Bondi killer Joel Cauchi’s psychiatrist said second opinion ‘wasn’t necessary’ to completely take him off antipsychotic medication

A psychiatrist who treated killer Joel Cauchi for about eight years said it “wasn’t necessary” for her to seek a second opinion when completely stopping his use of antipsychotic medication to treat schizophrenia years before the fatal Westfield Bondi Junction attack.

Cauchi, 40, killed six people and stabbed another 10 during a stabbing rampage at Westfield Bondi Junction on April 13, 2024.

Dawn Singleton, Yixuan Cheng, Faraz Ahmed Tahir, Ashlee Good, Jade Young and Pikria Darchia died in the incident.

Cauchi’s private psychiatrist, known as Dr A, arrived at the Coroner Court in Lidcombe on Tuesday to give evidence to the five-week coronial inquest.

Cauchi was diagnosed with schizophrenia when he was 17 and was medicated for more than a decade to treat the condition until he stopped taking all psychotropic medication in 2019.

Counsel assisting the coroner Peggy Dwyer SC earlier noted that she didn’t want to stigmatise schizophrenia, and most people with the condition “will never commit an act of violence”.

Cauchi was treated in the public system in Toowoomba from 2001-2012 until he was transferred to the care of Dr A.

He saw the psychiatrist about once a month and his dose of the antipsychotic drug, clozapine, was gradually lowered until he ceased taking it in June 2018.

Cauchi had raised concerns about over sedation.

His dose of abilify to treat obsessive compulsive disorder was also ceased the following year.

One of his treating nurses, who can only be known as RN2, on Monday told the court patients on clozapine were closely monitored due to potential life-threatening side-effects, and it was a general aim to keep dosage of the medication low.

The lowering of Cauchi’s dose was initially to manage side effects rather than to end it completely, she told the court.

She also couldn’t recall having experience with any other patients where the dosage was stopped without then being prescribed a different antipsychotic medication.

Cauchi’s mother raised concerns several times from October 2019 about her son’s mental health decline, and while Dr A gave him scripts for abilify and rexulti that year, he did not take them.

Cauchi moved to Brisbane in 2020 and unsuccessfully tried to join a Skype session with Dr A.

When the clinic discovered he’d moved to Brisbane, they believed he wasn’t eligible for Medicare Skype appointments or nursing support.

Cauchi didn’t want to attend appointments in person due to difficulties travelling, so the clinic cancelled the appointment.

The court was told staff contacted him over a referral to a Brisbane GP, but he told them he didn’t have one yet and would keep them posted.

Dr A then discharged Cauchi into the care of his Toowoomba-based GP, which “signified a rather sudden end to Cauchi’s treatment by Dr A after what had been consistent treatment and attendance over eight years”.

Second opinion over medication regime

Dr A said it “wasn’t necessary” to get a second opinion when completely taking Cauchi off clozapine in 2018 despite initially asking another psychiatrist for an opinion when she began to lower his dose years before in 2015.

A letter from a different psychiatrist was shown to the court, which stated they had discussed the potential risks and benefits of stopping the medication with both Cauchi and his mother, including the risk of relapse of symptoms and the potential exacerbation of other symptoms.

“(Cauchi) agreed that if there was any recurrence of early warning signs of psychosis that the reduction would have to be abandoned and a return to a slightly higher dose of clozapine would most likely be the recommended,” the letter stated.

It stated Cauchi was aware of the importance of not consuming illicit drugs and excessive alcohol.

“His mother was agreeable to support him through this time and in view of Joel’s limited recollection of his positive psychotic symptoms the family are most likely to be the people to recognise an early signs of relapse,” the letter stated.

Dr A told the court she’d also discussed the potential negative side effects with Cauchi and his mother.

Ms Dwyer put to Dr A that she’d “never seen Joel acutely unwell” as he’d been medicated on clozapine for about 10 years by the time he came into her care.

“He never showed any signs of positive symptoms, never showed signs of any relapse, and never showed signs, any issues with safety,” Dr A told the court.

Dr A was asked if she agreed with the second psychiatrists’ opinion that Cauchi’s family would most likely be the ones to recognise any early warning signs of relapse.

“And I fully honoured that,” Dr A said before the court adjourned for a short break.

The decision to lower Cauchi’s dose of clozapine was for “optimisation” of minimal side effects and schizophrenic symptoms, Dr A told the court.

No second opinion before stopping meds

Dr A never sought a second opinion before completely taking Cauchi off antipsychotic medication, the court was told.

When asked if she was planning to completely stop Cauchi on clozapine when she got a second opinion in 2015, she said “no not at all”.

She said this was because he needed ongoing treatment, and Ms Dwyer asked her why she thought this if he only had first episode schizophrenia that was fully resolved.

She said it was to ensure he stayed well and to “protect him from further relapse”.

“Especially in terms of studying and trying to establish a life independently from the parents,” Dr A told the court.

Further, the court was shown a 2015 letter from Dr A to Cauchi’s GP, which stated “I do believe Joel needs an antipsychotic for long term relapse prevention”.

However, upon deciding to take Cauchi off clozapine completely in 2018, Dr A told the court it “wasn’t necessary” for her to get a second opinion.

“I was very confident that he recovered from the first episode schizophrenia and there was no schizophrenia...symptoms,” Dr A told the court.

She was later asked if she took responsibility for the decision-making about taking Cauchi off clozapine and abilify.

“It was my decision and (Cauchi’s) decision,” she said.

‘Full remission’: Psychiatrist’s claim

Dr A said Cauchi was not showing symptoms of a relapse while his dose of clozapine was gradually being lowered.

In her opinion, this meant he was “in full remission” from the condition.

“We have been engaging during this time and I was withdrawing the medication and getting to know him, and I was more and more firmed up in my belief that he fully recovered from his first episode psychosis,” Dr A told the court.Cauchi was ‘frightened’

The court was told Cauchi was “frightened” of potentially relapsing, though he appeared keen to be coming off antipsychotic medication.

Clinical notes suggested Cauchi had big ambitions to become a Chinese language interpreter, to marry, and that he was doing well with a gradual reduction in clozapine.

On April 5, 2018, clinical notes from Dr A stated Cauchi was the “best I have seen him”.

His energy was normal, he was happy, however the notes also said he was finding it difficult to terminate clozapine.

The notes stated he wanted a slower reduction before completely stopping, and Dr A agreed with his plan.

When asked why he may have wanted this, Dr A suggested it could have been due to an upcoming holiday.

She then told the court “he was frightened of relapse”, however his clozapine dose was only at 25mg at the time so she “wasn’t really worried”.

When asked if she was conscious Cauchi would need ongoing monitoring at the time, Dr A replied: “I wanted to keep him in psychiatric care for the rest of his life”.

“He needed psychosocial help and monitoring,” she said.

Clinical notes on July 26, 2018, stated Cauchi was “a-psychotic” and “very happy to come off clopine”.

By November that year he was living independently.

“He was able to look after himself to the point that we were all reassured he would be able to move into accommodation,” Dr A said.

“It was a milestone.”

Further clinical notes from May 2019 stated Cauchi was “doing really well” and wanted to stop taking abilify, though Dr A didn’t appear to be concerned as there is always a risk when stopping medication, “however we were five years off remission of schizophrenia at that time”.

“They were dealing with psychosocial rehabilitation at that time so it was not against any guidelines,” she said.

“(I) gave him the ability to choose what he wants to do but always assured him that I would be there, I would never let him go down, I would always keep him in mental health care.”

Cauchi’s mum reported concern

Some of the signs of relapse Dr A told Cauchi to look out for were not sleeping for 24-48 hours in a row, his thoughts becoming muddled or confused, or if he felt he had hallucinations or “preoccupations with an idea” that he couldn’t let go.

A letter from a different psychiatrist who Cauchi saw in September 2019 while Dr A was away reported Cauchi hadn’t been sleeping well.

“The onset of disturbance seemingly was in the context of feeling medically unwell, but it has persisted,” the psychiatrist wrote to Dr A in a letter.

In October 2019 Cauchi’s mother had reported concerns of a possible relapse to the clinic, with clinical notes from a consult on October 17 stating Cauchi had a cold, had a bit less sleep for two days, but was otherwise showing no other signs to suggest a relapse.

“I always gave credit to the mothers concerns and I don’t know what was behind it, it was talked about medical problems,” Dr A told the court.“When people have a flu...the sleep goes out.”

His follow-up with the mental health nurses at the clinic was then changed from monthly to weekly “because of the stress and to monitor whether he would have early warning signs of relapse or not and he was unmedicated”.

Confusion over Cauchi’s diagnosis

Ms Dwyer said Dr A had earlier agreed Cauchi was suffering from chronic treatment resistant schizophrenia, given he’d unsuccessfully been medicated with two other antipsychotic drugs before he was put on clozapine.

However there was confusion about what Dr A believed Cauchi to be suffering from.

“In my mind he was suffering a long episode of first episode of treatment resistant schizophrenia,” Dr A told the court, and Ms Dwyer asked her to look through her notes during the break to see if she could find notes of this diagnosis revision.

Ms Dwyer questioned Dr A on whether it was a “first episode psychosis that lasted a decade”.

“It did not last a decade…even (the second psychiatrist) said the symptoms stop,” Dr A said.

“Let’s just move on because it is first episode in my mind.”

Psych ‘devastated’ by the attack

Dr A began her evidence on Tuesday by apologising to the families of all those affected by the tragedy.

“I would like to say to the victims, their families, Joel Cauchi’s parents, friends and everybody that I offer my sincere apologies …. that this tragedy has happened,” she told the court.

“I am aware that no words will ease the profound pain, suffering and grief felt by myself and everyone involved.”

Dr A said the attack had “devastated” her personally, and the inquest had her full support.

More to come...

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