Latest news with #DrA
News.com.au
22-05-2025
- Health
- News.com.au
Bondi Junction killer threw up ‘red flags' after medication stopped
Joel Cauchi was exhibiting 'red flags' that he was relapsing months after he was taken off antipsychotic medication five years before he went on a horrific rampage through Westfield Bondi Junction, a psychiatrist has told an inquest. An inquest is examining the events that led to Cauchi, 40, killing six people in Sydney's eastern suburbs on April 13, 2024. Dawn Singleton, Yixuan Cheng, Faraz Ahmed Tahir, Ashlee Good, Jade Young and Pikria Darchia died and another 10 were stabbed by Cauchi before he was shot by police. Cauchi, who grew up in Toowoomba in Queensland, was diagnosed with schizophrenia when he was 17 and was medicated until he stopped taking all psychotropic medication in June 2019. His mental health and treatment is one of the issues being probed during the five-week inquest. From 2001 to 2012, he was managed within the public mental health system with psychotropic medication and from 2012 until February 2020 he was treated by a private psychiatrist. The inquest previously heard that his private psychiatrist, known as Dr A, had not sought a second opinion when she decided in 2018 to take Cauchi off clozapine - despite doing so when she had begun to gradually reduce his dose in 2015 after he complained of oversedation. He took abilify to treat obsessive compulsive disorder until he was taken off the medication in June 2019. A panel of five psychiatrists - Professor Matthew Large, Professor Anthony Harris, Professor Edward Heffernan, Professor Olav Nielsen and Denmark-based expert Professor Merete Nordentoft - on Thursday gave evidence to the court about Cauchi's care. The court has heard that in a termination of treatment notice, Dr A described Cauchi as being treated for 'first episode psychosis' and he had no relapse for 'over 16 years'. However, the panel of psychiatrists agreed that it was wrong to refer to him as suffering from 'first episode psychosis' and rather he had a chronic condition. When asked by counsel assisting the coroner Peggy Dwyer whether it was a mistake to initially wean Cauchi off antipsychotic medication, Dr Nielssen told the court: 'Yes, in hindsight'. 'It appears to have been made very much with Mr Cauchi's wishes,' Dr Nielssen said. Dr Large told the court that: 'We are all subject to outcome bias and hindsight bias.' In late 2019, Cauchi's mother contacted his psychiatrist expressing concerns about his behaviour and a possible relapse. She said: 'I have noticed a gradual decline in his condition' and she had a feeling he was 'hearing voices'. She later told one of the nurses at the clinic that he had alluded in a note to being 'under Satanic control'. Cauchi separately emailed the clinic asking to help him arrange a 'porn-free phone'. He had initially agreed to go back on a low dose of clozapine however he later changed his mind. His father Andrew, who the court heard had also suffered from mental illness, was adamant that he did not want his son to go on medication. Professor Nordentoft said there were 'several red flags' which were raised by Cauchi's mother. 'I agree there are several red flags and I think the most important ones are the ones raised by his mother his knows the most about his condition,' Dr Nordentoft said. Professor Heffernan agreed there were 'red flags' and Dr Nielsen said that Cauchi was clearly relapsing at that point. The court was told that the risk of relapse for patients who discontinue anti-psychotic medication was 77 per cent at one year and 80 per cent after two years. While those who remained on medication, the risk of relapse was 10 per cent. The inquest heard details of his teenage years when he developed psychotic symptoms. In 2001, Cauchi's father had to move churches because Cauchi believed he was a prophet. The court was told he went from a scholarship student to experiencing symptoms of psychosis in his final year of school. He was verbally abusive and aggressive and threatened a person that he had a gun in his bag, He was hospitalised in early 2001 after he was damaging doors at home, exhibited auditory and visual hallucinations, was paranoid and believed he had been possessed by demons. The inquest continues.
ABC News
22-05-2025
- Health
- ABC News
Joel Cauchi 'satanic control' claim not taken seriously by psychiatrist, Bondi Junction inquest told
Joel Cauchi expressing feelings of "being under satanic control" after ceasing his schizophrenia medication was "not taken seriously enough" by his treating psychiatrist, a panel of experts has told the Bondi Junction inquest. The five experienced psychiatrists were called on by the court to provide their opinions on the treatment of Cauchi's mental health in the years leading up to the attack at the Westfield shopping centre in Sydney's east on April 13, 2024. WARNING: This story contains content that readers may find distressing. Each doctor agreed Cauchi was experiencing psychosis when he went on a stabbing rampage, killing six people and injuring 10 others before being shot dead by NSW Police Inspector Amy Scott. Psychiatrists Olav Nielssen, Edward Heffernan, Anthony Harris, Matthew Large and Merete Nordentoft were each asked to analyse Cauchi's treatment. This included his first episode of psychosis as a teenager to when he was weaned off all forms of anti-psychotic medication in 2019 by his private psychiatrist, referred to as Dr A. The court heard Cauchi was first admitted to the psychiatric ward of Toowoomba Public Hospital at the age of 17 after he was damaging doors and expressing concerns about being "possessed by demons". Hospital records indicate Cauchi had also threatened someone, claiming he had a gun and had moved churches because he believed he was a prophet. The panel agreed Cauchi's previous cannabis use likely contributed to his early onset of schizophrenia and "certainly made his symptoms worse". Professor Large told the inquest that cannabis "is the most potent and proven cause of schizophrenia". The inquest previously heard toxicology evidence suggested that Cauchi had been using cannabis in the days leading up to the attack. The panel also accepted there were "clear sign" that Cauchi had chronic schizophrenia, including his father's history of psychotic illness and the ongoing presence of symptoms despite being medicated for several years. The inquest heard Cauchi was discharged from the public system in 2012 while on a high dose of the drug clozapine — an anti-psychotic medication only prescribed when two other forms of medication fail to manage symptoms of psychosis. All five psychiatrists agreed that it was "reasonable" for Dr A to reduce Cauchi's dose of clozapine when she first received him as a patient at her private clinic in order to find an "optimal dose" that would minimise the "unpleasant" side effects associated with the drug. But they all disagreed with Dr A's decision to change Cauchi's diagnosis from chronic schizophrenia to first-episode psychosis, because she had assessed that her patient had been "well" for 16 years. Dr A previously told the inquest that she weaned Cauchi off all anti-psychotic medication by 2019 based on guidelines for treating first-episode psychosis, not chronic schizophrenia. The inquest heard that between September 2019 to February 2020, Dr A's clinic received multiple reports about Cauchi's health, which she did not consider psychotic. Those included Cauchi telling the clinic about an obsession with pornography and his mother expressing concerns that her son was writing notes about being "under satanic control". "When you collectively put them together, and I count nine different entries that were entries of concern, either insomnia or his mother suspecting symptoms … a change in behaviour, satanic control," Professor Heffernan said. Professor Nordentoft said the concerns were "not taken seriously enough" and described this period as a "missed opportunity" to put Cauchi back on his anti-psychotic medication. The inquest heard that at this stage, Dr A told Cauchi to restart his OCD medication but that he did not want to, and she didn't believe she could force him to. "And I think this is where a more assertive approach in terms of encouraging restarting medication needs to be considered," Professor Heffernan told the court. "It's very difficult when you have a voluntary patient … to change the course that has been in play for some time, and unfortunately it does involve having some hard conversations." The inquest heard that by mid-2020 Cauchi had moved to Brisbane and had been discharged from Dr A's clinic. On January 8, 2023, Cauchi called Queensland Police, saying his military collection, including "US army knives", had been taken from his room by his father, where a physical altercation then ensued at the family residence. Professor Nordentoft said that if she had been called to this situation as a psychiatrist with knowledge of his background, she would have placed him under involuntary emergency care. "It was a clear message he was psychotic and that he could be of potential dangers to others," she said. The inquest continues.
West Australian
22-05-2025
- Health
- West Australian
Bondi Junction killer threw up ‘red flags' after medication stopped
Joel Cauchi was exhibiting 'red flags' that he was relapsing months after he was taken off antipsychotic medication five years before he went on a horrific rampage through Westfield Bondi Junction, a psychiatrist has told an inquest. An inquest is examining the events that led to Cauchi, 40, killing six people in Sydney's eastern suburbs on April 13, 2024. Dawn Singleton, Yixuan Cheng, Faraz Ahmed Tahir, Ashlee Good, Jade Young and Pikria Darchia died and another 10 were stabbed by Cauchi before he was shot by police. Cauchi, who grew up in Toowoomba in Queensland, was diagnosed with schizophrenia when he was 17 and was medicated until he stopped taking all psychotropic medication in June 2019. His mental health and treatment is one of the issues being probed during the five-week inquest. From 2001 to 2012, he was managed within the public mental health system with psychotropic medication and from 2012 until February 2020 he was treated by a private psychiatrist. The inquest previously heard that his private psychiatrist, known as Dr A, had not sought a second opinion when she decided in 2018 to take Cauchi off clozapine - despite doing so when she had begun to gradually reduce his dose in 2015 after he complained of oversedation. He took abilify to treat obsessive compulsive disorder until he was taken off the medication in June 2019. A panel of five psychiatrists - Professor Matthew Large, Professor Anthony Harris, Professor Edward Heffernan, Professor Olav Nielsen and Denmark-based expert Professor Merete Nordentoft - on Thursday gave evidence to the court about Cauchi's care. The court has heard that in a termination of treatment notice, Dr A described Cauchi as being treated for 'first episode psychosis' and he had no relapse for 'over 16 years'. However, the panel of psychiatrists agreed that it was wrong to refer to him as suffering from 'first episode psychosis' and rather he had a chronic condition. When asked by counsel assisting the coroner Peggy Dwyer whether it was a mistake to initially wean Cauchi off antipsychotic medication, Dr Nielssen told the court: 'Yes, in hindsight'. 'It appears to have been made very much with Mr Cauchi's wishes,' Dr Nielssen said. Dr Large told the court that: 'We are all subject to outcome bias and hindsight bias.' In late 2019, Cauchi's mother contacted his psychiatrist expressing concerns about his behaviour and a possible relapse. She said: 'I have noticed a gradual decline in his condition' and she had a feeling he was 'hearing voices'. She later told one of the nurses at the clinic that he had alluded in a note to being 'under Satanic control'. Cauchi separately emailed the clinic asking to help him arrange a 'porn-free phone'. He had initially agreed to go back on a low dose of clozapine however he later changed his mind. His father Andrew, who the court heard had also suffered from mental illness, was adamant that he did not want his son to go on medication. Professor Nordentoft said there were 'several red flags' which were raised by Cauchi's mother. 'I agree there are several red flags and I think the most important ones are the ones raised by his mother his knows the most about his condition,' Dr Nordentoft said. Professor Heffernan agreed there were 'red flags' and Dr Nielsen said that Cauchi was clearly relapsing at that point. The court was told that the risk of relapse for patients who discontinue anti-psychotic medication was 77 per cent at one year and 80 per cent after two years. While those who remained on medication, the risk of relapse was 10 per cent. The inquest heard details of his teenage years when he developed psychotic symptoms. In 2001, Cauchi's father had to move churches because Cauchi believed he was a prophet. The court was told he went from a scholarship student to experiencing symptoms of psychosis in his final year of school. He was verbally abusive and aggressive and threatened a person that he had a gun in his bag, He was hospitalised in early 2001 after he was damaging doors at home, exhibited auditory and visual hallucinations, was paranoid and believed he had been possessed by demons. The inquest continues.
Daily Mail
18-05-2025
- Health
- Daily Mail
Inside psychiatrist's 'chat therapy' which replaced the powerful drugs that kept Joel Cauchi sane - as she is SLAMMED by experts for taking him off his vital medication
An expert criminologist has slammed the psychiatrist who took Joel Cauchi off his schizophrenia medication - and then told the inquest into the Bondi Junction Westfield massacre that her decision had nothing to do with his deadly rampage. Dr A treated Cauchi for eight years and told an inquest this week that he was not psychotic when he stabbed six people to death. She said his actions were 'likely due to his sexual frustrations and hatred towards women', although she backtracked the following day after her comments sparked anger and disbelief. Now criminal psychologist Dr Tim Watson-Munro has blasted her comments and said she is 'kidding herself' about her 'chat therapy' treatment of Cauchi's condition. The Bondi Junction inquest has previously heard 'clear and unanimous' expert psychiatric evidence that Cauchi was 'floridly psychotic' when he stabbed the 16 victims. Dr Watson-Munro said this was a tragedy for both the families of the victims and for the family of Cauchi. He stressed he did not wish to personally attack Dr A, and was focusing on the professional views she had expressed. But he said it was patently obvious that Cauchi was 'drowning in psychosis' when he launched his rampage. Queensland -based Dr A, who has run several psychiatry businesses, told the Bondi Junction inquest that Cauchi was not psychotic and did not take medication as it was 'not necessary'. Despite offering her 'sincere apologies' and saying the massacre 'devastated me personally', Dr A insisted Cauchi could not have had a psychotic episode at the time of the 2024 murders. She said his psychosis had previously exhibited as extreme disorganisation to the point he couldn't put 'two words together', and he therefore wouldn't have had the ability to launch his attack. 'That was nothing to do with psychosis,' the psychiatrist told the NSW Coroners Court. 'He couldn't have organised himself to do what he did. I think it might have been due to his frustrations, sexual frustration, pornography and hatred towards women.' In under three minutes on the afternoon of April 13 last year, Cauchi, 40, murdered Dawn Singleton, 25, Jade Young, 47, Yixuan Cheng, 27, Ashlee Good, 38, Pakria Darchia, 55, and Faraz Tahir, 30. Five were female shoppers at Westfield Bondi Junction and one a male security guard. Cauchi also injured 10 more with his US military knife, before he was confronted and shot dead by NSW Police Inspector Amy Scott. Dr Watson-Munro stressed he had never professionally examined Cauchi, but said he took issue with Dr A's claim that he didn't need medication. Cuachi had been on powerful antispychotic medication - clozapine and aripiprazole - to treat his schizophrenia for 18 years before he stopped taking them completely in 2020. 'That is all well and good if the person if not psychotic, but if someone is floridly psychotic and out of touch and deteriorating?' said Dr Watson-Munro. 'He was living in his car, had lost contact with his family ... was totally dishevelled and shambolic. 'He was obviously having issues about not having a relationship. I have read that treatment with antipsychotic drugs has side effects such as the impact of libido. 'Wanting to come off the medication and have a go at life is a separate issue and his parents were sufficiently concerned. 'But the evidence would suggest he had a well-established and documented schizophrenic illness. 'And we end up with this enormous tragedy.' Cauchi was taking 550mg of clozapine for 10 years under the care of public health doctors when he transferred to Dr A's private clinic in February 2012. Dr A has in the past promoted several types of therapy to treat patients, including 'dialectic therapy' where patients and therapists discuss their mental health. Dr Watson-Munro dismissed those treatments as 'chat therapy' for people with personality disorders or anxiety, but not effective for people with schizophrenia. The inquest heard Dr A worked with Cauchi to see if his symptoms, including a lack of joy or motivation, were caused by his schizophrenia or clozapine's side effects. Dr A embarked on a plan to lower Cauchi's clozapine dose, and his mother Michele agreed to support him through the gradual reduction. But in 2019, his mum became concerned Cauchi was suffering a schizophrenic relapse, after coming off his medication, when he said he was under Satanic control. He also had extreme OCD, compulsively used pornography and his gait - his walking style - had changed, she said. She contacted Dr A's clinic seven times to voice her concerns. The inquest heard that at first Dr A accepted Mrs Cauchi's concerns at 'face value' and prescribed her son aripiprazole, but then the doctor felt she had erred on the side of safety. Cauchi did not take the medication, and was not psychotic, Dr A claimed. She added that Mrs Cauchi was 'a beautiful, beautiful mother but she is not a psychiatrist'. Dr Watson-Munro was taken aback by the comment and told Daily Mail Australia there were 'some real pearlers' in Dr A's testimony. On Tuesday, senior counsel assisting the inquest Dr Peggy Dwyer SC asked Dr A: 'What would you say to the suggestion that you refuse to accept that Joel was psychotic on 13 April because you don't want to accept, yourself, the failings in your care of Joel?' The psychiatrist replied: 'I did not fail in my care of Joel and I refuse – I have no error on my behalf.' Dr Dwyer suggested she could have made a phone call. 'You could have done that, you just couldn't charge for it,' Dr Dwyer said, which the psychiatrist accepted. . 'It was conjecture on my part and I shouldn't have speculated four years later after I completed his treatment,' the psychiatrist said. Criminal psychologist Dr Tim Watson-Munro said a medical system which let Joel Cauchi fall through the cracks when he deperately needed treatment was to also blame for the loss of 7 lives, including Cauchi's (above) Barrister Sue Chrysanthou SC, representing the families of Ashlee Good, Jade Young and Dawn Singleton, described Dr A's testimony on Tuesday as 'shocking evidence to me and my clients' and 'contrary to all the expert evidence'. Daily Mail Australia spoke with Cauchi's shattered parents this week, who refused to lay blame. Cauchi's parents stressed that there was only one person who needed to apologise. 'My son let us down,' Mr Cauchi said. But Dr Watson-Munro said it was not just Cauchi to blame, but a medical system which let a severely mentally ill man fall through the cracks when he deperately needed treatment. What does it take to strip a psychiatrist of their licence? By Harrison Christian Psychiatrists can be held accountable if found negligent over a patient who went on to commit a violent crime - but it's unlikely to cost them their licence. If a psychiatrist fails to take steps over client posing a serious risk, they could face disciplinary action by the Australian Health Practitioner Regulation Agency (AHPRA), or a civil claim, or both. But stripping the psychiatrist of their licence would be an 'extreme outcome', even after even disciplinary action by AHRPRA, said Bill Madden, adjunct Professor at the Australian Centre for Health law Research. The more likely result would be suspension or that they're made to undertake supervision, he said. But he said they can face civil court legal action over perceived failures of care or a failure to sound the alarm when threats are made. He said the most prominent case is a landmark 1976 case when Prosenjit Poddar warned his therapist he would kill fellow student Tatiana Tarasoff - and then he did. The Supreme Court of California then ruled mental health professionals have a duty to reveal patient threats, and Mr Madden said it's the same in Australia. 'Ordinarily there's a doctor-patient relationship of confidentiality,' he said. 'Doctors are not normally permitted to release information, but the exception is where there is a serious (and perhaps imminent) danger to another person.' In the code of conduct for Australian doctors, there are provisions for doctors to breach confidentiality if a patient makes a specific or even a general threat. Mr Madden recalled a civil court claim after NSW's Morning Base Hospital discharged mentally ill patient Phillip Pettigrove who went on to kill his friend. While there are a few reported legal cases in Australia, civil claims are usually resolved out of court, limiting information available, Mr Madden said. 'They're all pretty rare, but there may be some scrutiny of situations by coroners, or civil cases that are made but often not reported, or disciplinary cases by AHPRA or the Medical Board,' he added. In the 2017 Victorian inquest into the death of Adriana Donato, the coroner scrutinised the response of James Stoneham's psychologist to a threat he made to harm an unnamed person. Under questioning, it was revealed Stoneham may have made reference to Adriana and admitted his plan. The coroner recommended a change to Victorian law, lowering the requirements for a breach of client confidentiality.
ABC News
17-05-2025
- Health
- ABC News
Witnesses defend interactions with Joel Cauchi amid Bondi Junction stabbing inquest
Multiple witnesses giving evidence in the Bondi Junction stabbing inquest have reiterated the "benefit of hindsight" in revisiting and defending their interactions with Joel Cauchi in the lead-up to the 2024 attack. The five-week coronial inquest has heard from a number of key witnesses about Cauchi's stabbing rampage at Westfield Bondi Junction on April 13 last year. WARNING: This story contains content that readers may find distressing. Sixteen people were stabbed, six fatally — Dawn Singleton, Jade Young, Yixuan Cheng, Ashlee Good, security guard Faraz Tahir and Pikria Darchia. Dr A, a psychiatrist who treated Cauchi between 2012 and 2020, was questioned about the decision to take Cauchi off his antipsychotic medication completely for his schizophrenia diagnosis. Dr A's comments came amid a tense day of her providing evidence. A separate psychiatrist also faced questions in week three of the inquest after providing Cauchi with a medical certificate in 2021 to assist in his quest to hold a gun licence. Dr C, who also cannot be identified for legal reasons, provided the certificate for Cauchi, though the Bondi stabber never followed up with completing the licence application. In the medical certificate, Dr C had written, "He does not pose an imminent risk to himself or others at this stage." "I was under the opinion he was very low risk to himself and others at that point," Dr C reflected in court. "It is very difficult for us in clinical practice to predict on future risk." Westfield Bondi Junction shopping centre manager Joseph Gaerlan also defended his performance in the emergency response role on the day of the attack. "I did the best I could with the information I had," he said. "If I reflect back on how I was at that time, I was one person trying to enact those duties. "I now have that hindsight which wasn't available to me at the time on the day." Under cross-examination by Sue Chrysanthou SC, who represents some of the victims' families, Mr Gaerlan was asked if he believed he was appropriately trained and prepared to carry out his role at the time. "Yes I do," he replied and doubled down when pressed further by Ms Chrysanthou. Mr Gaerlan was also asked why he personally did not contact police after entering the CCTV room and watching the footage minutes after the attack. A more junior member of the team, a CCTV control room operator, was asked to contact "blue lights". "I can answer that with the benefit of hindsight today, of course. "There's a lot of things that I think I would have loved to have done differently. As I mentioned though, it was so fast-moving," Mr Gaerlan said. A Queensland Police constable — who was called to Cauchi's family home in 2023 over a knife collection dispute — echoed a similar sentiment when providing her evidence. The constable was asked if the "complex" interaction with Cauchi was "a missed opportunity to link Joel back into the mental health service". The constable believed Cauchi was not exhibiting signs of aggression, and there had been nothing to show he was a threat to himself. "I don't know what Joel's baseline is. I don't know who he was when he was medicated. "I don't know who he was when he was not medicated, and I don't know where he was in the decline." She added: "Everyone is doing the best that they can with what they have, where they are." Counsel Assisting the Coroner Peggy Dwyer SC encouraged individuals providing evidence to give a "frank and full account of their experience". "The goal of this inquest is to work out what happened, and why, in order to identify any gaps in systems and processes, and to learn valuable lessons from any mistakes that were made." Dr Dwyer said the coronial inquest was not interested "to single out any single individual who was doing their best in a fallible system that was put to the test by Mr Cauchi's acts of violence".
