A man who went on a stabbing spree in an urban shopping centre had been worried years before that his mental health would deteriorate.

Joel Cauchi, 40, armed himself with a pigging knife when he launched his unprovoked attack at Sydney’s Bondi Junction Westfield in April 2024.

He killed six shoppers and injured 10 others during a psychotic episode before he was shot dead by NSW Police Inspector Amy Scott.

His later behaviour, when he killed multiple shoppers, was “incongruous” with how he appeared earlier, the nurse said.

She was shocked and had a visceral reaction when she heard the news of the tragedy.

“I vomited when I saw that it was him,” the nurse told the court.

“It really doesn’t make any sense.”

The nurse mentioned she hadn’t come across anyone being withdrawn from clozapine, an antipsychotic medication that Cauchi was taking, without being transitioned to another medication.

In February 2020, his mother spoke to the nurse regarding her concerns about his mental health and ability to take care of himself.

By that stage, he had moved to Brisbane and his apartment was a mess.

When confronted about it by his father, Cauchi became irritable and swore, the coroner has heard.

The nurse said that this was out of character.

However, she initially assumed the issues arose from the challenges associated with someone leaving their home for the first time, particularly an individual who was mentally underdeveloped.

She said she was “shocked” that patients discharged from psychiatric clinics were sent back to their GPs to find further mental health support.

Rather than continuing the same approach, she suggested adopting the Care Programme Approach used in the UK, where individuals receive follow-up care and are assigned a case worker once they are discharged from a clinic.

Readers seeking support can contact Lifeline on 13 11 14 or beyond blue on 1300 22 4636, Suicide Call Back Service on 1300 659 467 or MensLine Australia on 1300 78 99 78.