In 2024, Westfield Bondi Junction became the site of a heinous act. Joel Cauchi’s senseless rampage last year claimed the lives of six innocent victims and left ten others seriously injured. Fierce public backlash has followed the unfolding tragedy of Cauchi’s mental health care. Through this examination, we have uncovered a series of omissions in psychiatric care that played a role in this tragedy. Cauchi had a history of serious mental illness, including an acute paranoid-psychotic disorder. This brings to light critical questions on how his condition was treated prior to his attack.
Cauchi to first Advent to the psychiatric ward of Toowoomba Public Hospital as a very young 17. He acted out in more extreme ways, like breaking things and later freaking out that he was going to be “possessed by demons. After years of treatment, he was finally discharged from the public system in 2012. By that point, he was dependent on a maxed-out dose of clozapine, an anti-psychotic used only in the most extreme situations. By 2019, Dr. Andrea Boros-Lavack had weaned him successfully off all anti-psychotic drugs. She adhered to the best practice protocols for the treatment of first-episode psychosis to get this fantastic result. Dr. Boros-Lavack’s decisions are now under examination as experts question whether they adequately addressed Cauchi’s ongoing symptoms.
A Missed Opportunity for Care
Authorities reviewing Cauchi’s treatment have cited major lapses in his care. Professor Merete Nordentoft, a foremost psychiatrist from Denmark, noted in writing her very serious concern regarding Cauchi’s mental state. Had she been engaged with his case, she would have pushed for his involuntary emergency treatment. She underscored that the months before the attack were a “golden opportunity” to have restarted his anti-psychotic drug.
Austrian psychiatrist, Professor Olav Nielssen, one of the experts examining Cauchi’s treatment, told that all five psychiatrists who reviewed the case agreed on one thing. Cauchi, they found, was in a state of psychosis at the time of these brutal offenses. This widespread agreement indicates that a failure to identify his psychotic state played a role in the circumstances leading to his attack.
After discontinuing his medication, Cauchi started experiencing feelings of being “under satanic control.” Dr. Boros-Lavack downplayed several reports of Cauchi’s troubling behavior from September 2019 – February 2020. Yet, he could not recognize these behaviors as symptoms of psychosis. Failure to recognize this contributed to his rapid mental health deterioration.
The Role of Cannabis and Its Impact
Besides his psychiatric history, Cauchi had been consuming cannabis in the days leading up to the stabbing spree. Professor Matthew Large stated during the inquest that cannabis is a “potent and proven cause of schizophrenia,” which could have further destabilized Cauchi’s mental health. Co-occurring substance use and untreated psychotic symptoms further complicate the need of managing individuals with these behaviors.
Professor Heffernan remarked on the challenges faced when dealing with voluntary patients like Cauchi, stating, “It’s very difficult when you have a voluntary patient … to change the course that has been in play for some time.” He acknowledged that a more aggressive strategy toward re-adding medication sooner would have been better.
He called Queensland Police to report an altercation with his father over military collectibles. His recent arrest reflects a major shift in volatility in his mental health, which was obviously missed by his treaters.
The Aftermath and Continuing Investigation
Following the tragic events that occurred at Westfield Bondi Junction, a comprehensive investigation has been triggered. Officials are now investigating where the mental health care system failed. Each of the five psychiatrists who evaluated Cauchi’s treatment expressed concern at the way his case had been managed. In particular, they condemned the decision to discontinue his medication with no further plan in place.
Professor Nordentoft remarked, “It’s not correct to state there had been 16 years without relapse,” highlighting that the perception of stability in Cauchi’s mental health was misleading. In part, this misconception likely resulted in a lack of timely monitoring and escalation of care during pivotal steps in his course of treatment.
