It was at the end of the era of locked wards, strait-jackets and padded cells, electro-convulsive therapy and lobotomies. There was no really effective treatment of schizophrenia: patients in danger of self-harm or harm to others were cared for and protected in specialised wards.  

Photo: Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury. Pinel ordering the removal of chains from patients at the Paris asylum for insane women.- Wikipedia

However there are now psychotropic drugs which go far to relieve the symptoms and hallucinations that these unfortunate people suffer. 

With therapy, most are now able to lead productive and happy lives in the community. However many require supervision, as a lapse in treatment usually leads to a recurrence of symptoms: there is still no effective “cure”. 

The discovery of anti-psychotic drugs and mood-stabilizing drugs resulted in a shift in focus from containment in lunatic asylums to treatment in psychiatric hospitals, and eventually led to treatment at home or in less isolated institutions.

Photo- Picture of nurses on front lawn of Seacliff Lunatic Asylum, 1890. - Wikipedia

This reduced need for in-patient care has led to the closure of many residential Mental Health Units, such as we had at Sunbury and Bundoora. Multiple killers such as Hoddle Street shooter Julian Knight is incarcerated in the maximum security Port Phillip Prison in Truganina near Melbourne. Port Arthur shooter Martin Bryant is currently housed in the maximum-security Risdon Prison near Hobart. 

This raises some questions: how many out-patient schizophrenics receive adequate care and supervision? Is Joel Cauchi himself (and his family) victims of inadequate Mental Health Services? 

So I asked around our Hawthorn Rotary Doctors, and Kevin Rose added some thoughts:

But what is the solution? I do not believe that any health professional can assess and see the future of an individual’s action The individual may not even be consenting to assessment, and I believe we all have a right to go unhindered in our daily life. Access to support would be useful, but often the unwell person will not engage with family or professionals.

Unfortunately tragedies will continue to happen.

1,266 died on Australia’s road in 2023. We all know that this could be reduced to zero by adopting a speed limit of 10 Km./hour, but the society is not prepared to suffer the inconvenience. In the same way we cannot limit some members of our community from living their life.

Dr Billy Lugg gave some examples of two patients under his care who  are both chronically unwell, likeable in their own ways, nonetheless potentially dangerous. Fortunately, with good rapport, both agreed to higher intensity treatments that then require them to see a clinician once a week when out of hospital. Others may require long-acting injectable treatment (e.g. ECT, clozapine etc.) and a community treatment order (with the support of the office of the chief psychiatrist and the patient’s guardian) He believes this is the sort of care people like this, and the public, deserve.

In all, we agreed that the man involved in the Bondi stabbings appeared to have a chronic psychotic disorder with several risks (e.g. predilection for knives, guns, loneliness etc.). Based on the information available, he sounded like a man who deserved lifelong care.  We considered it to be highly possible, even likely, that he was a victim of inadequate care.  

There is a need for re-assessment of Mental Health Services, as the public don’t know much about it, and assume these (typically men) are getting appropriate care.

Photo - John Nash, an American mathematician and joint recipient of the 1994 Nobel Memorial Prize in Economic Sciences, had schizophrenia. His life was the subject of the 1998 book, A Beautiful Mind, by Sylvia Nasar.-  Wikipedia

Meanwhile, what can we do? Support Australian Rotary Health, of course:
ARH currently provides a number of types of support for mental illness research, including project grants, PhD scholarships and Post-doctoral Fellowships. In addition, it supports research into a wide range of other health problems with Funding Partner Grants, which involve Rotary Clubs raising money for a specific project and ARH providing matching support. ARH also supports students training as health professionals with Indigenous Health Scholarships, Rural Medical Scholarships and Rural Nursing Scholarships.
In addition to the important research on SIDS, ARH has provided funding for a number of projects that have had a practical impact on Australia or have received awards for their importance. These include projects on nutrition and mental health, clonidine added to psychostimulant medication for hyperactive and aggressive children, e-therapy for anxiety disorders, media reporting of suicide and mental health first aid guidelines.