A coronial inquest has disclosed that approximately 90% of individuals suffering from treatment-resistant schizophrenia who discontinue their antipsychotic medication experience a relapse within two years, as it investigates the mental health and care of Joel Cauchi.
The inquest, scheduled to run for five weeks, is examining the fatal stabbing of six individuals by Cauchi at Westfield Bondi Junction in April 2024.
Cauchi, aged 40 at the time, was responsible for the deaths of Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, injuring an additional 10 people at the shopping center on April 13, before being fatally shot by police officer Amy Scott.
At the time of the incident, Cauchi was not under medication for his schizophrenia, as he had been gradually withdrawn from the treatment by a psychiatrist and was supposed to be monitored, but wasn’t.
During Thursday’s hearing, a panel of psychiatrists provided expert opinions on Cauchi’s care and treatment. Clozapine, a medication known for its severe side effects, is often considered a lifelong treatment for individuals with treatment-resistant schizophrenia due to high relapse rates after discontinuation.
Psychiatrist Prof Olav Nielssen informed the court that homicidal acts committed by strangers with schizophrenia are rare in New South Wales, occurring approximately once every two years. These individuals often have a history of discontinuing medication and experiencing homelessness, which was the case with Cauchi during the Bondi Junction stabbing incident.
Prof Merete Nordentoft, a Danish psychiatrist, commented that while people with schizophrenia seldom engage in serious violent acts, a disproportionate number of homicides are committed by individuals suffering from psychotic illnesses.
Those responsible for harming others usually have delusions, such as believing they are being followed or targeted, and feel the need to protect themselves, explained Nordentoft.
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According to Prof. Nordentoft, clinics in Copenhagen provide support for patients who wish to discontinue their antipsychotic medication, with weekly monitoring for up to 18 months. However, most individuals find that they cannot completely stop their medication.
“The patients actually get a higher level of acceptance that this treatment is needed,” she noted, highlighting the positive aspect of the process.
