A nurse at the Queensland medical practice where Joel Cauchi was treated for schizophrenia remembers him as a “compliant” and “diligent” patient, telling an inquest she vomited when she learned he had fatally stabbed six people at a Sydney shopping centre.
Cauchi, 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 Westfield Bondi Junction on 13 April last year before he was shot and killed by police inspector Amy Scott.
Cauchi was treated at a private Queensland clinic from 2012, after being discharged from the public health system after 11 years in its care. Known only as RN2, the mental health nurse said she saw Cauchi on a monthly basis from 2015 to 2017, when she monitored his psychotropic medication for his schizophrenia and OCD.
She learned of the stabbings when she was sent a text stating the Bondi Junction attacker was from Toowoomba.
“I looked it up and then I vomited when I saw it was him,” she told the court.
“It’s odd, it’s incongruent with what I know of Joel. It really doesn’t make any sense.
“I was incredibly shocked. I wouldn’t have ever thought that was something that he would have done. I had a very visceral response to that.”
In the third week of the five-week inquest into the seven deaths, the Lidcombe coroner’s court was exploring why Cauchi was weaned off psychotropic medication and how he dropped out of the mental health system from 2020.
RN2 said Cauchi was “someone who was very compliant … He was never even late for appointments and there was no having to chase him up, he was very compliant.
“I actually thought he was relatively insightful and he was also concerned about his illness in that he was quite diligent in monitoring for signs of relapse. He didn’t want to get unwell and he was very conscientious with regard to his mental health. I think that was evidenced by his punctuality and engagement with our service,” the New South Wales coroner, Teresa O’Sullivan, was told.
“He had anxiety around it,” RN2 said, adding that Cauchi “wanted to get the support and do the right thing”.
Cauchi had been prescribed Clopine (clozapine), indicating that he had treatment-resistant schizophrenia, she said.
“That obviously meant that his condition was quite severe. However, because he was so compliant, he wasn’t difficult to manage and he was stable as well.”
Cauchi’s treatment plan was to reduce the Clopine to the most effective level relative to the side effects – such as cognitive “fuzziness” and sedation – as opposed to ceasing the medication, the court heard.
Cauchi’s medical notes from early 2016 showed he was “easier and more relaxed” on a lower dose of Clopine. The nurse said she saw an improvement in his energy levels and “more quality of life” and did not have any concerns about his medication being lowered.
The nurse left the practice and returned in 2019, by which time Cauchi had stopped taking Clopine altogether. She said she had never heard of a patient ending Clopine without moving to alternative drugs.
On 14 February 2020, the nurse spoke with Cauchi’s mother after she called the practice expressing her concern about his inability to keep his unit tidy, the inquest heard on Monday.
He was preparing to move to Brisbane at the time. When she broached the subject with him, he would become irritable. Notes from that call were read to the court.
“He can’t seem to look after himself”, the court heard, with dishes in his sink and “mess everywhere”. He was isolated, irritable and occasionally swearing, the practice was told.
“That was out of character,” the nurse said, adding that the concerns may have been due to Cauchi’s developmental delay because of his illness – or early warning signs of relapse.
Cauchi’s transfer of care ‘less than ideal’
Shortly afterwards, Cauchi moved to Brisbane and was discharged from the practice into the care of his GP in the Toowoomba area because he did not have a GP in Brisbane, the court heard.
RN2 recalled a conversation between practice staff suggesting Cauchi’s move from the area and its support network was “less than ideal” but that the team did not have specific concerns.
She said schizophrenia patients – who were often highly disorganised – having to self-manage their transfer to a new psychiatrist via a GP was “not an ideal system”.
Under cross-examination by Sue Chrysanthou SC, the barrister for the families of Young, Singleton and Good, RN2 said the concerns of Cauchi’s mother “needed to be taken seriously” given he could have been falsely reporting his symptoms to the nurse and his psychiatrist.
The nurse agreed that it was inappropriate to go from monthly monitoring to zero care.
When asked whether the practice should have followed up with Cauchi after March 2020 to check he had a new psychiatrist, she replied: “Ideally.
“The best system would be to ensure there was continuity of care,” she said.
The court was shown Cauchi’s discharge letter from the private practice to his GP in March 2020. There was no recommendation for monthly monitoring by his treating psychiatrist.
Chrysanthou asked RN2 if Cauchi showed signs of violence, hallucination, hearing voices or discussed having a knife collection when on medication. He did not, the nurse replied.
The nurse said Cauchi would have had to have been deemed at risk of harm to himself or others to be detained under the Mental Health Act and forced to take antipsychotic medication.
‘I want a totally porn free internet on my devices’
A year earlier, Cauchi’s mental health had rung alarm bells with his mother.
A second mental health nurse – known only as RN3 – who took over Cauchi’s medication monitoring at the private practice in 2018, agreed that Cauchi was in good health in the months after he ceased taking Clopine.
Notes from the practice, shown to the court, stated that in October 2018 Cauchi was “excelling in function, doing more than ever. Gym, looking for a unit, seeing employment agency for work, social activities, etc. Mum is happy with his progress”.
In September 2019, the notes showed that Cauchi was still “doing well” and finishing a Tesol certification but was sleeping poorly.
On 17 October 2019, Cauchi’s mother began to express concerns about a possible relapse. The notes state that other than fatigue and less sleep, Cauchi showed no early warning signs of a relapse.
They discussed Cauchi joining a peer support program to help him transition from home to independent living. Cauchi’s appointments were moved from monthly to weekly contact.
By the next month, Cauchi’s mother was raising significant concerns with the practice about a possible relapse.
His mother said he was writing “a lot of notes at home”, some suggesting he was under satanic control. He had a desire for porn and she had observed a “funny walk” and a “change in his gait”. He wore many layers of clothes to prevent himself from getting sick.
In an email from Cauchi to the practice, dated 12 November 2019, Cauchi acknowledged he wanted to limit his porn exposure: “Can we please cover some ideas for a porn free phone … I want a totally porn free internet on my devices” he requested.
In an email from Cauchi’s mother to the practice on 20 November 2019, she wrote: “I have a feeling he is now hearing voices etc. He is very distracted, forgetful and the OCD is getting out of hand with him going through half a cake of soap in one shower … I would hate to see him have to go back into hospital after 20 years of being stable when on medication … He quite possibly won’t let on what is going on in his head but I think you need to know how he is.”
RN3 said she took Cauchi’s mother’s concerns seriously, but that at that time, she “did not see any obvious signs of psychosis”.
RN3 said she encouraged Cauchi to restart antipsychotic medication, especially if there were early warning signs of relapse. But, the court heard, Cauchi’s father’s mental health history may have affected Cauchi’s approach to treatment.
The practice notes show that Cauchi’s father became adamant that he did not want his son to go on medication “as it will kill him”. He said he had been “traumatised by demons when awake and hears voices”.
In late 2019, Cauchi saw a sex worker, after which he took a month’s worth of HIV medication after becoming concerned about exposure to STIs.
The court heard that after Cauchi moved to Brisbane in March 2020, there was effectively no follow-up. Because he had moved from the Toowoomba area, he was no longer eligible for Medicare appointments over Skype.
“I was surprised that he was discharged,” RN3 said.
Recalling the day after the attack, RN3 said that RN2 called her to share the news of Cauchi’s involvement. “I was quite shocked. I had to … sit down,” she said emotionally.
“My thoughts went to all the people who knew Joel. The Joel we knew was not the person who did what happened on 13 April … We were all very shocked.”
She said Cauchi “continually presented well”.
In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org
