KOTA KINABALU: A consultant psychiatrist told the Coroner’s Court that understanding the background of Zara Qairina Mahathir’s parents, including their relationship before her birth and their roles as caregivers, was an essential component of assessing her mental state before her death.
Consultant psychiatrist Dr Wong Haw Huo said the approach was standard practice in child and adolescent psychiatry, which differs from adult assessments by requiring specialists to examine a child’s developmental history from before birth through adolescence.
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He explained that psychiatrists do not rely on a standardised checklist during interviews but instead conduct structured interviews while observing both verbal and non-verbal responses through the Mental State Examination (MSE).
“The way a psychiatrist asks questions is like an art. There is no so-called ‘checklist’ of what to ask or how to ask because we are trained in our professional training,” he said when questioned by counsel Nurul Rafeeqah Abdul Mutolip, representing Zara’s father.
Dr Wong said it was mandatory in child and adolescent psychiatry to understand the parents’ background, even before the child was born, in order to assess attachment, emotional support, family dynamics and the child’s developmental environment.
“So, it is very important for us to understand who her parents are, or if not the parents, who the main caregiver is.
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“Through understanding the caregiver and their background, even before their marriage, we can understand the psychological aspects, their potential temperament, personality characters, and then we can assess the type of attachment, bonding, emotional support, physical availability, and even financial commitment to fulfil Zara’s basic needs.
“So, it is a mandatory need for us to interview the parents about the time even before Zara was born into this world, in order to make sure we connect each dot in the puzzle to give us a reasonable and clear picture,” he said.
Responding to questions on why observations about Zara’s father were included in the report, Dr Wong said the interview was conducted primarily to obtain collateral history about Zara and to assess the reliability of the information provided.
He said psychiatrists begin assessing a person’s behaviour from the moment they enter the interview room as part of the MSE, observing factors such as punctuality, mannerisms, speech, comprehension and the consistency of responses.
Asked why the report recorded that Zara’s father arrived about 30 minutes late for the interview, Dr Wong said punctuality formed part of behavioural observations that could provide clues about cognitive functioning when considered alongside other findings.
“As we mentioned, this is our psychiatric way of working to assess our patients.
“Being late gives us a clue about cognitive domains and punctuality... We put this theory in our minds and during the interview process, we keep cross-checking whether our hypothesis makes sense,” he said.
Dr Wong rejected the suggestion that observations relating to Zara’s father’s mental state were irrelevant to the objective of assessing Zara’s mental condition.
Instead, he said the observations were intended to determine whether the collateral information provided by the father was internally consistent and reliable.
“The main goal of talking to the father was to get collateral history to understand Zara.
“But when we gathered information, we didn’t just jot down the superficial level. Whatever the father reported, we had to cross-check the consistency and reliability of that factual information.
“So, the Mental State Examination gives us an understanding of whether such information is reliable and accurate. It’s not about a connection between the mental state of the father and Zara, they are two different entities,” he said.
Dr Wong also clarified that references in the report to “clinical impressions” did not amount to formal psychiatric diagnoses of Zara’s father.
He explained that a clinical impression reflected a clinician’s assessment based on observations made during the interview, whereas a diagnostic impression required a comprehensive clinical assessment and confirmation of a psychiatric disorder.
“We were not treating the father as our patient, he was just an informant. So, we put it as our clinical observation or impression. We were not trying to diagnose him,” he said.
