony dressed in a cupboard because he thought his room was under surveillance, that he had called his bedroom a torture chamber. The doctors who saw Antony were aware of the dangers of not treating first episode psychosis. Dr Alistair Peter McGeorge told the court that he knew a deluded patient, when treated, is not likely to be dangerous, even if treated just once. He said he was also aware that after enough treatment patients gain enough insight to then begin to voluntarily take medication. He had asked two other doctors for a second opinion. One doctor, Olav Nielssen, recommended scheduling Antony. The other said not to because “Antony was not imminently dangerous”. Antony was not forcibly treated.
While waiting for the findings of the inquest to be handed down I met with Professor Vaughan Carr of the Schizophrenia Research Institute at St Vincent’s Hospital in Sydney. I recalled the writer David Malouf, not long after the tragedy, taking me to see Hamlet. It prompted me to ask the professor whether doctors take into account the character traits of their patients.
He told me that traits such as selfishness, kindness, envy and resentment are not taken into account because they are difficult to measure. “We do not concern ourselves with such things,” he said. “We don’t make judgements of that kind because all people are entitled to treatment whether they are good or bad.” But the professor went on to say that no two people suffer from the disease in the same way. “Each one brings to it their own unique style, their own life experiences.”
Under current New South Wales law, doctors are required to determine whether or not a patient is “at risk of serious harm to themselves or to others”. I asked the professor how this could be done when character isn’t taken into account. He didn’t answer. He told me that nothing more is known about the disease of schizophrenia today than was known 200 years ago.
At the inquest, doctors who had seen Antony told the court they knew Antony could not control his behaviour and had no insight into his illness.
Dr McGeorge told the court he wanted to establish a rapport with Antony. But the solicitor for the coroner pointed out that when Antony cut off his relationship with McGeorge there was no active follow-up. Antony moved to the Colo Heights area of Sydney’s north-west. At the family’s request, he was visited by a psychiatrist who had been sent his St Vincent’s medical notes, but she decided not to forcibly treat him. When Antony returned to St Vincent’s Caritas inpatient unit in 2007, Dr McGeorge wrote: “Antony does not meet the criteria for scheduling under the mental health act.” In November that year, he wrote that Antony “is likely to be psychotic and a danger to himself and others”. Ultimately, however, he told the court: “There was nothing to say he was going to do something at a particular moment.”
No single doctor should be asked to make such a decision. A senior homicide detective told me there is no way, even with sophisticated surveillance technology, they can predict whether a person will harm himself or herself or someone else.
McGeorge told the court he took the death threats made to family extremely seriously. Although he knew Antony couldn’t work, have relationships or function in society, he still wanted Antony to remain in the community. He warned Nick not to see his son unless it was in a public place. But how does a father ensure that happens? The doctors seemed satisfied when Antony told them that he didn’t mean to carry out his death threats on his family and his landlord.
We need to help doctors consider families with a member suffering from debilitating mental disease and demonstrating violent behaviour, for it is often the family who are at risk. This is the crack that Antony fell into, and all his family after him.
Dr McGeorge told me he was sorry, and to the court he acknowledged that doctors need better treatment guidelines.
Magistrate Paul MacMahon handed down his findings last year. The inquest honoured Nick and Chloe and the efforts of the doctors. But there is, as the homicide detective put it, “a screaming need for changes to be made”.
MacMahon recommended all families be made aware that under the current NSW health act, they can, as primary carers, make an application to have their mentally ill relative or companion sectioned for treatment if the doctors don’t do so. He suggested that this information be more widely publicised.
One of the recommendations made by counsel assisting was that an amendment be made to the Mental Health Act 2007, so it expressly states that in determining whether to schedule a mentally ill patient pursuant to s. 14(1) (a), the term “for the person’s own protection from serious harm” should be understood to include the harm caused by the illness itself. I believe this would make headway, because medical practitioners would then be dealing with concrete evidence. It would avoid the need for doctors to determine the impossible: what a mentally ill person with no insight “might do”. It would also mean they would have to take into account the misery and fear that families have to live with on a daily basis, sometimes for decades.
I believe the “harm criteria” should be deleted from the mental health criteria and replaced with provisions that allow for treatment for persons with mental illness who lack insight into their condition and capacity to make treatment decisions to be treated by doctors involuntarily where it is in their best interests to do so. Reports from family and carers and interested persons must be seriously taken into account. Doctors should be asked to provide reasons why they do not treat a mentally ill person who has no insight into their condition and who has demonstrated violent, uncontrolled behaviour.
Five hundred years ago Shakespeare found new ways to tell the saddest of stories. But these stories are happening today. We are living them. They concern us all. This story is not the only example of a failure to treat a person with tragic consequences.
I know that Nick Waterlow would welcome more open discussion and debate from politicians, decision-makers and medical practitioners, and all of us in the community. Nick spoke about Antony’s disease, and mental illness generally, most poignantly in his speech at his daughter’s wedding. For some, these conditions perhaps carry shame. But there is nothing wrong with shame. We must find room for it, for our humanity.
We all have an age-old duty to protect the innocent. I believe under the current legislation we are not doing this.
Last night, during a sudden thunderstorm, I stopped under an alcove and recognised a man who knew Nick and was also taking refuge from the downpour. He told me that last week his brother and mother had been slashed repeatedly with a barber’s shaving knife by his mentally ill daughter. The day before this incident an assessment team told the man his daughter was fine and would do no harm.
This article was first published in the print edition of The Saturday Paper on Jan 24, 2015 as "Cracks in the system". Subscribe here.