Sunday, September 28, 2008

British mother who drowned her daughter with CP has history of mental illness

From The Guardian in the UK Sept. 27:

Everyone in court agreed that Joanne Hill had suffered from serious mental health problems for almost half her life, even the prosecution, who argued that she had known exactly what she was doing when she drowned four-year-old Naomi (pictured) in the bath last year.

The lawyers conceded Hill had previously suffered significant psychiatric episodes, and struggled to cope with her daughter's cerebral palsy, for which she held herself personally responsible.

At one point during the two-week trial the forensic psychiatrist called by the Crown as an expert witness - who testified that Hill's actions did not suggest a mental disorder at the time of the killing - admitted that she "certainly" seemed to be mentally ill in court, as she sat in the dock flanked by two nurses and a guard.

Every day of the hearing, in fact, she was brought to Chester crown court not from a cell in the local prison but from the Ty Llewellyn medium-secure hospital unit near Bangor, north Wales.

And yet on Tuesday the jury decided that Hill, who had been known to local mental health services in Connah's Quay, Flintshire, since she was 17 and had seen a child psychiatrist, had been in control of herself when she killed Naomi by holding her head under the water of a bubble-filled bath for up to 10 minutes last November. They decided the 32-year-old was not sufficiently mentally ill when she took her daughter's lifeless body from the bath, dried her off, dressed her in dungarees and lay her on the back seat of the car, then drove aimlessly for eight hours, stopping to buy wine and petrol before eventually taking her to the local hospital, long after anything could be done to save her.

Simon Hill, her husband, had testified in court, saying Joanne had had "very dark thoughts". He said she once suggested Naomi should be adopted and thought it was her fault the child had cerebral palsy. Joanne veered between having a good, "overpowering" relationship with Naomi, when she would buy her a lot of toys, and being "not so good" with her, he said. After the trial, he said that what his wife did to their daughter was "evil".

Hill's barrister, Stephen Riordan QC, said his client had an "abnormal, tortured mind". The jury did not agree. Unconvinced that Naomi's death was the consequence of Hill's illness, they rejected her defence of diminished responsibility and found her guilty of murder.

Elgan Edwards, the Recorder of Chester, jailed her for life and ordered that she was not to be released for 15 years. He described the situation as a tragedy for all concerned. He told her: "This has been a very sad case. Sad for you, your family, for your husband and his family, and tragic for the daughter you killed."

During the two-week trial the jury heard that Hill was ashamed of Naomi's condition; the little girl had to use callipers to help her walk.

It is a case which has stirred many emotions. In the Daily Mail Rosa Monckton, whose 13-year-old daughter has Down's syndrome, wrote: "It was unquestionably an evil act and she deserved to be punished but I cannot help feeling sympathy for her." Mary Dejevsky, writing in the Independent, said: "Society's expectations of women, inadequate care services, and an adversarial court system that magnifies vice and virtue could, and should, have been in the dock, too."

Speaking to the Guardian yesterday, a leading psychiatrist who examined Hill for three hours in August said that she had had complex psychological problems that defied easy categorisation.

Aideen O'Halloran, clinical director of the Orchard, a secure unit for women inmates from Broadmoor hospital, had told the court, as a witness for the defence, that Hill as
"suffering an abnormality of mind" when she killed Naomi. Yesterday she said that Hill's mental disorder meant she had not been "able or willing to open up about the extent of her difficulties".

That might be why Hill did not seek the help she needed. The disability charity Scope, which helps people with cerebral palsy, told the Guardian it had no record of Hill contacting it for support.

"Joanne Hill was quite a closed person, who appeared to struggle to access her emotions and consequently may not have made professionals aware of her needs," said the psychiatrist, who had told the court that Hill was in a "trance-like state" for much of their time together.

O'Halloran said the case revealed "the difficulties of trying to present an individual patient, with a serious level of mental disorder, to the courts, who does not fit neatly into a diagnostic category".

She added: "This case highlights the weaknesses of relying on categorical diagnostic systems, which require individuals to fit neatly into category or risk not having the disorder recognised by the court. It highlights the mismatch between the clinical context and judicial context.

"It is difficult to get across complex psychiatric/psychological problems in an adversarial arena, where complex shades of grey do not fit neatly with the black/white answers required."

Hill's legal team criticised much of the media coverage of the trial, which concentrated not on her mental health but on her "shame" over her daughter. Liam Ferris, her solicitor, said: "What was very disappointing to many of those who know the case well was the way in which parts of the media chose almost to ignore the complex and important psychiatric issues involved. This can only have left the public misinformed about its real nature."

Hill first showed signs of mental illness in the 1990s, when she was 17 and saw a child psychiatrist for anxiety. In 2000 she twice attempted suicide and throughout the year was prescribed drugs for anxiety, depression and sleeplessness. In January 2003, shortly before Naomi was born, Hill was diagnosed with chronic anxiety and in April had a "hypermanic" episode.

Naomi was born 10 weeks premature in a "difficult" birth in June. Almost immediately Hill suffered puerperal depression, a severe form of postnatal depression. She was treated by her local community health team; appearing to make a quick recovery, she was recommended for discharge from outpatient care in September. On Boxing Day 2006 she had a severe relapse and left the family home to be cared for by her parents. But she recovered and went back to work part-time in March and then full-time a month later. In June doctors decided there was no need for further involvement by the local mental health team and in August her case was closed, although she remained under the care of her GP and on several types of medication.

In November it was recorded that she was drinking heavily, increasing the risk of depression and the likelihood that she would stop taking her medicine. Later that month she killed Naomi. After the child's death North Wales NHS trust conducted an interim review looking at the care she had, and recommended improvements to policies. A spokesman said yesterday these had been implemented. A full review is being completed under the control of Flintshire local safeguarding children board.

Alice Maynard, chair of Scope, said: "This case raises the wider issue of how many disabled parents still don't get the support they need in bringing up children and how society continues to portray disability in a negative light, creating shame and stigma around impairment. Tragically, in this instance, this combination of factors proved lethal."