Dr Russ Scott1
1West Moreton Mental Health Service, Australia
Biography:
As the first forensic psychiatrist accredited by the RANZCP, Russ Scott has been a consultant psychiatrist to community forensic outreach services and acute inpatient units at Thomas Embling Hospital, Melbourne and the High Security Inpatient Services at The Park – Centre for Mental Health, Wacol. He is a past president of both the Medico-Legal Society of Queensland and ANZAPPL (Qld). In 2023 he was appointed Clinical Associate Professor, School of Medicine, University of Queensland and he is the medical issues section sub-editor of the Journal of Law and Medicine. He is currently employed by the West Moreton mental health service.
Abstract:
On 13 April 2024 Joel Cauchi stabbed multiple victims in the Bondi Junction shopping complex. The subsequent coronial inquest considered a number of issues including:
-The management of Cauchi's mental health in Queensland, including the decision to reduce and ultimately cease his anti-psychotic medication
-The discharge process in early 2020 and information the private psychiatrist provided to the general practitioner
-Gaps in the Queensland mental health system that allowed Cauchi to be effectively without treatment or adequate supervision for nearly five years
The first speaker will provide context by reviewing the chronology to the mass murder.
The second speaker will expound on the evidence-based clinical definitions of “full remission” and “treatment-resistant schizophrenia” before discussing the incidence of “treatment-resistant schizophrenia” after a ‘first episode’ psychotic disorder and after a diagnosis of ‘paranoid schizophrenia.’ After reviewing the evidence-based treatment for “treatment-resistant schizophrenia” and augmentation of clozapine, the second speaker will outline a protocol for treatment with clozapine and also the regime of monitoring (including frequency of reviews by a psychiatrist) of a patient with “treatment-resistant schizophrenia” who has ceased clozapine.
The third speaker will consider what information a private psychiatrist in the community requires when a public mental health service discharges a patient for follow-up and the difficulties experienced in private practice in managing "treatment-resistant schizophrenia" particularly in instances when the patient wants to cease clozapine or declines to attend follow-up appointments. The symposium will conclude with a discussion of some of the recommendations made by the NSW coroner.