Bondi Junction inquest told most people with treatment-resistant schizophrenia relapse without medication
About 90% of people who have treatment-resistant schizophrenia and discontinue their antipsychotic medication relapse after two years, a coronial inquest has heard amid a probe into the mental health and care of Joel Cauchi. The inquest, scheduled for five weeks, is examining the fatal stabbing of six people by Cauchi at Westfield Bondi Junction in April 2024. Cauchi, then 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and injured 10 others at the shopping centre on 13 April last year before he was shot and killed by police officer Amy Scott. At the time, Cauchi was not medicated for his schizophrenia, the coroners court has heard. He had been weaned off medication by a psychiatrist and was meant to be monitored, but wasn’t. On Thursday, the inquest heard from a panel of psychiatrists who provided expert opinions on the care and treatment of Cauchi. The court heard that Clozapine – which can have severe side effects – was generally considered a life-long medication for people with treatment-resistant schizophrenia due to a high relapse rate of 77% after one year and 90% after two years for those who stopped taking it. Psychiatrist Prof Olav Nielssen told the court that homicide of strangers by people with schizophrenia was rare, with one occurring in New South Wales about every two years. He said a “feature of that small group” was having gone off medication and homelessness. Cauchi was unmedicated and homeless at the time of the Bondi Junction stabbings. Prof Merete Nordentoft, a psychiatrist in Denmark, told the Sydney court: “Most people with schizophrenia will never commit an act of serious violence, but a disproportionate number of homicides are committed by people with psychotic illness.” Those who do harm others, Nordentoft said, usually had delusions including thinking they were “being followed and somebody is trying to harm you, and therefore you need to protect yourself”. She said in Copenhagen there were clinics that supported patients who wanted to come off anti-psychotic medication. The patients had weekly monitoring for 18 months. But, the psychiatrist told the court, most people found they couldn’t completely end their medication. “The patients actually get a higher level of acceptance that this treatment is needed,” she said, noting the process had a silver lining.
