A man who stabbed a paramedic to death in an unprovoked attack has been found not criminally responsible for the fatal act on mental health grounds.

Jordan James Fineanganofo admitted stabbing 29-year-old paramedic Steven Tougher 55 times outside a McDonald’s in Campbelltown, in south-west Sydney, early on April 14, 2023.

The 23-year-old pleaded not guilty to murder on the grounds of mental health impairment and a NSW Supreme Court judge on Friday found the elements of the defence had been established.

“I accept the psychiatric evidence on the balance of probabilities that the accused suffered from a mental health impairment,” Justice David Davies said.

“That mental impairment had the effect that the accused did not know that his actions were wrong.”

Prosecutors agreed to a special verdict of “act proven but not criminally responsible” being appropriate for Fineanganofo, who said he had heard voices in the lead-up to the attack.

Forensic psychiatrist Kerri Eagle, who was engaged by the prosecution, found Fineanganofo was suffering from a psychotic illness at the time, consistent with a relapse of schizophrenia.

Eagle said he was aware enough to know what he was doing but could not properly reason that it was wrong due to his mental state.

Crown prosecutor Ken McKay SC previously told the court the killer had no interaction with Tougher before the chilling attack, which lasted close to four minutes.

Tougher tried to push Fineanganofo away but was unable to, saying, “What are you doing? Stop stabbing me mate.”

Despite the efforts of several people to help, Fineanganofo kept stabbing Tougher, walking away several times before returning to inflict more wounds on the NSW Ambulance worker as he lay on the ground.

Following his arrest, Fineanganofo reported auditory hallucinations in the form of various voices, including his own, telling him to kill himself and others.

He said the voices had increased in intensity over the past month and on that day he had been unable to cope with them, prompting him to attack a random member of the community.

Fineanganofo also pleaded not guilty on mental health grounds to a string of related charges over alleged incidents in nearby suburbs in the days before killing Tougher.

They included intimidating a woman who was pushing a stroller with a five-month-old baby, threatening several men at a service station and swinging a knife at a man during a roadside incident, piercing his jacket but not his skin.

Fineanganofo was remanded in custody after the verdict. A hearing was set down for Thursday to make further orders.

As he was led from the court, several people yelled out from a large group of Tougher’s family and supporters.

“You chose not to take your medication,” one person said.

“You’re the demon.”

Outside court, Tougher’s father Jeff read a statement, saying the family was “appalled” by Friday’s ruling.

“Steven has been lost in this deeply flawed and broken process,” he said.

Jeff Tougher said two forensic psychiatrists had delivered opinions that ultimately led to Friday’s verdict.

“These opinions were never tested in court, and the two psychiatrists responsible for this deeply offensive decision have not even set foot in the courtroom. Steven’s killer got away with murder,” he said.

Supporters of Fineanganofo’s family were also in court on Friday, sitting in a separate section of the public gallery. Outside, one person simply said, “We’re sorry”.

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-with AAP