Court will resume 10am Monday - and so will our live updates.

Defence lawyer Ron Mansfield returns to the account of Hanna's good presentation and how she was outwardly cheerful in manner.

She sounds vivacious and someone who wants to give a good appearance, says Neilssen.

People with those qualities often conceal the fact of their being depressed, he says.

In the circumstances of what's known about Hanna's mental health, you've got chronic thoughts of suicide you keep to yourself, and a combination of alcohol and Zopiclone, plus trigger events like work related stress and bereavement, the witness says.

The decision, following what Neilssen says was "unusual behaviour" like taking items to the tip, could have been unplanned, he says.

"My guess is that it would have been impulsive rather than something that would have been planned."

Neilssen says impulsive unplanned suicides frequently come up in his work.

That ends the psychiatrist's evidence-in-chief. 

He will return on Tuesday for cross-examination by the prosecution. In the interim, the defence will call other witnesses on Monday.

Justice Lang calls it there for the day. Court will resume 10am Monday.

He's reviewed a couple of cases of suicide in health managers in Australia, where it was a surprise to their colleagues. Hanna was a senior DHB manager with a high level role in the Covid vaccine rollout.

Neilssen says being a perfectionist makes you more vulnerable to depression.

He says the medical notes from time to time mention depression, but the medical notes showed the fluoxetine was continually prescribed.

Suicides may not be planned, Neilssen says. They can be decided in the moment.

What about the stresses of a demanding job? asks Mansfield.
Neilssen says the risk factor for high performing people is professional disgrace or failure.

The trial heard earlier Hanna told family she was worried she would be linked in the media to a botched procurement of PPE early in the Covid pandemic.Bereavement is also a risk factor, he says. (Hanna's mother died a couple of months before Hanna was found dead. And the alleged suicide attempt described by her sister Tracey happened after her father died, the jury heard earlier).

Neilssen says only 30 to 40% of people leave suicide notes.

"The minority actually leave a note."

Mansfield references Hanna having reported thinking about suicide around Christmas 2019.

Neilssen says the notes record she had considered driving head on into a truck. She had been referred to a mental health team and had given an undertaking she would see a psychologist.
Did you see any evidence of her having seen a psychiatrist or psychologist on any long term basis?

No, says Neilssen.

The ideation of suicide reported to her GP and the crisis team, do we need to take that into account when considering if there are suicidal risk factors for Hanna? asks Mansfield.

Definitely, says Neilssen.

Someone who has self-harmed previously is 100 times more likely to try commit suicide again.

"We've got to bear in mind suicide is a rare event."

Mansfield then references the previous suicide attempt alleged by Tracey Hanna.

"It does suggest that she is in a higher risk group," says Neilssen.
Then we've got the work pressures and the cocktail of drugs and alcohol, says Mansfield.

Neilssen  agrees they are risk factors too, as was the recent death of her mother Fay, to whom she was close.

Mansfield says, so just that we're very clear, you can't and you don't attempt to tell us whether Hanna did commit suicide?

Neilssen  agrees, and confirms he's just here to speak about the factors that "very greatly increased her risk compared to other people".

Dr Olav Neilssen, a psychiatrist from Sydney, says snippets that have come through from the material he's reviewed suggest Hanna was very perfectionist. 

Her personality seemed to really conceal her underlying mood, she doesn't want to show distress to other people and wants to show a good outward appearance physically and professionally, the witness says.

Mansfield asks if that despite these public appearances, whether the public appearance in itself is an indicator or not of suicide risk.

"It's very common for it to come as a complete surprise, particularly to work colleagues," Neilssen says.

While unsuccessful people are more likely to commit suicide, high achievers can also take their own lives, he says.

"Successful people do commit suicide too."

"It's less common among successful people ... but it still occurs."

The typical sleep pattern of heavy drinkers is to fall asleep in front of the television and then wake up a couple of hours later and not be able to get to sleep. That would cause you to reach for the Zopiclone, he says.

Alcohol and Zopiclone combined are "more than additive", he says Neilssen says that's what causes people to wake up in cable ties after a long flight.

"You can become quite uninhibited," he says.

Alcohol and Zopiclone combined have an "acute disinhibiting affect".

The combination of Hanna's chronic depression and the combination of Zopiclone of alcohol  "are very dangerous for suicide" says Neilssen.

Hanna was also taking the Zopiclone prescribed to her husband, and had been taking it for at least six months, as shown by the analysis of her hair sample, Mansfield says.

Neilssen says Zopiclone works on the Benzodiazepine receptor, and is designed to help people fall asleep.Is it a drug you can get used to?

Yes, says Neilssen, you can develop tolerance to all sedatives.

Phentermine, the amphetamine diet drug, should only be prescribed for three months, but Hanna's GP, who has interim suppression, said that was just on paper and long-term use could be fine. 

That was rejected by Neilssen.

"It's got a whole bunch of worrying side effects, foremost of which is depression," he says.

She had clearly developed a tolerance to it after a decade of chronic use, Neilssen says.

Hanna was also on weight loss medication, including one which was then removed from the market. 

It was replaced with phentermine about 2010, which Hanna then began taking.

"Look it's basically an amphetamine," says Neilssen of Phentermine.

How would the phentermine interact with fluoxetine? asks Mansfield.

"It's not a very good practice I would say," says Neilssen.

There's a contra-indication, because phentermine can cause serotonin syndrome, which can cause a dangerous state where people can become confused and die.

"This is what kills young people at music festivals," says the psychiatrist.

How would the cocktail of drugs she was taking with alcohol affect her?

Neilssen says the phentermine was the worst of them, which could cause a long term depletion of serotonin and noradrenaline leading to depression, the effect of long term amphetamine use.

That would render the anti-depressant fluoxetine she was taking ineffective.

Defence lawyer Ron Mansfield is questioning Dr Olav Neilssen, a psychiatrist from Sydney.

Mansfield asks if he can help the court with Hanna's "known psychiatric disorders".

Neilssen says she definitely had an alcohol use disorder, though it may have lessened in recent years. A bottle of wine a night for over a decade, as she described around 2013, was a hazardous level for a woman.

Mansfield asks what hazardous means. "The proper definition is someone who drinks more than their doctor," the witness says to laughs from the gallery, but clarifies that for women it's over two to three drinks per night regularly.

A bottle of wine is about eight standard drinks, he says.

How does alcohol affect other mood disorders? asks Mansfield.

Neilssen says alcohol is excellent at relieving anxiety, until it wears off, when anxiety worsens.

Mansfield returns to the alcohol intake in light of her treatment for depression and anxiety.

Can you help us with the impact of alcohol consumption on depression and anxiety? asks Mansfield.

Everybody who drinks will have anxiety as alcohol wears off, says Neilssen.

Alcohol is a neurological depressant and most people feel lower in mood when they're drinking heavily, the psychiatrist says.

Neilssen says Hanna was on fluoxetine (aka Prozac) for about 20 years.

Using alcohol with that medication renders them less effective, he says.

"It's just an arm wrestle with the alcohol winning."

She was prescribed naltrexone and at times Disulfiram (antabuse) to treat alcohol use disorders, Neilssen says. There was also a prescription for diazepam to mitigate withdrawal symptoms.

Might it be relevant, asks Mansfield, that Hanna had consumed alcohol (red wine) the night before she was found dead in the morning?

Yes, says Neilssen.

There was an empty bottle of Pinot Noir, Hanna's favoured drink, and an open bottle of Shiraz she had also drunk from, the trial hears again.

The alcohol renders the anti-depressant medication ineffective, countering any beneficial effect from her long term use of fluoxetine, Neilssen says.

Dr Olav Neilssen has a Master of Criminology and a PhD from the University of Sydney.

He's a consultant psychiatrist and also does work with the homeless.

Neilssen also teaches medical students at Macquarie University.

Defence lawyer Ron Mansfield is required to run through the CV of expert witnesses.

Neilssen has a particular professional interest in depression and suicidal risk. He says he's published about 40 papers on suicide, and it's a big part of his work with the homeless.

He confirms he's aware of the Crown case against Polkinghorne, and has reviewed his April 5, 2021 police interview transcript, the date his wife died.

He's also reviewed the toxicology report and has heard the "Longlands Recording" where Hanna speaks about issues in her marriage with close family members.

In addition, he's looked at some medical notes from Hanna's GP and prescription details.