Tighter patient controls urged

A psychologist left blind in one eye after being attacked by a patient wants stricter controls on where high-risk mental health patients can live.

Malcolm Falconer, 54, and community support worker Hilary Warren were on a routine visit to the patient at Kohukohu in the Hokianga Harbour area on December 7.

Mr Falconer said yesterday that at the patient's home, a bach without electricity and telephone, the man leaped at them.

"He came charging out of the longdrop toilet and hit Hilary first. The second blow knocked her off his deck.

"He appeared to be going after her to hit her a third time when I reached him to try to stop him. He turned on me and he had a padlock ... round his knuckles as a knuckle-duster."

Mr Falconer defended himself, then decided to run for their car, but slipped.

"I don't remember hitting the ground. He must have hit me round the ear and temple. Next thing he was on top of me.

"I came to with the pain of two thumbs in my [right] eye."

The patient also tried to gouge Mr Falconer's left eye. His colleague, knocked unconscious, was left with broken bones in a cheek and eye socket.

They were saved by the 41-year-old patient's brother, who lives 200m away on the same property, and his two sons who restrained the man.

He has been charged with wounding with intent to cause grievous bodily harm and is understood to be in the high-security Mason Clinic.

Mr Falconer described himself as an advocate of community care for mental health patients, but said the system had let this man down. He was on a compulsory community treatment order.

"We all knew this was going to end up in disaster."

He said mental health legislation needed to be tightened to let the state stipulate where patients at high risk of becoming violent should live.

The man, diagnosed with schizophrenia, had previously assaulted other mental health workers, which took him to the Mason Clinic.

"He had been moved up to our area from level four supported accommodation in West Auckland.

"Four is about the highest - it's 24-hour supervision by clinically trained staff."

Mr Falconer said family members and the health service, Hokianga Health, were unhappy about the patient shifting from 24-hour supervision to an isolated area, without a phone, where he would be visited by health workers once a week at most.

A family member told the Herald the patient's Auckland caregivers opposed the move.

"We still think he needs monitoring every day - proper care and proper facilities."

The Health Ministry's director of mental health, Dr David Chaplow, said last night the question of tighter controls on where patients lived had come up before this case, "because it's difficult to track some people down or to manage them if they are not compliant". However, he did not have an answer.

Officials would study the case to see if changes were needed.

An advocate for mental health patients, Jim Burdett, said that while the attack on the two workers was dreadful, it would be the wrong response to further curtail the liberties of people with serious mental illnesses, most of whom would never hurt another person.

Dr Allen Fraser, head of the New Zealand committee of the transtasman psychiatrists' college, said there was no authority to direct where patients under community treatment orders lived, but they could be required to be admitted to hospital if they could not be safely treated in the community.

He opposed allowing the state to direct community patients where to live. "If we are going to detain people, that's probably best done in hospital."

Patients' addresses

* The state cannot dictate where mental health patients on compulsory community treatment orders can live.

* The Health Ministry says hospitals have the power to direct where compulsory in-patients will live while they are on trial living in the community. This power lasts no longer than six months.