How Bondi killer fell through the cracks
How Bondi killer Joel Cauchi fell through the cracks of the country's mental health system after managing schizophrenia for nearly 20 years before he was 'lost to follow-up' will be probed during an inquest into the fatal attack.
Cauchi, 40, killed six people and stabbed another 10 during a stabbing rampage at Westfield Bondi Junction on April 13, 2024.
Dawn Singleton, Yixuan Cheng, Faraz Ahmed Tahir, Ashlee Good, Jade Young and Pikria Darchia died in the incident.
Cauchi was diagnosed with schizophrenia when he was 17 and was medicated for more than a decade to treat the condition until he stopped taking all psychotropic medication in 2019.
His mental health treatment is being probed over the five-week coronial inquest.
Counsel assisting the coroner Peggy Dwyer SC earlier noted that most people with schizophrenia 'will never commit an act of violence'. Joel Cauchi was diagnosed with schizophrenia when he was 17. Supplied Credit: Supplied
Cauchi was treated in the public system in Toowoomba from 2001-2012 until he was transferred to the care of a private psychiatrist, known as Dr A.
Cauchi saw the psychiatrist about once a month, and his dose of clozapine was gradually reduced while under his care until he stopped taking it in June 2018.
The court was earlier told Cauchi was concerned about over-sedation, and the decision to stop taking clozapine was supported by a second opinion from a psychiatrist in 2015 who had treated Cauchi in the public sector.
Cauchi then stopped taking abilify in 2019, meaning by June of that year he was not taking any psychotropic medications.
'In Mr Cauchi's case, his cessation of treatment unfortunately coincided thereafter with him exiting the mental health system altogether. He was effectively lost to follow-up from early 2020,' Ms Dwyer earlier told the court.
She said evidence suggested Cauchi's mother, Michele, had raised concerns several times with a Toowoomba clinic about her son hearing voices and writing notes he was 'under satanic control'.
Dr A gave him scripts for abilify and rexulti in November and December 2019. Bondi stabbing victims (top l-r) Dawn Singleton, Ashlee Good, Cheng Yixuan, (bottom l-r) Faraz Tahir, Jade Young and Pikria Darchia. Credit: Supplied
However, Cauchi didn't take it due to side effects, and Dr A left it up to Cauchi to decide whether to take the prescribed medications.
Cauchi moved to Brisbane in 2020 and unsuccessfully tried to join a Skype session with Dr A.
When the clinic discovered he'd moved to Brisbane, they believed he wasn't eligible for Medicare Skype appointments or nursing support.
Cauchi didn't want to attend appointments in person due to difficulties travelling, so the clinic cancelled the appointment.
The court was told staff contacted him over a referral to a Brisbane GP, but he told them he didn't have one yet and would keep them posted.
Dr A then discharged Cauchi into the care of his Toowoomba-based GP, which 'signified a rather sudden end to Cauchi's treatment by Dr A after what had been consistent treatment and attendance over eight years'.
The five-week coronial inquest on Monday is set to hear from Dr A and two nurses from the Toowoomba clinic involved in Cauchi's care.
More to come …
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The Advertiser
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Rather is done by getting enough donations to run an election campaign, even if that means compromising the public good in favour of sectional interests to as great an extent as they can get away with. In that context it becomes the pursuit of power for its own sake, necessitating the duping of many voters as to what they are doing. The Trumpists, the Brexiters, and the Coalition used distraction and blame to exploit the resentment of those who had lost out in the free-trade, economic-rationalist revolution by saying it was the fault of the Washington swamp, the Brussels bureaucracy, and the Canberra bubble - elite conspirators against older, white, male, Christian workers. 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On March 2 this year, I wrote on these pages: "Bulk-billing GPs have borne the brunt of the Coalition's stealth attack on Medicare." "They should have a very substantial catch-up, and in a way that makes bulk-billing pretty much universal," I said. "It would happen more quickly if the government did not just give more to bulk-billing GPs but also reduced the payment to those who do not. "And with specialists, too, there needs to be much bigger incentives to those who bulk-bill and reduced payments to those who do not. "Maybe Medicare payments should cut out altogether when specialists' gap fees rise too much - certainly if they are more than the scheduled fee itself." Last week the independent think-tank Grattan Institute came out with a similar proposal. It suggested that Medicare benefits should not be available to the patients of specialists who charge more than double the Medicare scheduled fee. I do not mention this to give myself a pat on the back, or, indeed, to give the Grattan Institute a pat on the pack. To the contrary, it shows that what I had proposed was hardly original. Indeed, it was the bleeding obvious. A lot of what you might read in this column each week is the bleeding obvious. The dispiriting thing is that government behaviour in Australia is often so bad that the bleeding obvious has to be pointed out again, and again, and again. Capital gains concessions, cash franking credits, negative gearing, tax-avoided trust incomes, superannuation tax concessions for the uber-wealthy, profit-shifting to tax havens; tax rebates on private-health premiums, GST exemptions for health and education enjoyed mostly by the well-off, over-funding of private hospitals and private schools, gambling advertising, food labelling, the sugar tax, exploitation of workers in the gig economy, massive immigration increases, fossil-fuel subsidies, idiotic and ineffectual housing subsidies that fuel the fire, massive investment in inefficient private transport, and the list goes on and on. Solid think tanks, like the Grattan Institute and the Australia Institute, and oodles of my journalistic colleagues, point out the merit of reform in all these areas and more, again and again and again. Yet nothing happens. Why? MORE CRIPSIN: Like most unfairness in Australia, this super problem can be traced back to one government It bespeaks the slow erosion of the way government is done in Australia. And now should be the time to do something about it. This is because nearly all of the items in the list above are legacies from the Howard government and all of them have made access to quality health, education, and housing much less equal and more unfair. Now with the election results declared, the final ironic legacy of the Howard government lies before us. Howard began the systematic process of removing nearly all the moderate people and moderate policies from the Liberal Party, which resulted in the party being unelectable and the country without an effective or constructive opposition. The pews to the left of the nave in Howard's "broad church" have been emptied. With that narrowing to the right, membership of the party aged and shrank, so it had to turn elsewhere for the resources (human and monetary) to underwrite election campaigns in the form of large corporate donations and shadowy organisations like the Exclusive Brethren handing out how-to-vote cards. The price was social and economic policies moving even further to the unacceptable right. To a lesser degree, it happened to Labor as well. To that extent, Prime Minister Anthony Albanese's address to the National Press Club was disappointing. Not because he said that he was reformist, not revolutionary, but because of the suggestion that the winding back any of those Howard agenda items would be "revolutionary" when in fact they would hardly be even reformist - just a return to the centre. The message Labor should get from the election is that, at the very least, the electorate wants an end to the unfair policies and the putting into effect very obvious evidence-based policies to protect people against harm - gambling and sugar, are good examples - all underpinned by more democratic processes. Labor's superannuation changes are an example of how not to do it - just tinkering at the edges while the rorts are left largely intact. Of course, the obvious cause for the policy inertia is the control of the major parties by sectional interests: big employers, big agriculture, fossil fuels, mining, property, big pharma, and the list goes on. It is fine for a major political party to have as its aim the gaining and retaining of power. The trouble now is the way that is done and for what purpose. These days it is not by appealing to what the mass of voters want or arguing a case before the voters so they support it. Rather is done by getting enough donations to run an election campaign, even if that means compromising the public good in favour of sectional interests to as great an extent as they can get away with. In that context it becomes the pursuit of power for its own sake, necessitating the duping of many voters as to what they are doing. The Trumpists, the Brexiters, and the Coalition used distraction and blame to exploit the resentment of those who had lost out in the free-trade, economic-rationalist revolution by saying it was the fault of the Washington swamp, the Brussels bureaucracy, and the Canberra bubble - elite conspirators against older, white, male, Christian workers. But people working in government or academia are much more likely to be on the side of the broad public interest than the real swamp and bubble dwellers - industry lobbyists who slink around the corridors of power promoting the selfish, sectional interests of their masters invariably in a way inimical to the public interest and the environment. Policy should be developed in a more open way, with the public, the Parliament, and the party rooms, and diverse inputs, not hatched in the Prime Minister's office and imposed from the top down. Whether Albanese calls it revolutionary or just reform does not matter. Getting rid of that way of politics would go a long way to making Labor the natural party of government if the Liberal Party continues to go down an unelectable sinkhole with the National Party. Otherwise, voters - who are slowly realising how they have been dudded and by whom - will continue to turn to the independents. On March 2 this year, I wrote on these pages: "Bulk-billing GPs have borne the brunt of the Coalition's stealth attack on Medicare." "They should have a very substantial catch-up, and in a way that makes bulk-billing pretty much universal," I said. "It would happen more quickly if the government did not just give more to bulk-billing GPs but also reduced the payment to those who do not. "And with specialists, too, there needs to be much bigger incentives to those who bulk-bill and reduced payments to those who do not. "Maybe Medicare payments should cut out altogether when specialists' gap fees rise too much - certainly if they are more than the scheduled fee itself." Last week the independent think-tank Grattan Institute came out with a similar proposal. It suggested that Medicare benefits should not be available to the patients of specialists who charge more than double the Medicare scheduled fee. I do not mention this to give myself a pat on the back, or, indeed, to give the Grattan Institute a pat on the pack. To the contrary, it shows that what I had proposed was hardly original. Indeed, it was the bleeding obvious. A lot of what you might read in this column each week is the bleeding obvious. The dispiriting thing is that government behaviour in Australia is often so bad that the bleeding obvious has to be pointed out again, and again, and again. Capital gains concessions, cash franking credits, negative gearing, tax-avoided trust incomes, superannuation tax concessions for the uber-wealthy, profit-shifting to tax havens; tax rebates on private-health premiums, GST exemptions for health and education enjoyed mostly by the well-off, over-funding of private hospitals and private schools, gambling advertising, food labelling, the sugar tax, exploitation of workers in the gig economy, massive immigration increases, fossil-fuel subsidies, idiotic and ineffectual housing subsidies that fuel the fire, massive investment in inefficient private transport, and the list goes on and on. Solid think tanks, like the Grattan Institute and the Australia Institute, and oodles of my journalistic colleagues, point out the merit of reform in all these areas and more, again and again and again. Yet nothing happens. Why? MORE CRIPSIN: Like most unfairness in Australia, this super problem can be traced back to one government It bespeaks the slow erosion of the way government is done in Australia. And now should be the time to do something about it. This is because nearly all of the items in the list above are legacies from the Howard government and all of them have made access to quality health, education, and housing much less equal and more unfair. Now with the election results declared, the final ironic legacy of the Howard government lies before us. Howard began the systematic process of removing nearly all the moderate people and moderate policies from the Liberal Party, which resulted in the party being unelectable and the country without an effective or constructive opposition. The pews to the left of the nave in Howard's "broad church" have been emptied. With that narrowing to the right, membership of the party aged and shrank, so it had to turn elsewhere for the resources (human and monetary) to underwrite election campaigns in the form of large corporate donations and shadowy organisations like the Exclusive Brethren handing out how-to-vote cards. The price was social and economic policies moving even further to the unacceptable right. To a lesser degree, it happened to Labor as well. To that extent, Prime Minister Anthony Albanese's address to the National Press Club was disappointing. Not because he said that he was reformist, not revolutionary, but because of the suggestion that the winding back any of those Howard agenda items would be "revolutionary" when in fact they would hardly be even reformist - just a return to the centre. 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Rather is done by getting enough donations to run an election campaign, even if that means compromising the public good in favour of sectional interests to as great an extent as they can get away with. In that context it becomes the pursuit of power for its own sake, necessitating the duping of many voters as to what they are doing. The Trumpists, the Brexiters, and the Coalition used distraction and blame to exploit the resentment of those who had lost out in the free-trade, economic-rationalist revolution by saying it was the fault of the Washington swamp, the Brussels bureaucracy, and the Canberra bubble - elite conspirators against older, white, male, Christian workers. But people working in government or academia are much more likely to be on the side of the broad public interest than the real swamp and bubble dwellers - industry lobbyists who slink around the corridors of power promoting the selfish, sectional interests of their masters invariably in a way inimical to the public interest and the environment. Policy should be developed in a more open way, with the public, the Parliament, and the party rooms, and diverse inputs, not hatched in the Prime Minister's office and imposed from the top down. Whether Albanese calls it revolutionary or just reform does not matter. Getting rid of that way of politics would go a long way to making Labor the natural party of government if the Liberal Party continues to go down an unelectable sinkhole with the National Party. Otherwise, voters - who are slowly realising how they have been dudded and by whom - will continue to turn to the independents.
The Age
15 hours ago
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Sydney Morning Herald
15 hours ago
- Sydney Morning Herald
Soaring doctor fees are a pain, but medics have another problem
If you have a history of medical mayhem in your family, specialists are part of your life from early on. Sure, you might feel fine. But my darling GPs have a different vibe. Feeling fine means nothing to them. So it is, with still a good six months to go in 2025, that I've nearly reached my safety net. Probably by this weekend, I'll be there. The Medicare safety nets come in when you incur a certain amount of out-of-pocket costs for out-of-pocket medical services. There's a scheduled fee. Then there is what we're really charged. This week, the Grattan Institute released a report which revealed, kind of, the true cost of visiting a specialist in this country. It says 40 per cent of Australians saw a specialist in 2023-2024, and, with government, we spent nearly $9 billion in 2021-2022. More than one in five Australians who saw a specialist in 2023 was charged an extreme fee at least once. Grattan tells us one in 10 Australians who saw a psychiatrist ended up paying $400 in out-of-pocket costs for their initial consultation alone. Grattan has a bunch of excellent recommendations. My favourite would be to strip Medicare rebates from specialists charging excessive fees. And then set the competition watchdog on specialist costs. Perfect. But money is not the only problem. It's the emotional cost, the cognitive load. Decades back, we spent time concentrating on the way doctors dealt with patients. Universities started to interview students based on their interpersonal skills – and choosing them on that basis, as well as stuff they could study for. The Australian Health Practitioner Regulation Agency received more than 11,000 complaints about medical practitioners last year – well up from the year before. About one in six of those complaints is about communication. Whatever universities and specialist colleges are teaching their students about communication, it is not enough. Five out of six in the list of top earners from the Australian Taxation Office are doctors of one kind or another. I'm sure they're happy. I wouldn't mind paying their gaps if I also thought I was getting good service. Clear, open communication. Warm hearts, warm hands. Medical receptionists who are not so overloaded they can't do their jobs properly. (A special shout-out to Anna. You are a gem and so is your boss.) A quick but seriously anecdotal and eavesdroppy survey of the people who shared a waiting room with me last week – people going to the medical receptionist every 20 minutes or so to ask how much longer they would have to wait. My own experience at this practice? Five hours of delay. 'Sorry, the doctor is very busy.' So are the rest of us.
