Latest news with #schizophrenia
The Guardian
a day ago
- Health
- The Guardian
Cauchi's mass murders put harsh spotlight on failings of mental health and police systems
Joel Cauchi's mother didn't appear before the coronial inquest examining her son's life and the day her son murdered six people at a popular Bondi Junction shopping centre. But her presence was often felt, taking shape in the form of notes she had written to his doctor or in a conversation with a police officer. One of the most striking moments of the inquest was when Michele Cauchi, now in her mid-70s, was filmed via body-worn video camera on a police officer. She was standing outside her tidy home next to blooming hydrangeas, explaining how her son – who spoke multiple languages and had a university degree – had been deteriorating since he stopped taking medication. 'I don't know how we're going to get him treatment unless he does something drastic,' she says. These moments painted a picture of a mother engaging in a Sisyphean struggle to get her son – then living with untreated schizophrenia – help. But she could keep pushing only so far. Person after person who gave painful evidence at the five-week inquest told a similar story of doing their best in a 'fallible system'. It crystallised into a key takeaway: the system is letting down people in a crisis, like Cauchi. Cauchi's attack and the severity of it was a rare occurrence. But the system's failure to pick up on his slide after he stopped taking his medication for treatment-resistant schizophrenia is sadly a familiar story. Psychiatrists who appeared as experts before the inquest said the vision when mental health asylums in Australia were dismantled in the 1970s was for community services to instead support those people in need. But Queensland psychiatrist Prof Edward Heffernan told the inquiry the planned funding for community services 'never really followed' the shift. Psychiatrists also told the inquest that services hadn't kept pace with population growth. Meanwhile, psychological distress was increasing across the population, and patterns of substance abuse and other modern stressors had made things worse. Ian Korbel, a psychiatrist not part of the inquest, tells Guardian Australia he once worked in a mental health outreach team that would respond to people in crisis. But that program stopped running in the mid-2000s. Korbel says the team that worked in Sydney's eastern suburbs used to check the beaches for people experiencing homelessness. Cauchi was reportedly sleeping rough there before the attack. Korbel says the faltering of services has resulted in the buck passing to police and the justice system. 'They're in the punishment business,' he says. 'They shouldn't respond to this, but the health system isn't resourced to respond to it.' Police are increasingly responding to such crises. The inquest heard that in New South Wales, police responded to 40% more mental health incidents in 2022 compared with four years earlier. Sen Sgt Tracey Morris told the inquiry: 'We will always look at [those incidents] from a policing lens. That may lead to charges and them going through the court system when [it's] effectively because of the mental illness.' Morris works as the mental health intervention coordinator in the Queensland police district where Cauchi's parents live, in Darling Downs. The day Cauchi's mother spoke to police, they referred Joel to her role – which helps people link in with health services – for a follow-up check. But the officer acting in her role while she was on leave missed the email. This moment to get Cauchi help was described by a psychiatrist at the inquest as a 'missed opportunity'. Fighting back tears, Morris told the court this was no reflection on that officer's capability, but a direct consequence of under-resourcing. At least four people should be doing her job in that particular police district, she said. One of the cruelest ironies of that under-resourcing issue came during the inquest in a blink-and-you-might-have-missed it-moment, where Morris said no one was covering her role while she was at the inquest for the week. She couldn't find anyone to backfill it. Matthew Morgan, an expert in policing mental health responses who lectures at the Australian Catholic University, says: 'The only people really to blame here is the government. If they're not going to invest in a proactive and responsive mental health system that can provide the community around-the-clock care … then the buck stops with them.' A recent report Morgan co-authored analysed Queensland coronial inquests into people fatally shot by police while experiencing a mental illness. Twenty-four people have been fatally shot in the state since 2008. There is a clear patten, he says. 'The state has really just failed them. 'There's just lots of patterns of sporadic treatment, lack of follow-up care, and then the police get blamed for their criminalising and sometimes lethal response to such situations.' The inquest heard there had been multiple improvements in crisis response since police spoke to Cauchi and his mother in January 2023. Police can connect with health professionals to get advice on incidents, and there are co-response models where healthcare workers respond to call-outs alongside police. Those changes – as Peggy Dwyer, counsel assisting the coroner, pointed out in the inquest – have come after multiple inquiries, internal police and government reports and coronial inquests. All make a similar recommendation: health professionals should respond to mental health crises, not police – at least not alone. Joining calls for this change are families whose loved ones have been shot dead by police while they were suffering a psychosis. One of the loudest recent voices has been Judy Deacon, the mother of Jesse, who police shot dead in Glebe in 2023 after reports he was self-harming. But co-responder models have not been rolled out nationwide, despite recommendations to do so. The leading model in NSW, known as Pacer, operates in just 20 of NSW's 57 police commands. During the inquest, Dwyer asked Dr Brendan Flynn, the executive director of the mental health branch of NSW Health: 'Why has there not been an expanded Pacer across NSW where sufficient demand is demonstrated, when this report came out almost four years ago?' Flynn responded: 'It's a resourcing issue. It would require new funds, and that's a matter primarily for government.' Later Dwyer asked: 'Is there a risk that we just then get stuck here for another four years where there's no rollout of more supports?' Flynn replied: 'I hope very much that's not the case.' Even if a version of Pacer were rolled out across NSW, Korbel says, more work needs to be done. 'Nowhere in Australia do we fund mental health as we should,' he says. 'NSW is the worst. It gives 5% of its health budget to mental health.' Korbel says that figure 'would need to be doubled at least' to match similar programs in countries such as England and Canada. Investment in health services can save money in the long term. Prof Olav Nielssen, a Sydney-based psychiatrist who appeared before the inquest, spoke about a supported housing charity he works at. It supports people revolving between hospital, prison and the homeless sector. He estimated the cost of having people in supported housing was a tenth of what it would otherwise cost having them bouncing around a network of hospitals, prisons and other institutions. He said NSW had 'plans' to have 70 of these beds but that there should be 1,000 to meet the need. Elizabeth Young, the mother of Jade Young, a victim of the stabbings, appeared before the inquest and described her 47-year-old daughter's murder as the 'stuff of nightmares'. She also described it as the result of 'years of neglect' within the mental health system. 'It seems to me that my daughter and five others were killed by the cumulative failures of numbers of people within a whole series of fallible systems.' In Australia, the crisis support service Lifeline is 13 11 14. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@ or jo@ In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on or text HOME to 741741 to connect with a crisis counselor. Other international helplines can be found at
Yahoo
a day ago
- Health
- Yahoo
A Fresno mother shares her journey with schizophrenia advocacy
Editor's note: This op-ed contains mentions of suicide and mental illness. If you or someone you know is in crisis, call or text 988 to the Suicide & Crisis Lifeline. My son died of schizophrenia when he took his own life at the age of 32. I first heard that term 'schizophrenia' applied to my child when he was 22. A psychiatrist sat opposite me at a huge empty conference table and said the word. The effect was total shock. But also total bewilderment. I had considered myself an educated person, but that word, hanging in the air, was beyond my understanding. Where knowledge should have been I found only a blur of misconceptions and movie plots that led to one inevitable conclusion: I had caused this. The doctor did not seem to feel that an explanation was required, so I was left on my own to learn about serious mental illness, a category with a blurry definition. 'Serious mental illness' is something that families come to recognize as we meet with other families facing similar problems. Touch points in our shared stories include involuntary psychiatric holds, jail, homelessness, refusal to shower and, of course, refusal to take medications. We talk about the voices our loved ones hear, the signals they receive — from cars, or cats, or grocery carts. Strangeness becomes familiar. We begin to believe we can't be shocked. But I recently learned something that astonished me: An expert declare that more Americans have schizophrenia than have Type I diabetes. That sounded ridiculous, so I looked it up — and it's true. Johns Hopkins says that about 1% of the population has schizophrenia, while Type I diabetes, according to the Centers for Disease Control and Prevention, is found in only 0.55% of the population. Odd, then, that there's so much research on diabetes, but so little on schizophrenia. Odd, too, that medical approaches are so different for the two illnesses. A diabetes diagnosis is likely to come with education, training and treatment, whereas a diagnosis of serious mental illness is a voyage into the abyss. There are medical and legal reasons for this discrepancy. In past eras, mothers were the single medically acknowledged cause of schizophrenia. So that's the medical precedent that may have led us here. On the legal side is patients'-rights legislation, well-intentioned law that can backfire for families like ours. A family member trying to get treatment for a loved one with serious mental illness — the way a family member of someone with Type I diabetes would seek access to insulin — will undoubtedly be frustrated. One of the hallmark symptoms of serious mental illness is anosognosia, the inability to understand that one is ill. Our loved ones with life-threatening illnesses are, by their own reckoning, not sick. Knowing themselves to be perfectly healthy, they logically refuse treatment. And this is where things get dicey, because this refusal is their legal right, even when it is clearly not in their best interest. They can be desperately ill but not meet the criteria for involuntary treatment. And there is nothing family members can do. Jerri Clark is a mother whose attempts to get treatment for her son were futile. As she has explained in advocating for changes to the law, 'my son met criteria for involuntary treatment the moment that he stepped off the roof of a hotel and plunged to his death.' Clark, now on staff at the Treatment Advocacy Center, is careful to use the wording 'no-fault diseases of the brain' when speaking of serious mental illness. 'No-fault' gets to a central problem in the world of serious mental illness, which is the impulse to blame someone — the patient, for exhibiting terrifying symptoms; the family, for having raised a person who now exhibits terrifying symptoms — for this disease. When they do consent to treatment, our loved ones are most often still being treated with drugs developed in the '50s. Research on serious mental illness is scant. John Snook, director of government relations at the National Association for Behavioral Healthcare, has warned about professional indifference to serious mental illness, despite alarming mortality rates. According to one study, the death rate among those with schizophrenia is four times higher than what is seen in the general population. Snook and other advocates have worked long but so far fruitlessly to get schizophrenia classified as a brain disease like Parkinson's or Alzheimer's instead of as a mental illness. 'The science is clear,' Snook says. 'It's a neurological condition.' Yes. It is. But treatment of our loved ones with serious mental illness does not yet reflect this reality. This neurological condition deserves research, understanding and treatment. Julia Copeland is a retired arts administrator who volunteers at her local National Alliance on Mental Illness office in Fresno.
News.com.au
3 days ago
- Health
- News.com.au
SA Supreme Court rules Cynthia Ellen Rigney was not ‘mentally incompetent' during Maria Luis killing
The young woman who stabbed a drug dealer 34 times allegedly over a $50 bag of marijuana will stand trial for murder after a Supreme Court justice ruled that she was mentally competent at the time of the frenzied attack. Cynthia Ellen Rigney stabbed cannabis dealer Maria Luis 34 times within three minutes in the Adelaide suburb of Kilburn on December 7, 2018. Police raided Ms Rigney's unit at 10.51pm that night, finding her asleep under a blanket in her bedroom with a plastic resealable bag containing marijuana attached to her leg and arrested and charged her with Ms Luis' murder. A search of the premise uncovered knives secreted in the bedroom and lounge room as well as a black handbag spattered with a bloodlike stain, which DNA analysis connected to the 61-year-old dealer. Ms Rigney, now 25, has pleaded not guilty to the charge of murder. Her defence team and prosecution have agreed to the 'objective facts' of the case, that Ms Rigney stabbed Ms Luis, but the long-running trial has turned on whether the young woman was mentally incompetent at the time of the alleged murder and whether she was fit to stand trial. Ms Rigney has treatment-resistant schizophrenia and she claims not have remembered stabbing Ms Luis. Expert witnesses provided reports on Ms Rigney's complex swirl of mental health problems, which together offer a conflicted picture the young woman's capacities. In one instance, a psychologist concluded it was hard to say whether Ms Rigney's inability to recall events on the day of the stabbing was a consequence of psychosis or whether Ms Rigney had feigned memory loss. Some experts also altered their opinions on Ms Rigney's mental competence as more information came to them. On Friday, Justice Anne Bampton ruled that it had not been established 'on the balance of probabilities that at the time of the stabbing, Ms Rigney did not know that her conduct was wrong; that is, that she was completely incapable of reasoning about whether the conduct, as perceived by reasonable people, was wrong'. Justice Bampton's detailed 112-page judgment also concluded that it had not been established that 'she was totally unable to control her conduct'. 'I am not satisfied it has been established, on the balance of probabilities, that Ms Rigney was, at the time of the stabbing, mentally incompetent to commit the offence of murder,' she said. Justice Bampton ruled 'there was no evidence either from Ms Rigney herself or any other source proximate to or at the time of the stabbing that Ms Rigney's actions were guided or directed by psychotic phenomenology'. 'There is no evidence before me that the stabbing was the result of florid psychosis or a delusional belief arising from her treatment-resistant schizophrenia,' she said. 'However, there is evidence of a credible, non-psychotic alternative explanation for the stabbing.' Justice Bampton also said the 'frenzied nature' of the stabbing or number of stab wounds did not point to either a psychotic or non-psychotic motive for the young woman's conduct.
Daily Mail
4 days ago
- Health
- Daily Mail
Shocking police oversight that led to woman nearly being killed in Beanie Babies tycoon mansion
Police were warned that the Army combat veteran who violently attacked a woman at Ty Warner's mansion was 'spiraling' and 'could harm someone', his relatives claim. Russell Maxwell Phay, 42, allegedly broke into the Beanie Babies founder's $400 million Montecito estate on May 21 and beat Linda Malek-Aslanian nearly to death. Phay was arrested after a standoff with deputies during which he locked himself inside a bathroom before jumping from a second-floor window of the sprawling 6.58-acre coastal mansion in southern California. Malek-Aslanian, 60, is in a coma after suffering a brain injury during the assault. Police have not yet identified a possible motive for horrific attack, but Phay's family has now alleged that his siblings called the Colorado Department of Corrections several times to warn authorities that 'he was in crisis'. 'We left multiple messages over the course of the week expressing our fear that Russell was spiraling and could harm someone,' his relatives told NBC News. The family claims Phay, who served in the Army roughly 20 years ago, suffers from 'severe schizophrenia', which they allege transformed him from a kind person to an unrecognizable man who is 'unstable' and 'at times violent'. Phay's 'heartbroken' family have condemned his alleged 'senseless act of violence' and hit out at authorities, claiming 'this tragedy might have been preventable' had officials intervened. 'We are devastated that our efforts to sound the alarm went unanswered,' the family told the news outlet. Phay's family received worrying calls from him in the weeks leading up to the attack at Warner's estate. A sibling, who spoke to NBC on the condition of anonymity, alleged that although Phay did not make any specific threats, he 'made little sense' on during the call and failed to provide details about his whereabouts. His concerning calls prompted the family to contact corrections officials, but never heard back. The sibling claims the family did not learn that Phay had been arrested until four days after the alleged attack when he called a relative from jail. Although many of the family has distanced themselves from Phay due to 'safety' concerns, his loved ones say 'we tried to take action when we saw warning signs that he was in crisis'. Phay has pleaded not guilty to multiple charges including attempted murder, kidnapping, assault and burglary. He remains in custody at the Santa Barbara County jail and is not eligible for bail. Beanie Babies founder Ty Warner, 80, (pictured in 2013) was home at the time of the attack and unharmed, with officials saying he was 'able to escape and contact authorities' for help Phay (pictured in his 2018 mugshot) has pleaded not guilty to multiple charges including attempted murder, kidnapping, assault and burglary. He remains in custody at the Santa Barbara County jail and is not eligible for bail Phay entered Warner's home with the 'intent to commit larceny' before holding Malek-Aslanian against her will, prosecutors said in a criminal complaint. He assaulted Malek-Aslanian, whom prosecutors described as being 'particularly vulnerable', caused 'great bodily injury', the complaint added. Investigators are 'uncertain' why Phay targeted the Beanie Babies mogul's home, which is neighbored by ritzy homes belonging to dozens of stars including Prince Harry and Meghan Markle. 'It's a big house, but of course it's in an area with a lot of big houses,' Santa Barbara County District Attorney John Savrnoch told People Magazine. He added that authorities do not believe that Phay, whom Savrnoch branded a 'serious danger to society', personally knew Malek-Aslanian or Warner. Warner, 80, was home at the time of the attack and unharmed, with the district attorney saying he was 'able to escape and contact authorities' for help. The toy tycoon's relationship with the victim, a financial services expert, wasn't immediately clear. Malek-Aslanian, who according to broker records is currently employed at New York Life, did previously work for Warner's hotels division. Artist Tony Shafrazi (left) and Linda Aslanian (right) attend the 11th Annual Children Of Armenia Fund Holiday Gala at Cipriani 42nd Street on December 12, 2014 in New York City Phay has a criminal history spanning multiple states that includes guilty pleas to violent acts including assault, stalking and menacing, court records reveal. He was named in a complaint as recently as last year, after he allegedly threatened a couple over the phone. The ex-Army combat soldier was arrested in Siskiyou County in 2018 and charged with battery and assault, but the case was dismissed last year. Phay also appeared in court in 2014 after he allegedly threatened his wife and followed her across state lines after she tried to flee with their son. A violent attack against his wife resulted in a prison sentence, but his release Phay was eligible for diversion programs that targeted ex-military personnel battling mental health issues. He told The San Francisco Chronicle after his release: 'They've recognized that I am salvageable. I need treatment, and I've gotten treatment. I feel like people here understand the brotherhood.' Phay left the Army as a trained infantry combat soldier with specialized weapons training, telling the newspaper how 'I have been trained to eliminate you'. He admitted that his remark 'sounds crazy, but it is true.' Phay was expecting to serve in Kuwait, but his tour of duty expired before he could be deployed. He was ordered to remain on parole in Colorado for two years after completing a 512-day prison sentence in 2021. Phay, accused of assaulting someone with a baseball bat, pleaded guilty to felony menacing in June that year. It is unclear if he was on parole at the time of the alleged attack in Montecito, though his family members claim state corrections officials said he was. In their statement to NBC, Phay's siblings said they were 'heartbroken by the horrific incident involving our brother, Russell M. Phay, and the innocent woman who was so grievously harmed. 'Our hearts are with her, her family, and everyone affected by this senseless act of violence. We are deeply saddened by the pain and trauma caused.' They added that they are also grieving the 'brother we once knew - and the system that continues to fail so many families like ours'. Police say the investigation into the attack is ongoing.
Medscape
4 days ago
- General
- Medscape
Study Underscores Need for Eye Exam in Psych Disorders
Individuals older than 50 years with bipolar or major depressive disorder were more likely to have retinal disease, and those with a diagnosis of retinal disease and a psychiatric illness were at sharply higher risk for impaired vision than those with retinal disease alone. METHODOLOGY: Researchers conducted a retrospective cohort analysis of adults aged 50-89 years with a diagnosis of schizophrenia (n = 160,414; mean age, 65 years), bipolar disorder (n = 391,440; mean age, 63 years), or major depressive disorder (n = 1,962,380; mean age, 67 years), matched with people without psychiatric conditions. They also examined how comorbid psychiatric disorders affected vision impairment in patients with retinal disease, focusing on those with schizophrenia (n = 8880), bipolar disorder (n = 22,678), or major depressive disorder (n = 265,544); these patients were matched to individuals with retinal disease but no history of psychiatric disorders. The primary outcome was a diagnosis of retinal disease, including chronic or age-related conditions, and the secondary outcome was having impaired vision. TAKEAWAY: Individuals with bipolar disorder showed a 4%-15% higher risk for retinal disease across all age groups older than 60 years (relative risk [RR], 1.04; 95% CI, 1.01-1.08 for ages 60-69 years; RR, 1.15; 95% CI, 1.10-1.20 for ages 70-79 years; and RR, 1.15; 95% CI, 1.07-1.23 for ages 80-89 years). Major depressive disorder also was associated with an increased likelihood of retinal disease in people aged 50-59 years (RR, 1.84; 95% CI, 1.79-1.89), with sustained increase in risk among those aged 60-69 years, 70-79 years, and 80-89 years. Among individuals with retinal disease, those with a diagnosis of major depressive disorder were about 50% more likely to have impaired vision (RR, 1.51; 95% CI, 1.48-1.54) as were those with a diagnosis of bipolar disorder (RR, 1.33; 95% CI, 1.25-1.42). While individuals with schizophrenia were less likely to be diagnosed with retinal disease (RR < 1 across all age groups), those who had both schizophrenia and retinal disease were 35% more likely to experience impaired vision as were those with retinal disease alone (RR, 1.35; 95% CI, 1.23-1.48). IN PRACTICE: 'Individuals with psychiatric disorders are often considered a vulnerable population due to systemic, social, and biologic factors that contribute to worse health outcomes compared to the general population,' the authors of the study wrote. 'Psychiatric disorders are also associated with comorbidities such as obesity, diabetes, and metabolic syndrome that are known to increase risk of retinal disease such as diabetic retinopathy. Our findings suggest the need for closer monitoring of retinal disease and visual impairment in individuals with psychiatric disorders.' SOURCE: This study was led by Jeffrey Chu of the Case Western Reserve University School of Medicine in Cleveland. It was published online on May 20, 2025, in Eye . LIMITATIONS: The retrospective nature of this study and potential variations in coding practices among clinicians and institutions limited the findings. Data for optical coherence tomography and visual acuity were unavailable in the network database. Additionally, unaccounted variables such as use of medication, duration of psychiatric disorders, lifestyle factors like smoking, socioeconomic status, and healthcare access may have introduced confounding effects that could not be controlled for. DISCLOSURES: This study received support from the Clinical and Translational Science Collaborative through a National Institutes of Health grant, along with partial support from some other sources. Some authors disclosed receiving personal fees, research fees, consulting fees, and speaking fees from several pharmaceutical companies.
