Untreated schizophrenia blamed in Sydney mall attack
No one can know the mind of Sydney shopping-centre killer Joel Cauchi, but psychiatrists say one underlying cause of his rampage is evident: he had schizophrenia, stopped his medication and was no longer getting treatment.
People have searched for a fathomable motive since the April 13 knife attack at Bondi Junction, in which five women and a male security guard were stabbed to death and another dozen wounded, including a ninemonth-old girl.
Cauchi’s parents have said their son was diagnosed with schizophrenia at the age of 17 and was successfully treated for about 18 years. A serious mental disorder, schizophrenia can cause hallucinations, delusions and disordered behaviour. It requires lifelong treatment.
New South Wales Police Commissioner Karen Webb said it was “obvious” to her and detectives that the 40-year-old Cauchi had targeted women and avoided men, sparking a media debate about misogyny in Australia.
Prime Minister Anthony Albanese described the gender breakdown among the victims as “concerning” and vowed to do more to combat violence against women, citing a toll of one woman dying at the hands of a man they knew every week.
“But we will never know what was in the mind of the perpetrator of these acts,” said professor Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre. “Ordinary people are trying to impose a rational explanation,” he said. “The most obvious one is the irrational mind of the perpetrator.”
Recurrence of the mental illness could not by itself necessarily explain the violence against other people, which was “extremely rare” in such cases, Hickie said. “Often these things are complicated by other factors; drug use, disconnection, social isolation, homelessness.”
No two psychotic people had the same thoughts, which were shaped by each person’s idiosyncratic, irrational perceptions of the world, Hickie said.
Cauchi might have attacked women simply because men were better able to defend themselves – like Frenchman Damien Guerot, hailed a hero for fending off the assailant with a metal post, he said.
“The wider issue of domestic violence and the number of women who are harmed or killed by men who do not have any mental illness in our country is a national problem. I don’t think this is a manifestation of that problem,” Hickie said.
“The social factors that matter here are homelessness and isolation, and the stigmatisation of treatments for mental illness.”
Cauchi’s parents say he gradually came off his medication over a number of years in consultation with a doctor because he felt he was doing well. He moved from the family home in the Queensland city of Toowoomba to the state capital Brisbane, and then recently travelled to Sydney.
He had been living in a vehicle and hostels since leaving home and was only in sporadic contact with his family via text messages.
He appeared not to realise he was becoming sick and “became homeless, completely disconnected from any sources of support, and ended up in this very acutely psychotic state”, said Patrick McGorry, professor of youth mental health at the University of Melbourne.
His behaviour was “completely disorganised or delusionally based”, said McGorry, a former president of the Schizophrenia International Research Society.
Attempts to ascribe Cauchi’s actions to misogyny were “completely off point”.
“It’s purely a case of untreated or poorly treated mental illness,” he said.
It highlighted that Australia’s mental-health system was “completely inadequate” to the task of ensuring patients such as Cauchi received continuing care. “It is true that he wanted to move cities but in that case the healthcare should have been set up for him at his destination,” McGorry said.
If patients with schizophrenia stopped medication, there was more than an 80 per cent chance of the disease returning, he said.
“And when it comes back, it is likely that the person will not recognise that it’s returning and won’t seek help.”
Carolyn Nikoloski, chief executive officer of Australia’s peak advocacy group Mental Health Australia, said there was a gap in support for people with complex care needs.
People were often turned away from hospital emergency departments because their illness was not judged to be serious enough at the time, she said.