A leading neuropsychiatrist says there was a potential "missed opportunity" by Queensland authorities to link Joel Cauchi with crucial treatment, in light of his mental health history and his interactions with Queensland Police.
Dr Harry McConnell, a neuropsychiatrist and former adviser to the Queensland government, says while he doesn't have access to Cauchi's clinical records, it appears that failures when it came to communicating Cauchi's situation may have seen him "lost in the system".
"It seems like there was a difficulty in monitoring, there was difficulty in communication between the public and private systems, between the police and the public system, and with the family and so, clearly, he fell through the cracks," he told 7.30.
The NSW government is funding an independent coronial inquest into the stabbings at Bondi Junction.
Cauchi was diagnosed with schizophrenia at the age of 17 and received treatment by the public mental health system for more than a decade in his hometown of Toowoomba.
In 2012, he was transferred into the care of a private psychiatrist and GP.
Queensland Health's records show the only interactions it had with Cauchi since then were not mental health related.
According to his parents, he started to come off his medication around 2019, with medical supervision.
Dr McConnell said while it's still unclear what triggered Cauchi's actions in Sydney, private patients coming off medication should have easy access to the public health system, including important networks providing home visits from nurses and social workers.
"Ideally what needs to occur here is two-way communication between private mental health and public mental health … if they're making important changes to medications," he said.
"There's very little communication oftentimes between the public health systems and GPs and private psychiatrists."
Dr McConnell said Queensland Health currently has some clinical case coordinators who act as a contact point for patients, but he'd like to see this expanded throughout the state.
"There's lots of different silos that don't communicate with each other, and that integration is key," he said.
"So you have somebody who can pick up the phone and talk to the police, or somebody who the police can pick up the phone and easily call and say, 'Hey, we have some concerns about your patient … can I tell you what's going on and we can discuss what the best avenue is here?'"
While Cauchi's condition has been widely reported, Irene Clelland, the CEO of Arafmi — a support service for families and carers of people with mental illness — wants to make it clear that people with mental health issues are often not violent.
"I think what's important to recognise is that families and unpaid carers of people living with schizophrenia know that there's help available," Ms Clelland said.
"In the vast majority of cases there is no harm to other people, and people [with schizophrenia] are more likely to be at harm themselves, and that's predominantly through lack of access to appropriate supports at the right time."
She also said it's important for the public to remember that a lot is still unknown about the lead-up to the Bondi Junction attack.
"It's important not to make assumptions, because mental illness impacts everybody in very unique ways, so every single person's experience is different," Ms Clelland said.
'A systemic failure'
Within a year of coming off his medication under supervision, Cauchi was sleeping rough – moving between Toowoomba, Brisbane, and the Gold Coast.
During this time he had multiple interactions with Queensland Police including a street check on the Gold Coast last December, and although he was never charged or found guilty of a criminal offence, one incident stands out.
In January 2023, Cauchi called the police accusing his father Andrew Cauchi of theft after he took away a number of his US combat army knives and gave them to a friend to look after.
Mr Cauchi said he told the police about his son's mental health at that time before his son drove to Tweed Heads and bought another knife the next day.
The Queensland Police Service's Acting Commissioner, Steve Gollschewski, said no further action was taken after that visit.
"Police are not mental health experts," he said.
"They have to deal with things that are presented to them and what threat there was to the community, and at that time there was no clear threat to the community and no action that could be taken by police."
Police can also use an authority, called an Emergency Examination Authorities, to have someone assessed when they're having a mental health episode.
"That did not reach that threshold at that time," the acting commissioner said.
Dr McConnell said without being privy to the conversation between the family and police it's difficult to know whether the threshold was met.
However, he said this appeared to be a crucial moment when information should have been shared, either formally or informally, between the various Queensland authorities.
"There's a whole network of communication here and a safety net that he missed out on," Dr McConnell said.
"Part of that was the communication between the police and the public mental health services, but also that loss of the link between the public mental health services and community resources and the private sector and the family.
"And that's the missed opportunity … that's a systemic failure in this case."
Dr McConnell said he's personally had effective informal communication with police about patients.
The Queensland Police Service (QPS) and Queensland Health have an existing Memorandum of Understanding that outlines information sharing obligations.
It states that there are specific instances where a mental health intervention strategy can be developed to "reduce the likelihood of a Mental Health Incident from occurring" and "to better prepare both parties to respond if a mental health incident does occur."
It's unclear whether a strategy was in place for Cauchi.
The QPS declined to comment on specific questions about whether it shared any information with Queensland Health after their visit to the Cauchi family home, citing the ongoing NSW police investigation.
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