‘Treatment resistant schizophrenia is uncommon, and general practitioners should not be expected to have thorough knowledge of this condition.’
Psychiatrists would have to hand GPs a defined set of clinical information before transferring care of a patient with chronic or treatment-resistant schizophrenia, under coronial recommendations the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has accepted.
The recommendations ask the RANZCP and the Royal Australian College of General Practitioners (RACGP) to develop a shared care guideline for chronic schizophrenia, with the RANZCP as lead organisation. One of them, directed to the RACGP, sets out in detail what that guideline should contain, including what it calls ‘minimum clinical handover standards’.
They followed the inquest into the deaths of six people at Westfield Bondi Junction in April 2024, and were handed down by NSW State Coroner Magistrate Teresa O’Sullivan on 5 February 2026.
No guideline has been published, and none has a date. In its formal response to the Coroner, lodged in June, the RANZCP said it would ‘explore’ the work with the RACGP and warned that progress ‘will be contingent on funding and support from the Commonwealth’.
What would have to change hands
The recommendations describe three points in a patient’s care and set out what the treating psychiatrist or specialist mental health team must provide at each. Most of the obligation sits with the specialist service.
When a GP takes on shared care
Once shared care of a patient with chronic or treatment-resistant schizophrenia ‘has been actively accepted by a general practitioner’, the specialist mental health team or consultant psychiatrist must give the patient, their carers and the GP:
- all relevant records from the public or private sector carer involved, including recent discharge summaries and specialist outpatient letters;
- information to assist with ongoing assessment of the current risk of relapse and other risks;
- the likely signs and symptoms of relapse; and
- the early warning signs and symptoms of relapse.
The recommendation describes these as ‘a shared responsibility’ between specialist services and general practice, requiring ‘appropriate and timely clinical handover’.
When the patient transfers to another GP
This is the section headed ‘minimum clinical handover standards’. On transfer, the current treatment team — specialist services, psychiatrist and GP — must explain to the patient, carers and the incoming GP that ongoing review by both a GP and a psychiatrist is needed, and prepare a comprehensive clinical handover letter covering:
- the patient’s current mental health status;
- the risk of relapse and any other risks at the time of discharge, including self-harm, suicide, homicide, access to weapons, driving and ability to adhere to medication; and
- the early warning signs and symptoms of relapse.
The patient receives a copy of the letter. The patient and, where possible, their family are also given contact details for support services and the options for psychiatric care.
When antipsychotic medication is stopped
A separate recommendation asks the RANZCP to write a professional practice guideline on deprescribing antipsychotic medication. Where a patient with treatment-resistant schizophrenia declines to stay on medication or is deliberately deprescribed, that guideline should require a written discharge letter on handover containing, as a minimum:
- a history of the patient’s illness and treatment;
- an overview of symptoms in the last six months of treatment;
- findings from the most recent mental state examination;
- the probability of relapse;
- advice as to early warning signs of relapse; and
- any relevant support persons available to assist the patient, with contact details.
The same guideline should advise that regular psychiatrist review belongs in the patient’s management plan.
What it means for GPs
The recommendations put the expert knowledge on the specialist side. Treatment-resistant schizophrenia is uncommon, they say, and GPs ‘should not be expected to have thorough knowledge of this condition’.
Specialist services would instead have to supply a definition of the condition, advice on the circumstances in which a GP can prescribe clozapine — which differ by state and must come with ongoing specialist support — an indication of relapse risk if medication stops, and advice about driving, heavy machinery and weapons.
Relapse risk would have to be given in a form a GP can use. The recommendation asks for it to be expressed concretely, ‘for example, expressed as an “extremely high risk” or by way of percentage’, along with the associated risks of harm to self and others.
GPs would carry an obligation of their own. The recommendation says the GP ‘should ensure that they liaise with specialist mental health teams/consultant psychiatrists to obtain advice’ on relapse risk, early warning signs and who to contact, and then pass that advice to the patient and carers.
The GP role is described as a substantial one: a key role in supporting patients with schizophrenia, and a role in early detection of prodromal symptoms, monitoring and preventing relapse, and treating the physical problems that accompany the illness and its treatment. The recommendation adds that this must be done ‘in conjunction with’ the patient’s specialist service.
What it means for psychiatrists
Effective care, the recommendation says, must be led by the patient’s specialist mental health service or consultant psychiatrist, ‘who commit to informing the patient, carers and the patient’s general practitioner to assist them to provide care in the collaborative framework effectively’.
It also asks for ‘a clear understanding that a psychiatrist should be involved in the ongoing management of patients with chronic schizophrenia’, and that the specialist service review the patient ‘at regular intervals appropriate for each patient in collaboration with the patient’s general practitioner’.
On medication, the recommendation states a preference plainly: it is preferable for people with treatment-resistant schizophrenia to remain on medication, and those who have relapsed after stopping should be advised to stay on it indefinitely.
The deprescribing guideline would go further than the letter. It should also cover advice to the patient on relapse risk and its cumulative effect, how to recognise early warning signs, a contingency plan with pathways to care, who to contact, and how to educate family and friends to recognise the signs.
Where the recommendations came from
The inquest examined the psychiatric care of Joel Cauchi, who had been treated for schizophrenia for years. He came off clozapine and then off antipsychotic medication entirely, moved interstate, and was no longer under psychiatric care at the time of the attack.
The RANZCP said the findings pointed to ‘fragmented service delivery, prolonged disengagement, gaps in continuity of care and insufficient integration across mental health, primary care, justice and community safety systems’, and that these were sector-wide structural risks rather than isolated weaknesses.
‘The overwhelming majority of people living with schizophrenia or other severe mental illnesses are not violent and are far more likely to experience harm than to cause it.’
RANZCP response to the Coroner, June 2026
The College accepted the recommendations directed to it on the day the findings were handed down, with President Dr Astha Tomar calling for ‘clearer shared-care frameworks between psychiatrists and GPs’ as part of wider system reform.
Timing depends on funding
The RANZCP’s formal response, lodged in June 2026, says the College will liaise with the RACGP and the Australian College of Rural and Remote Medicine to ‘explore collaborative development’ of a shared care guideline.
On deprescribing, it says it will advocate for Commonwealth funding for a new guideline and, in the meantime, ‘explore development of practical interim clinical guidance’. It makes the same funding point about a new clinical practice guideline for schizophrenia, which it wants accredited by the National Health and Medical Research Council.
The RACGP’s own response had not been published on the NSW Department of Communities and Justice register at the time of writing.
Case conferencing already funds the conversation
The recommendations cover two kinds of contact. One is the written record — the letter, the summaries, the risk statement. The other is direct liaison between the GP and the psychiatrist about a particular patient, which the recommendations ask for in several places.
That second kind is already funded. Multidisciplinary case conferencing has been in the Medicare Benefits Schedule for years, and the mental health family of items covers exactly this arrangement.
- A GP can organise and coordinate a mental health case conference (930 / 933 / 935) or participate in one organised by someone else (937 / 943 / 945).
- A psychiatrist can participate (961 / 962 / 964) or organise one (946 / 948 / 959). For a community case conference rather than a mental health one, the organising items are 855 / 857 / 858 and the participation items 825 / 826 / 828.
- Eligible allied health practitioners participate on 80176 / 80177 / 80178. Explanatory note MN.3.2 defines the eligible categories, which take in psychologists, mental health nurses, occupational therapists and social workers.
A case conference needs at least three participants. Explanatory note AN.0.49 counts a maximum of two medical practitioners towards that minimum, so at least one member must not be a doctor. A GP and a psychiatrist alone does not meet the requirement; a community mental health nurse, psychologist or social worker already involved in the patient’s care does.
The same note says all Medicare eligible patients are eligible for the service, and a care plan is not a prerequisite. The schedule sets three duration bands and leaves duration, frequency and team composition to the convening practitioner.
A case conference does not replace the written record, and nothing in it satisfies the handover standards described above. It funds the discussion that sits alongside them.
About Conference.care
Conference.care is an Australian platform for running Medicare-funded case conferences. The convening clinician organises the conference and claims the item; the platform handles the arrangements around it, including bringing a team together and rostering it to suit the patient, consent and paperwork, and a browser-based secure video room.
Where a patient already has treating clinicians, the GP names them and invitations are sent. Where a clinically indicated discipline is missing, a clinician is introduced for the conference. Participants advise the convening clinician and do not take over the patient’s care. Further detail is on the allied and mental health, case conferencing and who can attend pages.
Sources
- NSW Coroners Court. Inquest into the deaths at Westfield Bondi Junction. Findings of State Coroner, Magistrate Teresa O’Sullivan, 5 February 2026. Recommendations 3, 4 and 6 carry the shared care material quoted above; reproduced in full at dcj.nsw.gov.au.
- Royal Australian and New Zealand College of Psychiatrists. Bondi Junction Inquest: RANZCP accepts recommendations and calls for system reform, 5 February 2026. ranzcp.org.
- Royal Australian and New Zealand College of Psychiatrists. Bondi Junction Inquest Response, June 2026 (PDF). dcj.nsw.gov.au.
- Australian Government Department of Health and Aged Care. Medicare Benefits Schedule — item descriptors and explanatory notes AN.0.49 and MN.3.2. Item numbers above link to their entries on MBS Online.
General information for clinicians, current at the date of publication and drawn from the primary documents listed above. It is not clinical, financial or legal advice. The standards described are coronial recommendations accepted by the RANZCP; no guideline has been published. Item numbers and explanatory notes are as published in the Medicare Benefits Schedule and should be checked against the current schedule before claiming. Conference duration, frequency and composition remain clinical decisions for the coordinating practitioner. Readers who need support can contact Lifeline on 13 11 14.