The first psychiatric expert to interview Lauren Dickason after she allegedly murdered her children is today giving evidence at her High Court trial.
Dr Simone McLeavey assessed Dickason six days after she arrived at Hillmorton Hospital’s forensic psychiatric unit.
Dickason had been remanded to the unit after appearing in court for the first time - two days after she smothered her three little girls to death at their Timaru home.
McLeavey told the court Dickason "had the capacity to engage meaningfully" and spoke at length about her engagement with mental health specialists in South Africa due to her feelings of being a bad mother, depression and anxiety.
The 42-year-old South African woman admits she killed Liane, 6, and 2-year-old twins Maya and Karla in September 2021.
But she has pleaded not guilty to three charges of murder and has mounted a defence of insanity or infanticide.
So far, extensive evidence has been presented about Dickason’s life - her upbringing, marriage, the gruelling fertility treatment she underwent to have children and her long battle with anxiety and depression.
The jury watched footage of police interviews with Dickason and her husband Graham - who found his children dead in bed and his wife in need of medical attention when he returned from a work function.
In total, five experts will be called to give evidence - three for the defence and two for the Crown - about Dickason’s mental state at the time of the alleged murders.
So far the jury has heard from forensic and reproductive psychiatrist Dr Susan Hatters-Friedman for the defence and Dr Erik Monasterio for the Crown.
The former says Dickason’s case is one of insanity and infanticide, but the latter rejects both and supports the Crown case of murder.
McLeavey is a consultant psychiatrist at Hillmorton Hospital for Te Whatu Ora Waitaha Canterbury, formerly the Canterbury District Health Board.
She is the sole treating clinician responsible for the oversight and treatment of mentally disordered offenders like Dickason and works with a "diverse" range of mental illnesses.
McLeavey - like the other experts - was provided with all of the police and medical data relating to Dickason’s health and criminal case.
She interviewed Dickason a number of times and spoke with her husband, parents and psychiatrist in South Africa.
In her first "encounter" with Dickason the alleged offending was "a taboo topic" and was not addressed.
She said it was more important to "build a rapport" and "therapeutic alliance" with the accused and gather crucial background information for the courts.
Her priority was assessing "why" Dickason was there in the context of her mental health, and it was too "traumatic" to revisit the girls’ deaths that soon.
Dickason was told at the time McLeavey was to be providing a legal opinion for the court - and she could choose not to disclose any information.
Dickason told McLeavey that back in South Africa when her children were younger she had thoughts of harming them.
She was taking two different antidepressants which she described as "taking the edge off".
However, she still had "disabling depressive symptoms" including an increasing feeling of being "hopeless, helpless and worthless as a mother".
She told McLeavey she was "sad more days than not" and that any joy in her life was shortlived.
The pandemic put "severe stress" on Dickason, who lamented the fact that her twins spent much of their short lives living in lockdown conditions.
In the lead-up to the family moving to New Zealand, there were unavoidable delays that put mounting pressure on Dickason.
The financial stress of the lockdowns, the emigration and physical relocation process, the unrest and increasing crime rates in South Africa were all listed to McLeavey.
Dickason spoke about the wellness programme she embarked on - during which she stopped taking her medication.
She said when emigration stress started to build she "regretted" that decision.
"I didn’t appreciate how bad things had got, I was in the throes of it," she said.
Her husband offered to put a stop to the move but Dickason said she had "brain fog" and "could not communicate with him".
She was scared if she reached out to her psychiatrist it would impact the family’s visa for New Zealand.
She took a sedative medication when her symptoms became "unbearable" which was typically at night when she did not have parenting responsibilities.
Dickason described phases of feeling disassociated and described "out of body" experiences where she felt "her body does not belong to her".
She said she often sat "looking into space at nothing".
McLeavey said during their interviews Dickason denied any psychotic or delusional symptoms.
"I would inquire about psychotic symptoms… eliciting symptoms that might be indicative of a psychotic process… making enquiries about different types of delusions," McLeavey explained.
Dickason spoke of the week the family left South Africa saying she had feelings of "dread at the prospect".
"I was feeling the worst I had… that there was no coming back," she told McLeavey.
The expert said Dickaosn told her she "had morbid thoughts… to do what I did" but denied any planning.
McLeavey said that was "quite a profound statement" and she probed the accused further.
"The defendant confirmed she had had thoughts of harm or possibly killing the children - but without any means or disclosed method of doing so," she told the court.
"There was no reference to suicidal thinking."
When the family arrived in New Zealand they spent time in managed isolation.
Dickason said during that time the children were "wild" and she woke each day "dreading" when they would get out of bed.
She "ruminated" on the decision to move, worried about the lack of family support and felt "guilty" for taking the girls away from their grandparents.
Dickason spoke to McLeavey about her arrival in Timaru and ongoing requests for information from the family’s immigration advisor.
She was sleeping just three hours a night and feeling increasing pressure.
The day of the alleged murders - what Dickason told McLeavey
"She was able to provide all the necessary details required… she described symptoms of depression and anxiety before during and after the alleged offending," said McLeavey.
"She recalled being upset and said ‘it was just like every other day’. She had negative self-thoughts, thinking of herself as ‘a useless mother’."
Dickason said she felt "despondent" and felt that family life had even become "too much" for her husband.
"We were both at the end of our tether," Dickason said, noting her husband seemed "irritated".
"It was like he was giving up… at some point after (he left the house that night) she thought she deserved to die… she thought her children deserved better."
Dickason denied any hallucinations, hearing voices or commands or seeing visions.
"She had accompanying thoughts to harm the children in that moment. She said ‘I didn’t want to leave them alone with Graham without a mother - I didn’t want the raised by another mother’."
Dickason decided to "end the suffering" and told McLeavey "there was no turning back".
She considered various ways to kill her children and then herself.
"She said there was no preplanning… it was impulsive and disorganised. She said she left no suicide note because ‘what I did was pretty self-explanatory’," said McLeavey.
Dickason then explained how she killed the three children, admitting she "killed Karla first because she was angry at her".
She said it was "an out-of-body experience" and said: "it was like I was above."
Once she started killing the girls, McLeavey said at no point did Dickason consider stopping.
She had used cable ties initially to asphyxiate the girls and they left marks on their bodies, so Dickason felt she could not stop as there would be consequences.
She then took action to end her own life. That was not successful.
"Her motive for her suicide attempt was one of ‘self-destruction’ and the children’s killing was an extension of the suicidal act - the two were entwined.
"The defendant denied her suicide attempt as being in remorse for the offences perpetrated against her children.
"Her intent was to die… she said her husband returned earlier than anticipated."
Dickason said her first memory after her suicide attempt was waking "to my horror" in the intensive care unit at Timaru Hospital.
She was "devastated".
McLeavey said after the deaths Dickason reported "neverending" flashbacks and nightmares.
Her mental health deteriorated dramatically in the days and weeks after her initial hospitalisation.
When she arrived at Hillmorton Dickason underwent a formal mental state examination.
McLeavey said Dickason was underweight and "unkempt" and "looked older than her chronological age".
She was "tearful and sad" and "profoundly hopeless in outlook".
At the start of the interview, she was visibly anxious but that "dissipated" and she was "logical and cohearant with no formal thought disorder".
McLeavey’s evidence continues this afternoon.
McLeavey’s evidence today followed the conclusion Monasterio’s testimony.
He opined while there was no doubt Dickason had a mental illness, it did not extend far enough for her to have a defence of insanity or infanticide.
Further, he found there was no evidence of an altruistic motive and it was more likely that Dickason killed out of "anger and frustration.
"She systematically strangled the children and seemingly methodically checked for vital signs before resorting to smothering them until they were dead," he said.
"The alleged offences are unlikely to have been impulsive.
"In my opinion, as the defendant maintained awareness and behaved systematically, there is no evidence that she was in an automatic state or that she did not understand the nature and quality of her actions at the material time."
Monasterio said as Dickason had battled depression since she was 15, she could not claim her "disease of the mind" was connected to childbirth, thus removing infanticide as a defence.
"She had a history of these symptoms before pregnancy … the depressive disorder … occurred well before the defendant’s pregnancy … the depression was already there before she gave birth, so it cannot be called postpartum," he said.
"It is likely that the effects of pregnancy and adaptation to the demands of motherhood and the care of three young children contributed too - but did not fully account for the defendant’s major depressive disorder at the time of the children’s birth."
"There is no evidence the defendant has an infanticide defence available."
Monasterio was cross-examined at length by the defence who put to him that he "did not like" Dickason and as such his findings had a "bias", that he did not have "a good rapport" with the accused which resulted in her not giving him fulsome information in their interviews and that his conclusions were inaccurate.
This morning he took the stand again briefly to re-state his position during a rebuttal from the Crown.
Monasterio said he "accepts without reservation" Dickason had "continuing fluctuations with mood and anxiety symptoms".
However, on the balance of probabilities, her mood disorder had "remitted" at the time of the alleged murders.
He could not say "beyond a reasonable doubt" that was the case - but that was the job of the jury, not him.
"On the balance of probabilities my opinion still stands," he said.
"The defendant had a relatively high level of functioning in these days (before the girls died). Her mood disturbance was impinging and weighing on her - but she was engaging in complex tasks that required attention and concentration.
"She had sufficient capacity to appreciate what was occurring at the time of the alleged offence - therefore on the balance of probabilities the defence of insanity is not available."
Monasterio reiterated there was no evidence in his opinion of an altruistic motive - where a parent kills a child out of love and fear of what will happen to them if they continue to live.
The defence has told the jury Dickason’s case is a clear example of this.
"For an altruistic motive there has to be a sufficient concern that the children needed to be killed in order to spare them the suffering of living... I have found, in particular through social media communications... no evidence of that.
"I accept the defendant has provided motive of altruism to other experts - but to me she did not give an account that would justify that position."
He said it was not his role to decide on Dickason’s fate, just to give his professional opinion.
"Ultimately the position sits with the jury… and not with me," he said.
The trial is expected to run for at least another week.
SUICIDE AND DEPRESSION
Where to get help:
• Lifeline: Call 0800 543 354 or text 4357 (HELP) (available 24/7)
• Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: Call 0800 376 633 or text 234
• What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
• Depression helpline: Call 0800 111 757 or text 4202 (available 24/7)
• Helpline: Need to talk? Call or text 1737
If it is an emergency and you feel like you or someone else is at risk, call 111
