The trial of a dad who suffocated his wife and drowned his two children is due to continue today.
Sami Salem, 30, was charged with murder after his family’s bodies were found in their ground floor flat in Falkner Street, Toxteth.
Salem admitted killing his family and dousing the flat in 25 litres of petrol, leaving the gas on and taking an overdose on Tuesday, May 30, last year.
Residents in neighbouring buildings were evacuated over fears of a gas leak, but allowed to return a short time later.
Post-mortem examinations found mum Arena Saeed, 30, was killed by asphyxiation, suffocation and blockage of her airways.
Daughter Shadia, six, died of asphyxia, blockage of her airways and possible drowning, while son Rami, four, died from drowning.
Salem denies murder on the grounds of diminished responsibility, but prosecutors claim there is evidence he was “controlling” Mrs Saeed and suggest the killings were “planned.”
Salem’s brother, Nabeel Salem, told the jury that his brother had been “paranoid and agitated” for weeks before the incident, and had seen a mental health crisis team.
But a friend of Ms Saeed’s, Asrar Alshabi, told police the victim had confided in her about Salem locking her in the flat.
We are due to hear expert psychiatric evidence today.
Case called on
Mr Justice Holgate has returned to the bench and the jury are invited back into court.
Dr Collins is ready on the witness stand and Mr Myers will cross-examine him.
Dr Collins cannot say illness impaired Salem’s judgement
Mr Cole asks:how Dr Collins answers the question as to whether the abnormality of mental functioning substantially impaired Salem’s ability to exercise a rational judgement or self control.
DC: “You cannot highlight a symptom or group of symptoms that directly led to his actions…most of the cases that we see where a person suffering from schizophrenia committed a killing, it is usually fairly clear that the illness has caused the killing.
“And court cases are often uncontested as a result. But this case is unusual in that there is another clear, possible, credible motivation. Therefore you would wish to be that much more clear about the symptoms and their relation to the action. So that highlights the gap for me.”
Dr Collins says that he is unable to assure the court that the test is satisfied, and that Salem’s illness substantially impaired his ability due to a “lack of chain between the illness, the symptoms and the actions.”
Mr Cole has no further questions.
Judge Holgate says he will adjourn for lunch and Mr Myers will begin cross-examining Dr Collins at 2pm.
Salem ‘understood his conduct’
Dr Collins says Salem described “everything being perfect” on the night of the killing.
He said there had been no arguments and he had not experienced “anything unusual.”
DC: “He could not explain why he had killed her on that night, there was no final straw that made me kill her on that night, that’s what he told me.”
Mr Cole suggests that “financial issues” were raised during Dr Collins’ interview of Salem.
He states that Salem described Asrar Alshabi’s account of his wife complaining about being locked in the house was untrue.
DC: “He suggested the untruth lay with her…he didn’t rule out the police being untruthful either.”
Dr Collins says he told Salem he had seen the video, recovered from his phone, in which Ms Saeed had mentioned asking for a divorce.
He says the video appeared to be addressed to her father, and says that Salem replied: “I don’t see what this has to do with her father.”
Mr Cole asks Dr Collins to look at his conclusions as to what motivated the killings.
“It seems to me there is evidence that both could be seen as credible motivations. I have seen other similar accounts of this illness causing people to kill and I have seen other similar accounts of controlling men being driven to killl.”
He suggests it could also be a combination of both.
“It could be the paranoid schizophrenia exaggerating the controlling behaviour.”
He states there “remains the problem” of determining what “relevant contribution” each potential motivation played in the killings.
Mr Cole asks whether the illness could have prevented Salem from understanding the nature of his conduct, one of the limbs of the diminished responsibility defence.
Dr Collins says that schizophrenia is “usually an illness that leaves intelligence intact” and says that Salem’s intelligence is “clearly intact.”
He says that Salem used words like “strangling” and “drowning.”
Dr Collins says his symptoms had the potential to “impair his ability to form a rational judgment or exercise self control,” another element of diminished responsibility.
However he says that Salem has not described experiencing symptoms on the night of the killings.
He says Salem had described feeling paranoia as a result of voices, and says if he felt paranoia about his wife as a result of those voices that would represent an element of his illness contributing to his decision to kill his wife.
DC: “If he was hearing voices patients often describe how they get more insistent and more distressing if you don’t do what they say. And they learn that if you act on them they will diminish for a period before resuming again.
“He does not give an account of that, that would be an example where his self control could be frayed by the insistence and persistence of the voices.
“Another factor that affects self control is that people reach the end of their tether, with the illness, being in debt, a troubled marriage, not being able to go to work. All of that, being a consequence of his illness, may play into ability to exercise self control. But he does not give an account of that.”
Judge Holgate suggests that a patient give an account that does not directly describe that, but is “suggestive” of those factors.
Dr Collins agrees.
Mr Cole asks: “When the defendant killed the victim he was suffering from an abnormality of mental functioning arising from a recognised medical condition.”
Dr Collins says he was, and had suffered from schizophrenia since around November 2016.
“That would have affected his functioning on some level. But his account is it was a particularly good day in terms of his schizophrenia.”
Mr Cole asks: “Does that mean there can be good days and bad days with schizophrenia?”
Salem could ‘resist the voices’
Mr Cole asks Dr Collins whether he asked Salem if he was aware of his wife ever wanting or speaking about a divorce.
Dr Collins says yes and reads a response from Salem recorded in his report: “She never asked for a divorce, it was only in arguments…it was always sorted out. She could have divorced me easily if she wanted to.”
Dr Collins confirms that he diagnosed Salem with paranoid schizophrenia.
He is asked what his assessment was on Salem’s symptoms on the night of the killings.
He says : “On one hand he is saying that voices came between him and his family. On the other hand he is saying that he did not hear any voices on the day in question.”
Dr Collins says that “other factors were relevant” to the killings such as his wife “wanting a divorce.”.
“I would have expected him to experience some symptoms on the night of the offence if his illness played a significant role.
“Some symptoms such as hallucinations tend to be most influential when they are actually present. If you are receiving a command hallucination you are more likely to do it at the time you are hearing it. If time passes, you are less likely to act on it and more likely to resist it.
“If you suffer from delusional beliefs…they are commonly defined as fixed, false beliefs, fixed over time.
“I have carefully not spoken of delusions in this case because while Mr Salem reports quite a lot of paranoia, he had not spoken to me of having fixed beliefs about his wife. So that if you do as a result of your illness develop a fixed belief it will be present over time.
“He would say the voices told me this about my wife, he did not say to me he believed my wife was doing things.”
Dr Collins says in schizophrenia there are commonly both delusional beliefs and hallucinations.
Dr Collins says that Salem appeared to argue against what the voices were telling him, he did not believe them.
DC: “He would say, no, my wife was a good wife and things like that.”
Dr Collins says that in “hours of interview” Salem never discussed with him any delusional beliefs.
Mr Cole suggests that Salem “resisted” the voices, and reminds the jury that Salem had described driving a car and ignoring voices telling him to hit pedestrians.
DC: “He was able to put counter arguments to himself. So he would think I won’t do that, it would be wrong to do that. He was able to think independently of the voices.”
Dr Collins tells the court that Salem said that voices had ordered him to kill his wife in the past, and had resisted them in the past.
DC: “I don’t understand then why he would kill his wife when the voices were not telling him to do it…why was his ability to resist the voices so diminished on the night in question?”
Dr Collins says that if neither voices, nor delusional beliefs were present on the night of the killings he does not understand why Salem would kill his wife.
Mr Cole asks about the killings of the children.
DC: “The voices did speak about harming his children and making his children do things if he didn’t do things to them. But they featured much less in his accounts of his illness, so I struggle even more to tie in killing his children directly to his illness than I do his wife…again I have to speculate why they might be involved.”
“I felt nothing”
Mr Justice Holgate returns to court and the jury are brought in.
Mr Cole rises and calls Dr James Collins to give evidence.
Dr Collins swears the oath and confirms his is a consultant forensic psychiatrist who has been practising since 1992.
He confirms he is based at Ashworth Hospital as a consultant.
Dr Collins says he prepared two reports based on consultations with Salem, as well as a joint report with Dr Rahman.
He says he was in close contact with Dr Croy, who was directly responsible for Salem’s care at Ashworth.
Mr Cole asks Dr Collins to look at the first of his reports.
Dr Collins confirms he obtained a personal and family history from Salem, and had access to his medical history and an account of his drug and alcohol use.
He also had a “psycho-sexual history” and a psychiatric history of Salem.
Mr Cole asks if Salem spoke to him about “hearing voices” and being “aware of shadows and shapes that he went to describe as being a midget?”
He confirms that Salem said he first experienced those disturbances in around November or December 2016.
Dr Collins says that he tried to ascertain the symptoms Salem was suffering around the time of the killings, so that he could determine how big a role his illness played in the killings.
He says he asked Salem about the offence on October 10.
GC: “Did you ask him if he heard any voices? What was his answer?”
DC: “He said he hadn’t…he said he had not seen anything untoward or unusual…he said he had seen nothing.”
GC: “Is that significant?”
DC: “It is in that the symptoms that were present at other times in his illness were not present. The only thing he said was that he felt, I think the word was weird.”
Mr Cole asks him to confirm that he asked Salem to describe the incident.
Dr Collins confirms he took a verbatim account of what happened from Salem.
Mr Cole reads the account given earlier.
Salem begins by describing how he had been off work.
“I was saying to my wife I would come down to sleep. There weren’t any voices at all you know.”
He says he went and bought four bottles of cider and drank them outside the flat.
He says his wife called him and asked where he was.
“That’s when I strangled her. I wasn’t even angry with her, she was a good wife. I went behind her and put my arm around her. When she fell to the ground I got on top of her and strangled her again.
“I felt this weird feeling like I had never felt before…I picked her up and took her upstairs and put her on the bed, I wasn’t crying or anything, I didn’t feel anything.”
He says his daughter woke up.
“I told my daughter to wake up and get in the bath because we were going to Nanny’s…
“I told her to sit down in the bath. I said blow all the air out of her cheeks I have a trick. She did and I pushed her down and I drowned her, I could see blood coming out of her nose.”
Salem says he kissed his daughter on the forehead and carried her upstairs to bed.
He says he went and got Rami from bed.
He says he placed him in the bath, kissed him on the forehead, and pushed him under water.
“I carried him to bed and I spoke to my wife, saying wait for me I’m coming with you.”
He says he smoked cigarettes, ate bread and then went to the garage to get petrol before returning to the flat.
“The last thing I remember is sitting on the edge of the bed with a cigarette butt.”
‘Protective or controlling?’
Mr Cole is now going through Dr Collins’ report and asking Dr Rahman to confirm similarities between what Salem told him and what Salem told Dr Collins.
Mr Cole says in Dr Collins’ interview Salem told him that his wife was “entirely reliant” on him for money.
He asks Dr Rahman to confirm that Salem also denied that he locked his wife in the house and that he restricted her internet access or access to phones. .
Dr Rahman says there are gaps between this account and the evidence of Ms Alshabi, and also the video from Salem’s phone showing him arguing with his wife about phones.
In the video Areena Saeed can be heard to say she wanted to ask her father for a divorce.
GC: “He said he and his wife were happily married didn’t he? When parts of that video were explained to Mr Salem and that his wife made reference to wanting a divorce his response was simply that he did not see what it had to do with her father?”
DR: “That is correct.”
Mr Cole suggests that Salem “consistently denied any monitoring of or control over his wife.”
GC: “He portrayed his marriage as a happy marriage with only the normal ups and downs of any relationships?”
DR: “Yes that is what he also told me.”
Mr Cole suggests that the alternative reason for the killings, suggested by Dr Collins, is that the “defendant’s controlling and possessive nature” contributed to his actions rather than his mental illness. .
DR: “The reality is that Mr Salem’s wife is a recent immigrant to the country. Someone who can’t speak English, so there is a natural isolation from larger society. If the family is protective, that can be portrayed as controlling. My interpretation is probably less negative than Dr Collins’ was, but it is a possibility.”
Dr Rahman suggests that if you are suffering from paranoia you are “more likely to be suspicious of someone’s motives. And we all know that we are suspicious of them then out interactions with them are likely to be difficult.
“The point that I was trying to make is that Dr Collins’ inference, it is a matter of degree really.”
Mr Cole has no further questions.
Mr Myers rises to re-examine Dr Rahman.
He asks him to confirm that it was put to him that the lack of explanation for killing his wife “is a gap that requires speculation.”
Dr Rahman says that if you have schizophrenia your recollection of events is likely to be even more limited.
Mr Myers asks: “Does the fact that Mr Salem has a gap in various part of his explanation require pure speculation on your behalf that schizophrenia is operative?”
DR: “The speculation is a clinical judgment based on reviewing hundreds and thousands of homicide cases. It is speculation indeed but based on that clinical experience.”
“At the end of the day these are all opinions, and in that way they are all speculation.”
Mr Myers has no further questions.
Judge Holgate asks Dr Rahman whether he attaches more importance to his clinical experience with patients or his academic study of cases.
He says a bit of both.
That concludes Dr Rahman’s evidence. He is allowed to leave court.
Judge Holgate excuses the jury for a short break.
“He said I’m sorry, then he drowned them”
Mr Cole asks Dr Rahman to look at Dr Collins’ report.
He says that Salem told Dr Collins that on the night of the killings “everything had been perfect.”
“He said there were arguments and that he had no unusual experiences on the night in question.”
GC: “That’s a gap that requires speculation to fill.”
DR: “It is.”
Mr Cole says Salem told Dr Collins that he had not heard any voices and neither had he had any hallucinations.
DR: “That is what he told Dr Collins.”
GC: “He went on to say he had no idea why he should have killed her on that night..Is that a gap?”
Mr Cole reads from Dr Collins’ report: “(Salem said) There was no final straw that made him kill her as everything was good that night. He denied hearing any voices telling him to kill his wife.”
GC: “These are potentially gaps that can support the clinical view that the mental illness that Mr Salem had played a relatively small or little role in the killings, that’s right isn’t it?
DR: “It is a possibility The reason I formed a different view is we have a number of gaps and contrary to popular belief these are not particularly unusual…I invite everyone in this court to recall what they had for breakfast two weeks ago. Human memory is actually quite fallible. This is what we don’t always take into account.
“In high stress situation the memory is not made properly in the mind in the first place. If the memory is not made in the mind in the first place any future recall will be faulty…
“Research has shown repeatedly the most significant issue associated with violence is drugs and alcohol but the next most significant issue we find in violence is psychosis… That’s my starting point, that’s pretty much accepted research. ”
Mr Cole says that Salem had actually recalled specific things about that night to Dr Rahman.
He asks Dr Rahman to turn to the report of an interview conducted with Salem by Dr Collins in October 2017.
He says Salem gave an account of the offence.
“It was night time my wife had put the children to bed, she came to the living room asking if I was coming to bed as well. I said in a minute. I started feeling weird…
“I don’t want to remember this it’s horrible I know it sounds crazy no one will believe me. It was 2am she was coming up telling me I needed sleep.
I was saying to my wife I would come downstairs. There weren’t any voices you know. I just felt something weird, I didn’t see the midget, I didn’t see anything. In the end I snuck out of the flat and bought four cans of cider.
“When I got in I went to the living room, she came up again. Then he describes strangling her. He then went on to describe in detail what he did to his children. He went on to say he filled the bathtub. His daughter had said something like ‘where’s mum? he said something like ‘she’s asleep what do you want?’ She said I want my mum. He filled the bathtub and told his daughter she needed to go to the toilet and then get in the bath, and then he drowned her.
He then went on to describe going into his son’s bedroom, saying ‘I’m sorry’, and then taking him to the bathroom and drowning him.
GC: “He was giving an account, it was a very similar account to what he said in March?”
Dr Rahman says that when he interviewed Salem, the defendant’s account of what happened had “a lot of gaps” in it.
“They are not necessarily contradictory but they are not the same account.”
‘Difficulty’ explaining murder of the children
Mr Cole asks him to confirm that at the time of the killings both psychiatrists agree that Salem had an abnormality of mental functioning.
He says that the disagreement is whether the abnormality “substantially impaired” Salem’s ability to understand his conduct and form a rational judgment.”
Dr Collins also differs from Dr Rahman’s assessment in whether the abnormality of mental functioning caused or significantly contributed to causing the act of killing.
Mr Cole turns to Dr Rahman’s report, and reads a section that describes Salem as being “polite” but appeared “guarded, fearful and anxious.”
Mr Cole asks what he meant by guarded.
DR: “In that particular context means not being forthcoming.”
GC: “Does that mean being reluctant to answer questions?”
DR: “That is part of it…but you have to look at the whole presentation of the person and I formed the opinion that the guardedness was part of the mental illness rather than anything else really.”
Mr Cole asks him what he meant by describing the case as a “complex case.”
DR: “Just by the fact that there are three victims, there are other issues, there is a short mental illness and other factors.”
GC: “When you say there are three victims does that mean you have concerns clinically about the killing of the children?”
“Contrary to popular belief homicide is a very statistically rare incident in England and Wales; every year there are between 600 and 700 homicides. Statistically it is very rare having more than one victim. When there are three victims it is statistically extremely rare. The starting point with a statistically extremely rare event is that it is not normal in any sense.”
GC: “Do you have difficulty explaining clinically the murder of the two children?”
DR: “I do.”
GC: “It is a problem isn’t it?”
DR: “It is.”
Mr Cole asks whether Salem had difficulty recalling what took place.
Dr Rahman says this is correct.
GC: “You told Mr Myers you had some difficulty believing what Mr Salem said?
DR: “I would not say believe but I had some difficulty because there was a lack of explanation and details.”
Judge Holgate asks Dr Rahman what he meant by saying that Salem was more forthcoming about some things than others.
He asks him to confirm how he attributed Salem’s guardedness to mental illness rather than other things.
Dr Rahman says that when Salem was being guarded, he was being guarded about visual hallucinations such as the chimpanzees.
He says he would ask further questions of the details of his hallucinations.
DR: “When I was probing those questions he was slightly guarded about that, that is typically what you see.”
Mr Cole asks Dr Rahman to confirm that there were gaps in the explanations provided by Salem about what happened.
How big a role did Salem’s illness play?
Mr Cole rises to begin cross examining Dr Rahman.
He asks him to confirm that Salem has been in Ashworth Hospital since being transferred from prison.
He asks Dr Rahman to confirm that he himself is not based at Ashworth Hospital.
Dr Rahman says he is based in a secure unit in Manchester.
However Dr Rahman confirms that Dr James Collins, who will give evidence later, is a senior consultant at Ashworth.
Mr Cole asks him to confirm that his first consultation with Salem was cut short due to Salem’s distress.
Dr Rahman says this is correct.
He confirms that he did not visit Salem between the two consultations in October and March.
Dr Rahman says that his final consultation with Salem lasted around an hour.
Dr Rahman says he did not have access to records from Ashworth hospital relating to Salem between October and March.
Mr Cole asks why.
DR: “There was not time to have the records made available to me.”
He says he asked to see them around March 1, he says by email or phone call.
GC: “In relation to those Ashworth records, did anybody stop you seeing those records?”
DR: “Not really…it is about priority and efficiency.”
He says that his priority in the March consultation was assessing Salem’s fitness to plead and come to court, and says he did not need hospital records for that process.
GC: “You asked to see the records, the records would have been provided to you if you had specifically wanted to read those records?”
DR: “If I felt that it was absolutely necessary to my task.”
He says having had access to Dr Collins’ report, speaking to staff at Ashworth and looking at video evidence from Salem’s phone, he felt it would have been “better but not absolutely necessary” to see the records from between October and March.
Dr Rahman confirms that Dr Collins’ report summarised the records from between October and March.
Mr Cole asks: “In Dr Collins report, he says a case can be made that the illness of Sami Salem played a relatively small or minor role in the actions of Sami Salem, do you agree with that?”
Dr Rahman says he believes the illness played a greater role, but says “it is a matter of emphasis.”
Case called on
Mr Justice Holgate has entered court and Salem is escorted into the dock.
Dr Rahman is ready in the witness box to continue his evidence.
The court usher is asked to fetch the jury.
Jonathan Humphries here, court reporter at the Echo, and I’m back in Liverpool Crown Court for the trial of Sami Salem.
A reminder of the lawyers in the case: High Court judge Mr Justice Holgate presides over the trial, while Gordon Cole, QC, prosecutes.
Benjamin Myers, QC, represents Salem assisted by junior counsel David Toal.
Dr Rahman says Salem also showed signs of delusions of passivity, ie. believing that he was being controlled by someone.
He says that this is not based on Salem’s own description of his symptoms, but on other evidence he has assessed.
Dr Rahman confirms that he believes it more likely than not that Salem was suffering from an abnormality of mental function arising from a recognised medical condition at the time of the killings.
Mr Myers asks if he feels it was more likely than not that the schizophrenia substantially impaired Salem’s ability to understand the nature of his conduct, to form a rational judgment and to exercise self control.
Dr Rahman says it is difficult to separate the three questions, but says it is his opinion that Salem’s judgement was substantially impaired.
Mr Myers: “Was his mental illness the cause or a significant contributory factor to the deaths of the victims?”
DR: “In my opinion yes that’s a significant contributory factor.”
He says that Salem’s recollection is poor.
“My way of looking at it is looking at other possible causes, and trying to see what other clinical evidence we can find to confirm or deny those hypotheses.”
He says he has considered two alternative factors, including the role of cannabis and alcohol and “interpersonal conflict.”
He says he has discounted alcohol and cannabis.
BM: “If somebody is in a schizophrenic condition, what areas of their life will that affect?”
DR: “It will affect all aspects of their life really.”
BM: “In terms of interpersonal conflict, how do you regard the role of schizophrenia as a contributing factor to the relationship between Mr Salem and his partner?”
DR: “It would affect his interpersonal relationship with everyone really. In his particular case…his delusions of a time which is persecutory type, suspicious of other people.”
“From my perspective, there are unanswered questions about his relationship with his wife he gave me descriptions that it was a loving relationship, but there is evidence that there are questions that were unanswered…
“I would be surprised that any marriage is without a problem..I try to think clinically, can there be other situations. I questioned whether there was conflict between them that he was not exposing.”
He says he asked Salem about any problems but Salem did not report any.
Mr Myers: “In your opinion is it more likely than not that schizophrenia was a significant contributory factor in causing the defendant to kill?”
DR: “Ultimately it’s a matter for the jury I must emphasise that…my clinical opinion is yes.”
Mr Myers has no further questions for Dr Rahman.
Judge Holgate says the case will be adjourned until 10.30am, when Mr Cole will begin his cross-examination of Dr Rahman.
Thanks for following, we will return with further live updates tomorrow.
Voices “ordered Salem to hurt wife and children”
Mr Myers asks whether Dr Rahman was aware of Salem’s condition when he was recovered from the flat in Falkner Street.
He says he was, and states that Salem was considered a suicide risk from his arrest.
He says that Salem was placed on suicide watch soon after he was placed in HMP Liverpool.
Mr Myers states Salem is still in Ashworth receiving treatment for schizophrenia.
Mr Myers asks: “Was he suffering from an abnormality of mental functioning?”
DR: “My answer is yes at the time he was suffering from an abnormality of mental functioning…
“In my opinion Mr Salem has suffered from schizophrenia, a recognised medical condition within the mental health act.”
He states that the illness includes symptoms of hallucinations, delusions, and muddled thoughts and thought disorders and changed behaviours.
Dr Rahman lists the symptoms reported by Salem from November 2016 and describes these as indicative of the prodromal (precursor) stage of the disease.
He states it is difficult to say when the illness became full blown.
He says he estimates it would likely have been a few days before he killed Arena, Shadia and Rami on May 30.
Dr Rahman says that Salem had heard “auditory commands to hurt others including his wife and children” before the offence.
He says these voice commands had also urged him to hurt pedestrians.
The voices had also described him in negative terms.
Dr Rahman again describes the hallucinations of a black entity and chimpanzees.
He says “These illusions have an emotional significance to him.”
He says Salem also showed signs of delusions of persecution, including believing that his co-workers were laughing at him.
Dr Rahman says that is evidenced in the witness statement of Salem’s manager at Parcel Force, Brian Robinson.
Mr Robinson visited Salem to check why he had not been attending work. Mr Robinson described Salem asking: “They won’t laugh at me will they?”
“I did not fear death”
Dr Rahman says Salem’s condition had appeared to improve while at Ashworth as medication took effect.
He says Salem experienced nightmares and flashbacks, although it was unclear whether this was related to schizophrenia or to depression or other mental disorders.
Mr Myers refers to Dr Rahman’s account of what Salem said about the killings.
He reads: “Gave minimal description of the alleged offence when I interviewed him at HMP Liverpool.But at Ashworth his recollection was somewhat improved although left a number of gaps in the narrative.
“He recalled on the 29th of May he left for mother’s house…some time after midnight he returned home with his family. After putting the children to bed he had intercourse with his wife…
After that his wife took a shower and went to bed. Mr Salem could not sleep and went upstairs to smoke cigarettes. He left to go to a garage and buy rizlas and bought four cans of lager.
He said he felt as if something was wrong and not right. He received a phone call from his wife seeking his whereabouts. He drank three cans of lager and hid one in a tree before sneaking in. He said he could not remember anything else but added his wife died of suffocation and his kids of drowning.
Dr Rahman says Salem was very distressed when describing this incident, and said he was unable to recall whether he heard any auditory commands to hurt his family.
He says that Salem claimed he could not recall spreading petrol around his house, and said he had bought the plastic container to use on his aquarium.
“He added he did not fear the consequences, he did not fear death.”
Mr Myers asks whether the inability to recall details of the incident “has any relevance to acting in a schizophrenic state.”
DR: “It’s not unusual for people involved in such incidents to be unable to recall…people involved in high stress situations such as killing someone.”
However he states that this applies to people in general, and says it does not specifically relate to schizophrenics.
Salem saw “tall chimpanzees” while in prison
Mr Myers asks Dr Rahman to confirm that Salem heard voices in English in Arabic.
Mr Myers reads from the report “He heard voices saying don’t go into his house because something bad was going to happen. He heard voices instructing him to hurt other people.
“He says one time when he was driving it said, “don’t push the brakes, you can do this.”
Dr Rahman says that his family gave him a present of a mug with his picture on.
“He said this thing represented the black entity. It didn’t want me to be near my family or be happy.”
Salem appears upset and is sobbing quietly in the dock.
Dr Rahman says Salem described seeing a number of “very tall chimpanzees” around his bed when he arrived at HMP Liverpool.
“They would circle his bed and climb on top of each other creating a tall pyramid like structure, and when they reached the roof one would fall and replace the one at the bottom.”
Mr Myers asks Dr Rahman to confirm that Salem was under one to one observation in March 2018.
Dr Rahman says this was due to his risk of suicide or self harm.
“He expressed hopelessness on a number of occasions.”
Salem “observed black entity”
Mr Myers asks how Salem said he felt about his wife.
Dr Rahman: “He said he was in love with her. He said that they had arguments but they never escalated to the level of physical violence….
“Mr Salem expressly denied restricting access to her mobile phone or her travel.”
Mr Myers: “DId he say when he first became aware when something wasn’t quite right?”
DR: “He started noticing that something wasn’t quite right in November 2016, he recalled hearing a voice that didn’t feel quite right. But he didn’t give me more information about that.
He also said he had been observing this black entity for the past year. “
Dr Rahman says this “black entity” is not an unusual feature of schizophrenia.
He says Salem was finding it more difficult to sleep, there was weight loss, inability to relax.
“Even with his family he said he was on edge, he felt as if something bad was going to happen.”
The “Black entity” became more prominent and took the form of an oval or a person.
Dr Rahman quotes a response from Salem: “I used to get crazy feelings, something went wrong. This black thing I have seen before and it didn’t bother me, but now it bothered me quite a lot.”
Mr Myers asks about Salem hearing a voice in November.
BM: “For a person suffering with schizophrenia, how real is it when they hear or see things?”
DR: “The description when we do our training is given as such, there is no subjective difference for the person who is experiencing a true stimulus and an auditory hallucination..you would not be able to tell the difference between a real voice and an auditory hallucination.”
He says that for someone observing a person with schizophrenia it would appear as if the patient is listening to a voice.
Dr Rahman says that all the symptoms he observed in Salem were consistent with schizophrenia.
“Rocking back and forth”
Mr Myers moves on to GP visits following the hospital visit.
The medical records state that Salem reported severe anxiety, low mood, constantly on edge, paranoid thoughts and pacing around the room.
Dr Rahman confirms this is consistent with a diagnosis of paranoid schizophrenia.
Mr Myers moves on to Dr Rahman’s interviews with Salem.
The first was on July 28 in HMP Liverpool.
DR: “He appeared extremely anxious and agitated. He was crying, it took me quite a bit of effort to calm him with the assistance of the main nurse.
“As the interview progressed he was becoming a bit calmer, a bit more settled but he found it difficult to discuss the index offence.”
Dr Rahman says Salem become distressed when his children and wife were mentioned and was unable to complete the interview.
The first interview was one and a half hours long.
Mr Myers asks how Salem presented during the interviews.
DR: “During both interviews Mr Salem stood up from his chair suddenly on several occasions and paced around the room. He was polite, there was no hostility, there was good eye contact.
“He was guarded, he was on edge he became distressed and tearful whenever I mentioned his family. During the first interview he was rocking back and forth on his chair. He was doing this in the second interview, but more so in the first…
“During both interviews he appeared as if someone was talking to him, he appeared distracted…. there was a gap between asking a question and giving an answer.”
Dr Rahman says Salem appeared fairly unwell in HMP Liverpool, and had improved slightly by the time of the interview in Ashworth.
He says when he first saw Salem he had only just started taking an anti-psychotic medication, but the medication would have taken a while to kick in.
He says in Ashworth Salem had been placed on a more effective medication.
That particular medication is prescribed for “treatment resistant schizophrenia.”
Dr Rahman confirms that after taking this medication his condition gradually improved.
Salem “fearful all the time”
Dr Rahman says it is difficult to say precisely, but abnormalities in Salem’s behaviour appear to have become apparent in November 2016.
Mr Myers asks about the visit to the Royal Liverpool Hospital on May 20 last year, 10 days before the killings.
Dr Rahman confirms that Salem saw the mental health crisis team after being taken to the hospital by his brother Nabeel.
DR: “He was anxious and distressed but he displayed no psychotic symptoms.”
He explains that psychotic symptoms include delusions and hallucinations.
DR: “There was concern about his mental state but there was no clear evidence of those symptoms, so he was referred back to his GP at this point.”
Judge Holgate asks if there is a link between psychotic symptoms and schizophrenia.
Dr Rahman says yes, “but often people do not mention psychotic symptoms.”
Mr Myers states that he medical records show that Salem was “so impaired that he could not wait in the waiting room but waited in the car outside until he could be seen.”
Dr Rahman confirms he reported feeling fearful with no obvious trigger.
Mr Myers suggests that Dr Collins has diagnosed Salem with paranoid schizophrenia.
Dr Rahman says that there is not a significant difference between the diagnoses.
Mr Myers: “Is somebody saying they are fearful all the time consistent with paranoid schizophrenia or irrelevant to it?”
DR: “It is consistent.”
Mr Myers reads that Salem was “tearful and distressed” during the visit but was unable to say why.
He reads that Salem also paced up and down.
Nursing staff recorded that he appeared to be developing a mental illness and was referred to his GP.
Mr Myers says that Salem described hallucinations and other symptoms after the hospital visit.
He asks Dr Rahman whether he may have felt those symptoms but not disclosed them/.
DR: “He said to me he did not want to disclose those symptoms because he didn’t want his brother to know the extent of his mental illness.”
He says this is not unusual in psychiatric patients.
Salem “suffers from schizophrenia”
Dr Rahman confirms he also spoke to doctors and staff at Ashworth, and discussed the case with Dr Collins.
He confirms that on the second interview with Salem, on March 13, he was able to view the video recovered from Salem’s mobile phone in which he records an argument with Arena Saeed.
Mr Myers asks Dr Rahman about Salem’s use of substances.
BM: “Did he take any particular substance?”
DR: “So Mr Salem has been very forthcoming about his substance misuse, primarily cannabis but occasionally alcohol as well.”
BM: “Did you conclude that alcohol or cannabis had any part to play in what happened?”
DR: “Not in my opinion.”
Mr Myers asks about Salem’s medical history.
He confirms that Salem attended his GP in 2011 for anxiety related symptoms.
Dr Rahman says that was the only history of Salem seeking treatment for mental health issues until the weeks leading up to the killings.
BM: “By the time you came to assess Mr Salem for the first time, did you find he was suffering from any particular illness?”
DR: “Yes I did…schizophrenia…my opinion was from November 2016 to December time there was a change in his presentation.”
Mr Myers asks him to explain whether in his experience schizophrenia appears “out of nowhere” or whether there is a build up.
DR: “There is a build up.”
Dr Rahman explains there is often a “prodromal” stage before the onset of schizophrenia, or a precursor.
DR: “There were multiple reports of him feeling anxious, having panic attacks which he reported to family members, becoming increasingly isolated. The neighbors have reported some unspecified change in his family life.”
He tells the jury that his expertise includes suicide, self-harm, homicide and mentally disordered offenders in a secure setting.
Dr Rahman says he conducts reports when instructed by defence and prosecution teams, Parole Boards and mental health tribunals.
He says he prepared reports on Sami Salem dated October 2017, and March 2018.
Mr Myers asks him to confirm that he also prepared a joint report with the expert instructed by the prosecution, Dr James Collins.
Mr Myers asks Dr Rahman to confirm his report looked at Salem’s mental health, his fitness to stand trial and the issue of diminished responsibility.
He confirms that he held in mind the law in relation to diminished responsibility.
Mr Myers begins by outlining what material Dr Rahman relied on when preparing his reports.
He confirms he looked at a case summary, medical records from HMP Liverpool, medical records from Salem’s GP appointment on May 22, and records relating to Salem’s hospital visit on May 20.
Mr Myers confirms that Salem was transferred from HMP Liverpool to Ashworth Hospital on September 12 last year.
Dr Rahman says he had access to medical records from Ashworth up until his second assessment of Salem in October.
Mr Myers asks him to confirm that Salem was on the hospital wing of HMP Liverpool when he first interviewed him in July
“Abnormality of mental function”
Judge Holgate says before the experts give evidence, he will give legal directions on diminished responsibility.
He says this will make it easier for the jury to follow the expert evidence and consider the relevant issues.
Judge Holgate tells the jury that to acquit the defendant of murder, the jury must be sure on the balance of probabilities “that it is more likely than not” that Salem was suffering an abnormality of mental function at the time of the killing.
He says they must also believe that the said abnormality arose from a recognised medical condition, and that it substantially: a) impaired the defendant’s ability to understand the nature of his conduct, b) and/or form a rational judgment, and c) and/or exercise self control.
The judge also says the jury must be sure that the abnormality of mental function explained the act of killing.
Mr Myers rises and calls Dr Mohammad Rahman to give evidence.
Dr Rahman takes to the witness stand and is sworn in .
He confirms he is a consultant forensic psychiatrist and outlines his qualifications.
Salem will not give evidence
The issues are dealt with and the jury are escorted into court.
The members of the jury take their seats and Judge Holgate explains to the jury that Salem will now formally enter guilty pleas to the charges of manslaughter on the grounds of diminished responsibility.
He says this is simply to formalise Salem’s admissions of unlawful killing, which they have already heard.
The clerk asks Salem to stand.
She reads the charge that he murdered Arena Saeed and asks Salem how he pleads.
Mr Toal, junior counsel for the defence, stands by the dock and assists Salem through the process.
Salem replies, in a low voice: “Not guilty to murder, but guilty to manslaughter on the basis of diminished responsibility.”
He makes the same response for the charges of murdering Shadia and Rami.
Judge Holgate now asks Mr Myers whether Salem will give evidence.
Salem has declined to give evidence in the trial.
The court hears the next witnesses will be psychiatric experts.
Case called on
Mr Justice Holgate has entered court and the Sami Salem has been escorted into the dock.
He addresses counsel on legal matters ahead of the jury being brought into court.
“My husband treats me nicely”
Mr Myers, defending Salem, rises to cross-examine Dr Rodgers.
He asks Dr Rodgers to clarify that the skin slippage due to contact with petrol was after death.
Dr Rodgers says that the contact with petrol was “definitely after death.”
Mr Myers has no further questions and is excused from court.
Mr Cole asks for some documents and photos to be handed to the jury.
The images show the inside of a washing machine inside the family flat in Falkner Street, where a knife and rolling pin were found wrapped in washing.
Further photos show the living room area, showing a fish tank and a plastic container.
Mr Cole moves on to read some pieces of evidence agreed between the prosecution and defence, known as agreed facts.
He tells the jury that the defendant admits that he unlawfully killed his wife, Arena, daughter Shadia, and son Rami.
Mr Cole says Salem also admits that he intended to kill his family at the time, and that he admits manslaughter.
He says it is agreed that the main issue the jury must consider is whether Salem was of diminished responsibility.
Mr Cole tells the jury that a whatsapp message was recovered from Arena Saeed’s phone, sent to her friend Asrar Alshabi.
It read “My husband is treating nicely and I don’t know how to treat him in the same way.”
He says that there was no internet router in the family flat, and that Arena would access the internet by tethering her mobile phone to Salem’s phone.
Mr Cole says that the bodies were recovered from a front bedroom, and were lying next to each other on the bed, fully dressed.
He says the bathroom floor was very wet when paramedics and police attended.
Mr Cole says Salem was arrested at the hospital on suspicion of murder.
He says that in all his police interviews Sami Salem exercised his right to remain silent when asked questions.
Mr Cole says that is all the evidence the prosecution wish to call apart from the psychiatrist.
Judge Holgate says there are legal issues which must be addressed before the next stage of the trial goes ahead.
The jury are excused until 2pm while the matters are clarified.
Rami died by drowning
Mr Cole asks Dr Rodgers to move onto the post mortem of Rami, who was four when he died.
Again Dr Rodgers confirms there was no evidence of natural disease that could have contributed to Rami’s death.
He says that it is not possible to conclude which child died first.
He says that skin slippage was also present on Rami, who was wearing coloured pyjamas.
He suggests that the slippage was likely to have been caused by exposure to petrol.
He says the petrol caused the colour from the pyjamas to leak and stain his legs.
Dr Rodgers suggests this would have been contact with liquid petrol, rather than merely petrol fumes.
Mr Cole asks about any hemorrhages in Rami’s face.
Dr Rodgers says in Rami’s case there were no bruises or hemorrhages at all in the face, but he says there was a prominent white froth present in his mouth and airways.
He says that the examination of Rami’s lungs showed similar findings to Shadia, although more prominent.
Mr Cole asks whether Rami’s hair was wet.
DR: “Yes his hair was wet and his pyjama top was wet, due to water not due to petrol.”
Dr Rodgers says that Rami’s hands were wrinkled as if they had been underwater for a period of time.
He says in Rami’s case the cause of death was recorded as drowning.
Mr Cole has no further questions
Shadia may have been both drowned and suffocated
Dr Rodgers says there were no bruises to Shadia’s face and neck.
He says there were tiny abrasions on the nostril.
He says there were small, fresh bruises to the upper right arm and back of the right elbow.
Mr Cole asks about the fact Shadia’s hair was dry.
DR: “The hair was dry, and if you’re proposing that someone drowned why was the hair dry.”
He suggests the findings are extremely subtle.
He says while the internal findings suggested drowning, the petechial hemorrhages are not usually associated with drowning.
DR “There may have been an element of external airway obstruction, so hand on mouth. There are internally clear features to suggest drowning in my view, but it is difficult to determine exactly what the main cause of Shadia’s death was and it may have been a combination of factors.”
He says the cause of death was recorded as asphyxia caused by external occlusion of the airways and possibly drowning.
GC: “THere are features consistent with drowning, and there are features consistent with asphyxia?”
DR: “There are elements of both.”
Mum killed before children
Dr Rodgers says in Arena’s case rigor mortis, the stiffening of limbs after death, was not present.
In the little boy Rami and girl Shadia, there was still the presence of rigor mortis.
He suggests this shows the mother was killed before the two children, but it does not give any other reliable indicator of time of death.
Mr Cole asks Dr Rodgers to move onto the post mortem report of Shadia, aged 7.
Again Dr Rodgers confirms disease was not a contributory factor in Shadia’s death.
He says as well as rigor mortis, there was evidence of “skin slippage” in her case, which is when the outer layer of skin begins to peel away after death.
Dr Rodger says a substance similar to petrol was found in Shadia’s blood.
He says he thinks this had been ingested after death, and was a level low enough to suggest that Shadia had not been exposed to fumes before her death.
Dr Rodgers says that Shadia’s long, thick hair was dry.
He says there were scattered petechial hemorrhages on Shadia’s eyelids, eyes, and the right side of the face.
He says these hemorrhages were “poles apart” in terms of prominence compared with her mother, and that in Shadia’s case they were not as obvious.
Dr Rodgers says there was a white froth in the mouth.
He says the diagnosis of drowning is difficult, because the changes are subtle, and is even more difficult in children.
However he says in bodies pulled from water recently, without CPR, a classic sign is the presence of a “froth plume” in the mouth and nose.
Mr Cole says the internal examination of the lungs showed that Shadia’s lungs were over-expanded and full of fluid.
They were also “crepitant” meaning the tissue would crackle if squeezed.
He says those features are all associated with drowning.
Salem “suffocated Arena with his hands”
Mr Cole asks him to confirm there were no injuries to the bone.
He asks Dr Rodgers to explain facial congestion.
DR: “That’s the pink purple intense discolouration in the face, you can get facial congestion for many reasons…in this case the congestion is due to compression change,s, either compression to the neck which we don’t think was a factor in this case, or obstruction of the airway.”
He explains that petechial hemorrhages are pinpoint bruises that occur in cases involving suffocation or compression of the neck.
Mr Cole asks him to give his view on the mechanics of what caused those injuries.
DR: “So the presence of asphyxial v is either going to be external obstruction of the airway or compression of the neck, in other words strangulation. IN this case there were no classic finger tip bruises to the neck there were no scratches at the neck from the victim trying to claw hands away, there were no injuries to the tiny muscles insides, and the hyoid and thyroid horn bones were uninjured…
So I did not think the asphyxial hemorrhages were from strangulation in this case.”
He says the subte bruises to the jaw, the injuries to the lips.
“Taken all together that is almost classic obstruction of the airways from a hand.”
He says the injuries to the lips and the face are indicative of Ms Saeed moving around after a hand was placed over her mouth.
Dr Rodgers says she may have lost consciousness quickly.
“In reality this could have gone on for a number of minutes, but it is very difficult to say.”
Dr Rodgers says the cause of death is asphyxia due to suffocation, due to manual occlusion of the airways.
Arena Saeed’s face was “deep purple”
Mr Cole asks Dr Rodgers to look at a section of his report where he outlines his conclusions on the death of Ms Saeed.
Dr Rodgers confirms at the time of Ms Saeed’s post mortem he was aware of the death of Shadia and Rami, the arrest of Sami Salem and the fact that petrol and medications had been found at the scene.
Mr Cole asks him to confirm there were no signs of natural disease that could have contributed to the cause of death.
Dr Rodgers confirms this, and also that Ms Saeed had not been administered any noxious substances.
Mr Cole asks him what his findings were.
Dr Rodgers: “What I found was mainly marks and injuries to the head. There was nothing to the upper limbs. Sometimes in violent deaths one can see defensive injuries…but there was nothing..
“What was present was that the face was intensely congested. In the initial examination the face was purple apart from some areas of pallor, some areas of white skin.
“If you for example press against a part of your body really firmly it will go white as the blood is pushed out of the capillaries…sometimes that pallor can remain.”
He says the pallor was most prominent around the nose and mouth, and contrasted with the “deep purple and pink congestion” around the rest of the face.
Dr Rodgers says that there were injuries around the lips and mouth of Ms Saeed, indicating her lips had been pressed.
He states there was some bruising on the left angle on the jaw, and there were petechial hemorrhages on the face.
Mr Cole asks if there was any internal bruising associated with the petechial hemorrhages.
Dr Rodgers says there was bruising beneath the skin on the jaw and on the neck.
The legal issue has been considered and the usher is asked to bring the jury into court.
The members of the jury take their seats and Mr Cole stands. Mr Cole begins by calling Dr Brian Rodgers to the witness stand.
Dr Rodgers is sworn in.
Mr Cole asks him to confirm his name and the fact he works as a Home Office pathologist.
Dr Rodgers says he has practised as a Home Office pathologist for around 20 years.
Mr Cole explains that when somebody dies in circumstances that require further investigation, the coroner instructs a Home Office pathologist to conduct a post-mortem exam.
Mr Cole asks Dr Rodgers to look at reports from the post mortem of Arena Saeed, which took place on May 31, 2017, at the Royal Liverpool Hospital.
Mr Cole asks him to confirm that he was provided with a history of the case as the police understood it to be at the time of the post-mortem.