Joel Cauchi, who had been diagnosed with treatment-resistant schizophrenia, would become the subject of a tragic investigation. This announcement follows the tragic stabbing death of a Bondi Junction shopkeeper. Cauchi’s documented mental health history should have been a serious red flag. His mental health care and management of medication leading up to the attack are what stand out as egregious failures. During his teenage years, a psychiatrist in Queensland kept him under surveillance. In recent days, his behavior indicated an imminent and dangerous relapse that went unheeded.
Between 2012 and 2020, Cauchi was treated by Dr. A at a clinic located in regional Queensland. During his time in jail, he was prescribed antipsychotic medication to keep his schizophrenia symptoms at bay. By the end of 2019, he was totally weaned off all these medications. This transition triggered a worrisome deterioration of his psychological well-being. His mother was horrified by her son’s declining health. She spoke to the clinic on his behalf about his fears of “hearing voices”.
In November 2019, it was Cauchi himself who first contacted the clinic’s reception via email. He wrote candidly about his compulsive obsession with pornography and attempted to find treatment for what he referred to as a worrisome problem. This obsession had allegedly escalated in the years prior to the stabbing attack.
Signs of Relapse Ignored
For Dr. A, Cauchi’s fixation on pornography was the first warning sign. It meant she was having a relapse into psychosis. Even so, he contended that discontinuing the medication was justified in light of Cauchi’s history of being stable on treatment.
“During my eight years of treatment, he never showed any signs of positive symptoms, never showed signs of relapse,” – Dr A
The reality described by Cauchi’s family and a tragic series of recent incidents tells a very different story. His mother noted that he had been “very unwell since he came off his medication,” indicating signs of deterioration that were not adequately addressed by the clinic.
In retrospect, Dr. A has argued that exceptional cases deserve a reconsideration of Med management. He stated, “In selective cases you can consider taking them off psychotic [medication]. I was listening to the patient. Medication is [one] part of psychiatric care.” From this perspective, it is possible to start interrogating the way decision-making about Cauchi’s treatment came about.
The Day of the Attack
On the day of the stabbing incident, experts testified that Cauchi was showing signs associated with extreme psychosis. When Dr. Dwyer saw him in the wake of the incident, she used the terms “floridly psychotic” to underscore the extent of his madness.
Cauchi’s past rants and online activities were very troubling. He appeared to be exhibiting red flags long before he committed his act of horror. So his mother is concerned about her son’s welfare. He is refreshingly candid about his own battle with pornography, and in the process, he uncovers a wounded man.
“He was doing so much better when he was on [medication],” – Joel’s mother (via receptionist’s record)
In response to Dr. A’s defense of his treatment of Cauchi, the charge of negligence has been strongly rejected. He noted that frustrations over Cauchi’s lack of sexual health probably contributed to the nature of the assault. These interventions, he stressed, were unrelated to Cauchi’s psychosis.
“I honestly believe, in my opinion, that was nothing to do with psychosis. It might have been due to his frustrations sexually, pornography, and hatred towards women,” – Dr A
A Systemic Failure
The circumstances leading to Joel Cauchi’s treatment have exposed possible deep systemic breaches in the protocols and management of mental health. After being discharged from the clinic, authorities say Cauchi “fell through the cracks.” This indicates a failure of continuity of care that arguably contributed to this tragic outcome.
Dr. A’s request for a second opinion regarding lowering Cauchi’s medication dosage four years prior raises further questions about the appropriateness of his treatment plan. A concerted effort was taken to meet the specific needs of Cauchi. Overwhelming and tragic oversight happened when his health deteriorated without any consistent observation or action taken to intervene.
