For those who have dealt with mental health services for many years, the circumstances of the man who killed six people at Westfield Bondi Junction are not unique.
While many details are still to be clarified and a major coronial inquest will be conducted, the man who carried out the stabbing attack has been identified as .
In a statement Cauchi's family said he had battled mental health issues since he was a teenager, with reports that he had been diagnosed with schizophrenia at 17 years old.
According to police, Cauchi was thought to be homeless, and he had moved to Sydney from Queensland in March.
NSW Health Minister Ryan Park told ABC's 7.30 program the government had so far not been able to find any interactions between Cauchi and the state mental health system.
His parents told reporters on Monday that Cauchi had been in the care of doctors in Queensland for around 18 years but had gradually come off his medication.
It is too early to draw conclusions about the factors that contributed to Cauchi's attack and Sydney University professor of psychiatry Anthony Harris said details of his mental state and whether there were other contributing factors, such as substance abuse, at the time of the attack had not yet been established.
But Harris said some aspects of Cauchi's situation could reflect the lack of resources in the mental health system in general. He said it's possible for schizophrenia to be well managed so people can work and live happy lives.
"The fact that we see things like (the Bondi Junction attack) happen, reflects a system which has allowed this gentleman to drop out of regular care and to lose contact with both family, community and a mental health system that should have been able to support him," he said.
Harris said the lack of resources meant the focus in the system was on treating the most unwell and responding to crises, rather than on keeping people well.
"There are very few other illnesses in our community where the most unwell people are left to fend for themselves in the community," he said.
"Mostly, if someone is severely unwell they receive a high level of care. Unfortunately for many people with mental illness, our most severely unwell people are left in disorganised states in the community with very few resources. This needs to change."
Mental health services in 'dire straits' due to lack of funding
Last year an Australian Institute of Health and Welfare (AIHW) report found mental health issues made up about 15 per cent of NSW’s total burden of disease, but its funding only equated to around 6.5 per cent of the health budget.
National Mental Health Consumer Alliance chair Priscilla Brice said funding should be increased to a level proportionate to the burden of disease.
"Every service that I can think of is crying out for more help," Brice told SBS News.
"We cannot support the number of people who really need mental health support in NSW."
Brice said mental health services in NSW were "very poorly funded" and, on a per capita basis, the state was doing a worse job than most other jurisdictions.
We cannot support the number of people who really need mental health support in NSWNational Mental Health Consumer Alliance chair Priscilla Brice
AIHW data from 2021/22 showed NSW spent $2.2 billion on government-funded mental health services, equating to $268 per resident.
Only Queensland had a lower per capita spend of $263. The Northern Territory had the highest spend of $421 per person, while the federal government contributed around $472 per person nationally.
Per capita spending on state and territory mental health services. Source: SBS News
Seeing a specialist could also be expensive, especially after the federal government's decision to reduce the number of funded psychologist visits down from 20 to 10 a year.
Brice said the full out-of-pocket cost for a psychologist could range from around $180 to $230 per session. It could also be difficult to find an expert who had available appointments, especially in rural or regional areas.
"Many clinicians have closed their books to consumers," she said.
"I would say we are in dire straits right across the country."
NSW Minister for Mental Health Rose Jackson said the government knows there are gaps in the system.
"We remain committed to doing everything we can to ensure we are providing accessible support for those experiencing a mental health crisis," she said.
New South Wales Mental Health Minister Rose Jackson says the government is aware there are gaps in the system. Source: AAP / Mick Tsikas
Jackson said NSW Health would undertake a review this year to understand what investment is required to comprehensively meet the mental health needs of people in NSW.
"Part of that work includes conducting a gaps analysis review to rapidly identify key priority areas and agreed gaps in the NSW community mental health system and introducing legislation for a whole-of-government approach to suicide prevention," she said.
"It’s important to recognise most people living with mental illness are not dangerous and violent. These terrible instances are very rare."
'Ramshackle' system of care letting down the most vulnerable
Professor Anthony Harris said a recent royal commission into Victoria's mental health system indicated the need for better services was a national problem.
"Put simply we're not supporting people in the community with severe mental illness," he said.
"The system of care is ramshackle and poorly coordinated, and has been deteriorating for years."
NSW resident Dorothy Cross, whose husband has schizophrenia, said the support of family and professionals was often crucial to ensuring someone's mental health did not deteriorate once they left a hospital's psychiatric department.
The system of care is ramshackle and poorly coordinated, and has been deteriorating for yearsProfessor Anthony Harris
"It is common with schizophrenia but also other mental illnesses, that once you take medication for a while and you start to feel better, you may stop taking that medication, especially if you don't have the support network to continue to hold you accountable," she said.
"If you have a mental illness that's not treated and you can't hold employment — you cannot pay your bills — that leads to homelessness."
Cross said those with more serious conditions like schizophrenia also needed to see a psychiatrist — whose appointments were not covered as part of the federal government's 10 free psychologist sessions — in order to be prescribed medication.
Patients must also pay for this medication, and it can take a lot of trial and error to find the right treatment.
She said those waiting for an appointment in the public system can face waiting periods of six to 12 months.
More funding needed
Harris said funding for community mental health teams in particular was needed. These are generally run by not-for-profit organisations.
He said these teams would usually be assigned to look over someone discharged from a psychiatric unit but they were so poorly resourced, patients were often put in the care of their local GP instead.
"GPs often don't have the skills or the resources to care for people with severe mental illness," he said. "(They) frequently don't follow people up well (if) they haven't turned up for care."
Prime Minister Anthony Albanese told ABC Radio National on Monday the government was looking at mental health issues as part of its efforts to strengthen Medicare and the health system.
"We provided some $586 million for mental health and suicide prevention in our last budget," he said.
"This is an issue which we need to deal with. You can never do enough in an area like that. There's no question about that.
Prime Minister Anthony Albanese says the government is looking at funding for mental health issues. Source: AAP / AAP
'Most people with schizophrenia are not violent'
Cross said with the right mix of medication and therapy, people with schizophrenia could work and live a normal life.
"Most people with schizophrenia are not violent people and would not harm other people," Cross said. "They are more likely to harm themselves or have harm or crime committed against them because they're not aware always of the reality of a situation."
She said the longer someone with schizophrenia was left undiagnosed, the worse the illness could become and it could be harder to communicate to them that they need help.
Events like the Bondi Junction stabbing left those with schizophrenia scared to tell others they have the condition, she said.
"(They) can be quite ashamed of that diagnosis."
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