A NSW teenager told her mother, "I think about killing people all the time", and was waiting for a referral to a Sydney psychiatrist before she killed a 10-year-old girl, court documents reveal.
The 15-year-old, who cannot be identified for legal reasons, on Tuesday was found not criminally responsible for the death at a property in Gunnedah, in the state's north-east, last July.
As an acting Supreme Court judge ruled the defence of mental health impairment had been established, police body-worn camera and interview footage revealed the teen's reaction after the incident.
"How do you feel about it?" a detective asked her.
"I don't feel anything about it," she replied.
According to an agreed statement of facts, her mother made an appointment with a GP two weeks before the killing, prompted by a disturbing conversation.
"Mum I want to tell you something but I'm not sure how you will react," the girl said.
"Try me," her mother replied.
The teen said: "I think about killing people all the time".
During the teleconference appointment one week before the incident, a GP noted the girl played "disturbing" video games for hours and mentioned seeing "eyes" and hearing a voice.
She had also spoken of killing chickens at the property.
"The doctor informed [the girl's] mother that some of [her] behaviour was standard teenage behaviour but that it was concerning, and [she] should get assessed by a doctor in Sydney," the agreed facts state.
The GP advised the mother a referral would be sent through and she would receive a phone call, but there had been no call by the time of the killing.
During her police interview, the girl was asked about seeing a Sydney doctor.
"I think it's stupid," she said.
"It's unnecessary and a waste of money."
Evidence from a psychiatric assessor diagnosed the girl with schizophrenia, while a separate psychiatrist found she was suffering acute psychotic symptoms.
Dr Hazel Dalton from the Orange-based Centre for Rural and Remote Mental Health said the main factor hampering access to mental health support in rural areas was a lack of staff.
"Even for the population we serve, we are underdone on the workforce," Dr Dalton said.
She said the need for GPs to often refer patients to city-based specialists increased the likelihood the process would be delayed.
"It just provides more opportunity for communication to drop out and things not to work."
A 2019 policy statement, The Royal Australian and New Zealand College of Psychiatrists described a "severe shortage of consultant psychiatrists in rural and remote Australia."
It argued that there were just 3.4 psychiatrists per 100,000 people in outer regional areas, compared with 15.1 in major cities.
Dr Dalton said research organisations and advocacy groups were realistic in their expectations of how much the situation could improve.
"I don't think we all expect a psychiatrist around the corner," Dr Dalton said.
"What we do expect is some way of bridging the access gap and having local support and specialist support, whatever way that can come."
The teenager will remain in custody.