Insane killers: The devastating fallout from untreated psychosis

Around one-in-ten homicides are carried out by someone suffering from a treatable psychotic disorder. Experts say that’s unacceptable. Mava Moayyed and Kim Peacock spoke to families who have suffered as a result of the lack of treatment available.

More than 20,000 people in New Zealand are suffering from a psychotic disorder right now. The vast majority are never violent, in fact, they’re far more likely to be the victims of violence.

But a small group with key risk factors – including those with a history of violence and drug and alcohol use - can suffer extreme delusions, causing them to do the unthinkable to innocent people.

Between five and seven New Zealanders are killed each year by someone suffering from a treatable psychotic disorder.

Senior forensic psychiatrist Erik Monasterio told Sunday that at-risk sufferers are increasingly missing out on psychiatric care due to under funding, a lack of resources, and disorganisation in mental health services across the country.

“The very group who present the highest risks are not receiving adequate long-term treatments. My concern is that if the chaos continues, we will see more and more adverse incidents occurring,” Monasterio said.

He said it’s only become worse since the 2019 Mental Health Inquiry and psychiatric staff are leaving public service in high numbers, at a time when they are most needed.

“It is very sad for me to observe this decay in the availability of services. Remember that you can judge any society by the way it treats its most vulnerable and that is a question that New Zealand may want to ask itself at the moment.”

Kevin Boyle remembers the call from police about his son’s arrest.

"It was 30 degrees out and he's got a motorcycle helmet on and he's fishing out his window,” said Boyle.

“He wasn’t well.”

In 2016 his son, Joe Boyle, was arrested for yelling abuse at passing motorists while trying to catch fish on his concrete driveway in Invercargill.

A court-ordered report from a psychiatrist concluded that Boyle qualified for an insanity defence. Despite this, it would be four years before his psychotic disorder was properly diagnosed.

Joe, 32, loves being outside. His father describes him as “a good kid” who was always “polite” and enjoyed fishing and hunting.

After a post-hunting car accident in 2010, Joe was left with a brain injury.

“He became a recluse. He didn’t talk as much. Joe was never 100% after that, and it just got worse and worse and worse.”

Psychiatrist notes released to Sunday by his family show that he first reported hearing voices in 2011.

He said they frightened him, and he struggled to sleep. He also experienced taste and smell disturbances and described having an “invisible friend”.

The year after, he was arrested for harassing fast-food staff after paranoid delusions of having food from McDonald's contaminated with a silicone fly, planted by the Yakuza.

In 2012, he was diagnosed with bipolar disorder by a Southern District psychiatrist and was prescribed the mood stabiliser lithium.

“I looked up everything and you could see there were some symptoms that were probably [bipolar]. But I kept on saying to the doctor, there’s something else,” said Kevin.

Joe’s treatment was fraught. His father complained to Southern District Mental Health Services multiple times that his son wasn’t getting the treatment he needed.

Joe himself wrote a letter in 2015 requesting a new psychiatrist, saying his one yelled at him and showed “explosive anger during the meeting.” He noted it “upset me so much that I broke my sunglasses I was holding”.

He continued to struggle with voices and delusions. He had multiple run-ins with the law. He remained on lithium and was periodically prescribed anti-psychotic medication. But because he didn’t have a diagnosed psychotic disorder, he was always taken off them when his mental health improved.

Joe had the constant support of his family, including his dad and his stepmother, Tania Boyle.

“I’d go and live with Joe to try to get everything right. It caused us arguments, but I’d go to make sure he was taking his medication,” said Kevin.

By 2019, Joe was so seriously unwell he saw worms coming out of his dishes, and a rabbit jump out of his television.

Kevin called Southern District dozens of times, saying he was worried his son was “losing the plot”.

“I kept on ringing. I told them that I was worried for Joe’s safety and other’s safety.”

In Joe’s psychiatric notes, Southern District Mental Health staff wrote that they tried to visit him but for various reasons – including being afraid of his dog, the high gate outside his house, and believing he wasn’t home – no one saw him.

“He was home. I was there with him,” said Kevin.

A few days later, Joe's stepbrother, James Clarke, needed somewhere to stay. Joe got on well with his brother and wanted to help him, giving him his bedroom while he slept on the couch.

But on the evening of December 8, 2019, believing 19-year-old Clarke was the devil, Joe killed and decapitated him.

He called 111 himself, telling the operator that “someone is on the ground bleeding” but he said he didn’t know why. He was arrested for murder.

While in prison, staff made multiple requests for psychiatrist assessment and care.

On 21 December 2019, he gouged out his eyeball using a pencil stub and his finger. A Southern District psychiatrist who assessed him afterwards noted that he “was able to engage in a civil manner... and displayed no thought disorder or symptoms relating to psychosis”.

The psychiatrist wished him a Merry Christmas and a Happy New Year and advised him to continue his lithium medication.

More than a year later, after being transferred to Auckland's Mason Clinic, his diagnosis was changed to schizophrenia. The doctor said he had a “diagnosis of schizophrenia” and “untreated psychosis”.

“How come down here [in Southland] they could see him and keep on misdiagnosing him? Whereas he goes to the Mason Clinic, and they know exactly what the go is?” said Kevin.

Joe was found not guilty of murder by reason of insanity.

In court, Justice Nation said Kevin “did all he could” to ensure his son was not a danger to himself or others. He acknowledged the huge loss Kevin and Tania had suffered.

“I have seen evidence which shows that, as a family, you never gave up on either James Clark or Joseph Boyle.”

Two months ago, James’ mother, Tania, died by suspected suicide.

“We were as thick as thieves. I wish she was here. I wish James was here. I wish Joe was here. But what’s wishing get you?”

In response to a complaint from Kevin about substandard care of his son, the office of the Health and Disability Commissioner (HDC) investigated and said: “I am reassured that Southern District provided an adequate standard of care for your son.”

Sunday has made multiple attempts to receive information from the HDC under the Official Information Act concerning their decision.

The office of the HDC missed several deadlines and have stopped replying to correspondence, despite complaints raised by TVNZ.

Joe is being held in secure psychiatric unit in Dunedin. In January, he and his father claim a psychiatrist tried to dissuade him from speaking to the media.

In an email to Southern District Mental Health staff, Kevin wrote: “I believe she upset Joe to the point that he needed his anxiety medication.... The lady said there were different ways of going about it...to which Joseph replied he wouldn't be dropping the complaint as if he'd been diagnosed properly the whole events would not have taken place and he would not be where he is today.”

Despite multiple follow-ups, Kevin says no one has contacted him about the outcome of his complaint. In fact, the psychiatrist he complained about is now his son’s lead clinician which he feels is inappropriate.

According to Te Whatu Ora, there are currently six full-time roles vacant within the Southern District Mental Health team.

Christina Blithe remembers her dad always wearing a sailor’s hat.

“I used to say, ‘please can you take that hat off? We’re going out for lunch!’! If I could go back now, I would’ve let him wear that hat to my wedding.”

All the things that used to annoy her are what the 30-year-old misses the most about her dad, Colin Blithe.

“He didn’t take life seriously and he just wanted to help. He was always there to help.”

Colin was living in shared accommodation in the heart of Napier.

“He fell into the role of property manager because he also used to be like the maintenance man. My dad loved it there. He used to call it his castle.”

But one of the tenants, 34-year-old Timothy Buchanan, was causing problems.

Buchanan had been diagnosed with paranoid schizophrenia in 2009 and was subject to a community treatment order.

He stopped taking his medication in 2022 and started experiencing almost constant auditory hallucinations. He assaulted a work colleague and a random stranger.

“I do remember him saying to me that he had people living there that he was not happy with that he was going to talk to about moving out. But I had no idea someone like that was living there,” Christina said.

Colin became increasingly concerned about Buchanan. After complaints from other flatmates, the 68-year-old served Buchanan with a two-week eviction notice and was in contact with Buchanan’s mother, Paula.

Paula was worried. She hadn’t heard from her son in days and contacted Colin to organise help.

A doctor visited Buchanan on January Friday 13, 2023, and assessed him as being “more psychotic than baseline”.

A text message Paula received after the visit stated that there were some grounds to admit Buchanan, but the mental health inpatient services were full, and they’d reassess him after the weekend.

The message went on to say that if Buchanan became “reactive” in public again over the weekend, the mental health team would respond. But, for now, “his doctor feels this is the best response having seen him”.

“I believe that the doctor had the power and choice to intervene but chose not to,” Paula told Sunday.

The following day, Buchanan killed Colin.

“Had there been a bed available my dad may still be here today. The fact that it was preventable, it kills me every day,” says Christina.

Buchanan later told psychiatrists he believed some people on earth were impostors, identical in their physical appearance to real people, but not from Earth.

He said he’d learned about this by listening to his voices, in particular a voice he referred to as the ‘master teacher’, ‘God’, or ‘Anabus’. He thought Colin was one of these impostors.

On the evening of 14 January, Buchanan went to Blithe’s room and placed Colin in a choke-hold until he stopped breathing. He left the room taking some of Blithe’s personal items with him.

In July, Justice Gwyn found Buchanan not criminally responsible on account of insanity and acquitted him of murder.

She said, “the truly awful event that occurred... may have been prevented if a bed had been available” at the mental health inpatient unit.

For Christina, though, the judgement only made her feel worse.

“[The verdict was] probably the hardest thing I’ve ever had to hear in my life, because there’s no other way to describe what he’s done. It wasn’t an accident. Reading that he’d been acquitted of murder, in my mind, is a joke.”

She and her family are grateful for the support of their police liaison officer and Victim Support, but they want to see a full inquiry. Te Whatu Ora said there is currently a mental health system review into events prior to his death.

Amiria Karekare remembers her mum wearing a ring adorned with dozens of little diamonds.

“She wasn’t wearing it when she died. She had taken it off and left it in the glovebox of her car.”

Now, Karekare wears the ring every day.

“She wasn’t big on possessions, but she bought this ring for herself. She treated herself. It helps to have something solid of hers. She’s always with me.”

Karekare’s mum is Pania Melrose. The 57-year-old lived in Rotorua and worked at a childcare centre.

On her days off, she’d drive one hour to Te Teko to stay with her partner, Bobby Hill. His 24-year-old son Te Hiiritanga Hill also lived at the property.

The three spent a lot of time together, including the March 2020 Covid lockdown. Karekare says at first everything was fine, but she then got an alarming call from Melrose about Te Hiiritanga.

“Mum said he’s hearing voices. His behaviour was becoming more angry and violent. They had no idea what was wrong. My suggestion was to take him to the doctor.”

Te Hiiritanga later told police he believed Melrose was performing satanic rituals at the house and that she had taken control of his mind.

“A week or two before the incident, she told me that he had threatened her, he had held a knife to her throat. The worst part is, she looked me dead in the eye and said ‘he would never hurt me’. I think she believed that," says Karekare.

On June 9, 2020, Te Hiiritanga’s father took him to see the GP who said he was likely experiencing psychosis. He prescribed him risperidone, an anti-psychotic medication.

The GP also sent a referral marked “semi-urgent” to the Whakatāne Community Mental Health team, triggering a response time of 72 hours. He asked Te Hiiritanga to come back and see him in two days.

In a Serious Incident Report shared by Karekare with Sunday, the mental health team say they trusted the GP.

“The GP...was well regarded and highly respected by the Whakatane CMH [team] as having an in-depth knowledge of mental illness .... The [team] thus decided to await the planned GP consultation with Mr Hill...prior to contacting the GP or the patient.”

“This is a young man who’s presenting for the first time with undeniable symptoms of a very serious mental illness. He wasn’t assessed by a psychiatrist. He should've been,” said Karekare.

The Whakatāne Mental Health team never assessed him, because on June 12th, Te Hiiritanga was arrested for the murder of Melrose.

“He deserved the treatment that he needed. Because he didn’t get it, my mum paid the ultimate price,” said Karekare.

Te Hiiritanga later told psychiatrists that on the day he killed Melrose, he believed she was part of a devil cult and was controlling his thoughts. He described hearing voices from Satan, making him feel angry, agitated and scared.

He struck Melrose about eight times in the head with the hammer and left her to die on the front lawn.

“She wouldn’t hurt a fly and the way she died was so violent and so brutal. It’s just so unfair.”

In the Serious Incident Report, the Bay of Plenty DHB admit the Whakatāne Mental Health team were under-staffed, noting that when Te Hiiritanga’s referral came in, there wasn’t a fulltime employee to triage referrals.

According to Te Whatu Ora, while the triage role has been filled, there are still 3.7 full-time roles vacant within the Whakatāne Community Mental Health Service.

In court ordered assessments, psychiatrists diagnosed Te Hiiritanga with schizophrenia. He was found not guilty of murder by reason of insanity.

“You leave the courtroom knowing that there will never be any justice. It’s over, he’s not guilty, and that’s crushing,” said Karekare.

She doesn’t want Melrose to be remembered for what happened to her. Rather, for the wonderful woman she was.

“My mum Pania was a wonderful mother. She raised me on her own and was fiercely independent. My whole life she provided for the both of us. Her heart was so big that it was almost detrimental to herself. She was a softie and probably the most empathetic person I’ve ever known in my life. So many people loved her.”

Sunday took these cases to Te Whatu Ora to hear their view as to what went wrong.

Murray Patton, its clinical lead specialist for mental health and addiction services, said they were limited in what they could say about individual cases due to the need to protect the privacy of those involved.

But he reviews take place after "serious adverse events" to fully understand what happened.

"We are committed to learning what we can from these reviews with the aim of improving services if possible.

"People who need specialist care are at the centre of everything we do. We know however that it is still too difficult for some people to get the specialist help they need. That said, the wider health reforms underway aim to create a better-resourced, more joined-up health and mental health system that delivers for all New Zealanders.”

Those reforms come too late for the family members who have lost loved ones who Sunday spoke to. They can only hope the resources are there in future to prevent a repeat.