I am a psychiatrist covering Bondi. We need to invest in mental health services, not stigmatise people
The devastating scenes that unfolded in Bondi Junction on Saturday took place a mere 3km from where I live – and in the catchment area I cover as a psychiatrist. Like others, I am still trying to process the shock of it all and thinking of those grieving for their loved ones.
Predictably, certain commentators pounced on the opportunity to stir up racial hatred, falsely claiming it was an Islamist terror attack before any details were apparent. In fact, the perpetrator was Joel Cauchi, a 40-year-old Queensland man with no known ties to terrorist ideology.
Police have stated that Cauchi had a diagnosed mental illness since the age of 17, reportedly schizophrenia. He was also known to have a predilection for knives, and had come to the attention of the police for this, but had never been charged.
Speaking to media from his home in Queensland, Cauchi’s father, Andrew, said his mentally unwell son had been a “very sick boy” since he was a teenager and the family had done everything in their power to help him. “To you, he is a monster. To me, he was a very sick boy,” he said.
Serious mental illnesses such as schizophrenia are in fact rarely implicated in mass attacks such as this. Although
there is an increased risk of violence in people with schizophrenia, the vast majority of people living with the condition will never commit a violent offence. Furthermore, they are more often the victims of violence themselves – almost five times the rate of the general population.
So we should be careful not to stigmatise all sufferers of schizophrenia on account of this. If Cauchi was indeed in the grip of a psychotic episode at the time of the offence, can we find it in our hearts to see him as sick rather than a monster too?
Speaking in general terms, the journey to committing atrocities such as this often starts early with a traumatic childhood that develops into social isolation and despair in later life. We have heard that Cauchi commented on online groups seeking company. Narcissistic traits can also be a factor, so the attacker seeks notoriety when belonging remains elusive. This toxic mixture can eventually reach boiling point when the attacker exacts revenge on society for perceived mistreatment, with catastrophic consequences.
In my work as a psychiatrist I often assess the risk of potential violence in my patients with schizophrenia or other mental illnesses, asking questions to elucidate their symptoms and assess their mental state. It is an inexact science but regular follow-up can help identify problems early allowing us to intervene.
Although it’s not clear exactly what mental health treatment Cauchi received, underfunded public mental health services often mean patients do not receive the level of care they require.
Our mental health services are short-staffed. Positions are vacant and hard to fill. The pressures of the pandemic and cost-of-living crisis mean clinicians of all disciplines are choosing to work elsewhere. Patients with schizophrenia and a high-risk profile should ideally have a “case manager” – a nurse or social worker, for example, who would keep in touch with them regularly and monitor risk. Paying healthcare professionals fairly for this demanding work may prevent the mass exodus and attract more talent.
The fact that five of the six victims thus far are women (security guard Faraz Tahir being the exception) has raised the question whether Cauchi was targeting women specifically. The NSW police commissioner, Karen Webb, said on Monday that the possibility Cauchi targeted women was a line of inquiry, since videos appeared to show he “focused on women and avoided the men.”
Violence against women in a scourge in Australia, where 39% have experienced violence since the age of
15. The National Plan to End Violence against Women and Children has made progress in this area but there is clearly still much to be done.
The implications of this incident are far-reaching for the community. Survivors of mass attacks such as this are at increased risk of mental health problems such as post-traumatic stress disorder (PTSD), as are those who live in close proximity or can relate to the victims. So our mental health service is offering support at Westfield Bondi Junction this week for anyone in need.
While police are still looking into the motives of this attack and the investigation continues, a renewed focus on adequate treatment for people with serious mental illness is imperative. This should be a wake-up call for decision makers to fund mental health services adequately.
Dr Kamran Ahmed is a psychiatrist, film-maker and entrepreneur writing on mental health, culture, politics and healthcare
In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123.Other international suicide helplines can be found at befrienders.org