The Bondi Junction attack shocked millions. For people with schizophrenia, there was extra dread

Like millions of others in Australia and abroad, Cameron Solnordal watched the events of Saturday’s Bondi Junction attack in horror.

Having lived with schizophrenia since his mid-20s, Solnordal’s dread deepened as speculation swirled around the killer, 40-year-old Queenslander Joel Cauchi, and his diagnosis with the disorder as a teenager.

“I have schizophrenia, and I’d be trying to protect my family in that situation. I’d be running for my life … and I would be doing everything I could to stop someone bleeding to death,” Solnordal says.

Cameron Solnordal, who was diagnosed with schizophrenia in his mid-20s, has watched many negative stereotypes about people with the disorder play out this week. Credit: Simon Schluter

Cauchi’s father told police his son had schizophrenia and had recently stopped taking his medication. His mother said she believed something must have triggered him into psychosis.

NSW Police Commissioner Karen Webb said police would look at what role Cauchi’s history of complex mental health issues had played, but admitted they “may not ever get an answer”.

What we do know is homicide of strangers by people with severe mental illnesses is extremely rare (about one in 14 million people a year), and often combined with other issues such as drug and alcohol use and homelessness.

What is psychosis?

As Solnordal puts it, a person in psychosis is unable to distinguish between what is real and what is going on in their head. During an episode of psychosis, people can have delusions, they can hear, smell or see things that are not there, and can experience disordered thinking and behaviour, making up words or using them in inappropriate situations.

Some people believe these hallucinations and delusions are real, while others are aware they are experiencing the side effects of psychosis. There are some behavioural warning signs that can hint that someone may be in, or at risk of, psychosis. They may withdraw socially, become intensely enthusiastic about new or unusual ideas, or have trouble keeping on top of personal hygiene and housework.

Episodes can last anywhere from a few hours to many months, and manifest differently. “My state of psychosis, when I was in one, was that I thought everyone was out to hurt me,” Solnordal says.

There are many different reasons why someone might be in a state of psychosis. While it may be a symptom of a mental illness such as schizophrenia, bipolar, or post-traumatic stress disorder, it can also happen to people who will never be diagnosed with a disorder but may be struggling with issues such as sleep deprivation, drug and alcohol use, or the side effects of some prescription medications.

What is schizophrenia?

Where psychosis is one symptom of a broad range of conditions, schizophrenia is a chronic brain disorder that can only be confirmed by a psychiatrist once other factors have been ruled out. It affects about 1 per cent of the global population, and about 2.4 in every 1000 people in Australia.

Its exact cause is unknown, but it is probably influenced by a range of genetic, neurological and environmental factors.

Professor Ian Hickie, a psychiatrist and co-director at the University of Sydney’s Brain and Mind Centre, says two stages of development are crucial for determining a person’s risk of developing schizophrenia.

The first is in early development, when complications (a virus, for example) during pregnancy and early childhood can interfere with the normal maturation of the brain. These developmental issues may manifest in the later stages of the brain’s development, during puberty or early adulthood.

This is a particularly vulnerable time for those with neurodevelopmental issues or a family history of schizophrenia. Exposure to trauma during this time can precipitate psychosis and schizophrenia, as can drug use – a number of studies in Australia and abroad have found the use of cannabis and psychoactive substances, in particular, is associated with an earlier onset of psychotic illness.

“There are things that increase the probability, but it’s assumed that’s against the background of either a genetic predisposition or unusual brain development as a child,” Hickie says.

Solnordal started using marijuana in his teens as a way of dealing with a traumatic childhood which included institutional sexual abuse. “It was the only way I could deal with it,” he says.

Years later, bullying by a colleague tipped him into a mental breakdown which eventually led to his diagnosis.

How is it diagnosed?

There’s no one laboratory test to diagnose schizophrenia. Diagnosis is typically based on the persistent presence of key symptoms (hallucinations, delusions and disorganised speech) over at least six months. A psychiatrist must be satisfied the symptoms aren’t caused by another condition.

It took a while for Solnordal to find the right balance of medication, but he was back at work in 18 months (a result which surprised his doctors at the time). He has kept up his medication ever since, but says not everyone is in the position to be able to afford to maintain regular contact with a psychiatrist “when treatment is $400 an hour”.

Schizophrenia is more common in men, who are typically diagnosed in their late teens or early 20s when symptoms first appear.

Stella Dracos was 42 when she was diagnosed with schizophrenia.

Women tend to be diagnosed later. Stella Dracos, from Melbourne, avoided drugs and was always careful around alcohol after her mother was diagnosed with schizophrenia at the age of 33.

When Dracos turned 42, the stress of a marriage breakdown and the side effects of prescription medication sent her into a spiral. She started having delusions about spies bugging her house and doctors poisoning her food in hospital. “It was like I was living in a horror film, an absolute living nightmare,” she recalls.

Dracos tried to take her own life twice, had a seizure and was placed in a coma, but that still was not enough to let her doctors in on what was happening in her mind. It was only when she thought the police were coming to arrest her that she went to her GP “and spilled everything”.

“I still do cry about it because I worry about my children’s future, with a mother and a grandmother with the illness.”

How is it treated, and what happens when it isn’t?

Schizophrenia is treated with a combination of antipsychotic medication, psychological therapies and support programs that help people maintain social contact, physical health, work and accommodation.

Treatment can change throughout a person’s life, but schizophrenia is a lifelong condition. The longest Solnordal has gone without medication is four days, by the end of which his thinking had become disordered, making him question his reality.

“I can fall into a psychosis if I don’t take my medication,” he says. “The thing is, none of that psychosis is making me violent, none of that psychosis is making me think negative things. It’s making me afraid.”

Solnordal says understanding of complex mental health issues has improved in the past 20 years, and has reduced the barriers for young people to seek help. But he worries old stereotypes resurface, particularly in media coverage, when someone with a schizophrenia diagnosis commits a horrific act. “It’s like five steps forward and two steps back,” he says.

Rates of violent crime and homicide are higher among people with schizophrenia, but still rare, and often combined with other mental health issues and risk factors such as substance use and homelessness. The chances of stranger homicide are even rarer – about one per 14 million population per year, or one in NSW every two years.

People with schizophrenia are more likely to be the target of violence, says Dr Anna Ross, a mental illness stigma researcher at the University of Melbourne. A 2013 review found people with severe mental illnesses were between two and 16 times more likely to be victims of violent crime compared with the general population.

Despite the overall homicide rate dropping in NSW, a 2022 study found homicides involving people in psychosis had not.

Lead author Dr Olav Nielssen, a psychiatrist at St Vincent’s Hospital and professor of psychiatry at Macquarie University, says many people with complex mental health issues are bouncing between community health centres, homelessness services, GPs, prisons and emergency departments without any continuity of care.

Nielssen says the problem has been worsened by declining access to housing around the country.

“Homelessness makes it very difficult to look after people with severe mental illness unless they seek out services,” he says. “Housing is a treatment, and not having housing makes it very hard to treat people.”

If you or anyone you know needs help, call SANE on 1800 187 263 (and see sane.org), Lifeline on 13 11 14 (and see lifeline.org.au) or Beyond Blue on 1300 22 4636 (and see beyondblue.org.au).

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