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    "At the end of the day it has been stressful for he [sic] and his family. Of course it has. We recognise that. We appreciate a great deal the diligence he has put in under the circumstances and how he has driven the company to where it is at the moment."  

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    The Waterlow killings 

    Tom Kelly reviews The Waterlow Killings: A Portrait of a Family Tragedy by Canberra lawyer Pamela Burton ... Falling through the cracks ... Anthony Waterlow and the fatal stabbing of his father and sister 

    Chloe Waterlow and her father Nick

    THIS sensitive account of a family tragedy details the terrible consequences when the mental health system fails. 

    How's this for a great horror/who-done-it plot?

    Nick Waterlow is a world-renowned art curator, past director of the Biennale, with an Order of Australia medal.

    He is an Englishman of noble origins, who migrated to Australia and is the next in line for a baronetcy. His deceased wife was the daughter of the wealthy Australian who started the Breville electronic goods corporation.

    His partner, Juliet, is the granddaughter of the first chairman of the board of BHP.

    Nick organises a dinner for his son, Anthony, at the home of his daughter, Chloe, who is an attractive and achieving mother of three young children.

    Anthony is Jesuit and university-educated, usually charming, a would-be actor with matinee-idol good looks.

    Before the dinner is served, Anthony has brutally stabbed his father and sister to death and seriously injured his young niece.

    He takes off, goes bush, and is not apprehended for three weeks.

    The funerals of the deceased are conducted by a family friend, a priest named Father Sinn, and attended by various Sydney A-listers, including family friends, the film director Jane Campion and actress Rachel Griffiths.

    As a consequence of Nick's death, Anthony is now the first in line to the baronetcy, and will be entitled to be addressed as "Sir Anthony" in the fullness of time.

    When Mark Twain said that truth is stranger than fiction, he could have been writing about this book, which is the thinking reader's true crime.

    This is not a who-done-it homicide, but a why-did-he? - and the author goes about answering this in a most lucid, thorough, sensitive and readable manner.

    The thoroughness includes researching various court exhibits, transcripts and medical records as well as a trip to England to meet Nick's family and to research earlier episodes of Anthony's aggressive psychosis. 

    We have a picture of the difficult tensions and dynamics that exist in most families, and which partly contributed to the horrific killings.

    The book also documents the terrible stresses of living and dealing with a close family member and friend who is suffering a serious untreated mental illness.

    The author interviewed experts in mental health and thoroughly researched schizophrenia.

    One of the best aspects of the book is its excellent description and discussion of this illness, its symptoms and the way it should be dealt with.

    For instance, Burton emphasises that sufferers are at much greater risk of harm to themselves through misjudgement or misadventure or even suicide, than they are of harming others.

    There is an analysis of the breakdown of an essentially effective, if under-resourced, mental health system - and the consequences that flow when mental health professionals do not properly apply the law that allows them to treat a mentally ill person contrary to their wishes. 

    Anthony Waterlow: not guilty of murder on ground of defect of reason So is there a villain in this true-crime book?

    Anthony hardly fits the bill.

    When he is well, he is charming and personable. Now he is incarcerated in the psychiatric hospital in the grounds of Long Bay prison, dealing with the facts that he has killed two of the people to whom he was closest, is estranged from the family whose approval he sought so much, and does not know when or if he will be released.

    Then there are the shortcomings of mental health professionals who, over a four-year period, failed to hospitalise and treat Anthony involuntarily. 

    These include the mental health assessment team in London in 2006, which failed to section him after he tried to seriously harm his English relatives; the psychologist who persisted with behavioural therapy (counselling) when medication was the obvious tool; and the Caritas Centre at St Vincent's Hospital in Sydney.

    The family's unfortunate experience with Caritas is fully explored. Caritas comes from the Latin for love and compassion. This institution closed a few years ago, after the Waterlow killings. 

    I presided over hearings of the Mental Health Review Tribunal at Caritas and it was probably the worst psych unit I ever attended.

    It was located in an historical 150-year-old house where confusion reigned, often with unresponsive staff and a lot of patients milling around in confined common areas.

    The usual room where the hearings were held was devoid of pictures or any decoration and smelt either of urine or damp, I was never sure which. 

    The patients were among the most challenging, being mostly young, homeless and drug users who came from the Kings Cross-Darlinghurst area.

    For many years money was spent on various of St Vincent's centres of excellence and its showcase, St Vincent's Private Hospital, but the psychiatric unit for mentally ill public patients appears to have been underfunded.

    After Caritas closed it was replaced by a modern public psychiatric unit nearby. A year or two later an additional and luxurious psychiatric ward was opened in the private hospital for treating the wealthy mentally ill.

    The old Caritas building is currently being converted into expensive inner-city apartments.

    Burton's book charts, on my counting, 12 occasions over a 28-month period when doctors at Caritas refused to schedule Anthony at the request of his family and friends.

    Each of these refusals immediately followed a violent or threatening episode. Amazingly, on one of those occasions, the views of Dr Olav Nielson, a prominent Sydney forensic psychiatrist, were not accepted.

    Eventually, the family gave-up on the psychiatric profession.

    It is hard to understand how such consistent and worrying information about threats and actual instances of violence could be provided by so many credible members of Anthony's family and friends, on so many occasions, over such a long period, and for them to be substantially ignored. 

    On each occasion, the psychiatrists sent Anthony away with advice to take his prescribed anti-psychotic medication, in spite of the fact that he made it abundantly clear that he had no intention of ever doing so.

    When assessing many seriously psychotic persons, a few minutes' conversation will easily demonstrate the need for an Involuntary Patient Order.

    However, a minority of sufferers will present as prima facie normal, although a good psychiatrist or forensically experienced lawyer should be able to work it out if a history is available and detailed questioning undertaken. 

    Anthony was in this latter category, being clever and capable of coherently denying the allegations of threatening or violent behaviour, often involving knives. 

    The worrying behaviour occurred after drinking and his subsequent psychiatric presentation occurred when he was sober.

    The question arises whether Anthony would have benefited from a compulsory admission to the Dickensian Caritas.

    In my view, the answer is yes. In spite of its considerable shortcomings, it would at least have been able to ensure that he took the medication that he had previously refused.

    As a result of the medication he has been forced to take since his arrest, he has became well, gained insight into his illness and accepted the necessity of maintaining his medical regime.

    There can be little doubt that if he had received compulsory hospitalisation, followed by discharge with a properly administered community treatment order, it is likely his father and sister would be alive today.

    In Anthony's case, on all the evidence, the relevant criteria for scheduling as set out in the Mental Health Act should have been satisfied, that is: he suffered from hallucinations or delusions or serious thought disorder or disturbance of mood that required care, treatment or control, in order to protect him or others from serious harm.

    Some of the fallout from the killings is still pending.

    First, Anthony's long term future is yet to be determined.

    Secondly, after Anthony's trial, Kevin Humphries, the New South Wales Minister for Mental Health, supported public demands to amend the law to allow decisions by hospitals - such as St Vincent's - to refuse to schedule a patient to be appealed to the Mental Health Review Tribunal.

    The tribunal usually sits with a panel of three: an experienced lawyer, a psychiatrist, and another mental health professional. 

    At present the tribunal only reviews patients who have previously been scheduled. The proposed appeal process would provide an additional check in the event of frontline professionals failing to act.

    Yet nothing has happened in the past 18 months to implement this change to the law.

    Rumour has it that allocation of additional funds has been the hurdle. Any reform without the necessary funding will create as many problems as it may resolve, as other patients may be prematurely discharged to provide beds and patients who do not need to be scheduled may be detained unnecessarily, if the tribunal is not resourced so that it can hear appeals quickly.

    In October the government announced a review of the Mental Health Act to report in the New Year, and this proposed reform is now being considered as part of the review.

    No doubt many people, including the remainder of the Waterlow family, will be very interested in the recommendations.

    Lastly, and unusually, there is the pending Coroner's inquest.

    In most homicide cases where a criminal prosecution results in a determination of the cause of death, which was the situation here, the inquest is dispensed with.

    Occasionally, when there other aspects that merit the Coroner's consideration, such as possible system failures, an inquest may still proceed.

    In the case of Nick and Chloe Waterlow, I understand this is likely to occur this year.

    Tom Kelly was an Official Visitor to Rozelle Psychiatric Hospital in the 1970s and President of the New South Wales Psychosurgery Review Board in the 1980s. In 1985 he established the Mental Health Advocacy Service within New South Wales Legal Aid Commission. He has been a legal member of the New South Wales Mental Health Review Tribunal for the last 15 years. He was consulted by the author on legal issues during the writing of this book. 

    This is a revised version of a review recently published in the Newtown Review of Books

    Pamela Burton The Waterlow Killings: A Portrait of a Family Tragedy, Melbourne University Press, 2012, 272pp, $29.99

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