A man who stabbed paramedic Steven Tougher to death outside a McDonald’s appeared to be in a trance and may have been experiencing a psychotic episode, a court was told.

Tougher was stabbed 55 times while on a break during a shift in Campbelltown, south-west Sydney, in the early hours of April 14, 2023.

Jordan James Fineanganofo, 23, admitted stabbing the 29-year-old to death but pleaded not guilty to murder by reason of deteriorating mental health, at the start of what was expected to be a six-week trial in the Supreme Court of New South Wales on Monday.

The court was told prosecutors had agreed to back a mental health verdict if Fineanganofo signed a statement of facts admitting the physical elements of the crime, which was captured on CCTV.

Instead of continuing with the trial, Judge David Davies adjourned until Friday to consider whether the mental health defense was justified.

Screams of pain echoed among relatives as the court was told details including that Fineanganofo did not say a word as he approached and began stabbing Tougher in a chilling attack that lasted about four minutes.

Fineanganofo bowed his head and covered his face as details of the murder were read in court.

Crown prosecutor Ken McKay SC said Tougher was unable to escape because he was trapped between the back of the ambulance and his attacker.

Mr Tougher tried to push Fineanganofo away but couldn’t and said: “What are you doing? Stop stabbing me buddy.”

Despite the efforts of several people to help, Fineanganofo continued stabbing Mr Tougher, walking away several times before returning to cause further injuries as the NSW Ambulance worker lay on the ground.

At one point, Fineanganofo told Mr Tougher: “Apologize to me.”

“Sorry, buddy, whatever you think I’ve done,” Tougher responded, seriously injured but still conscious.

Passerby James Arthur ran in an attempt to help, kicking Fineanganofo and yelling at him to stop.

“They’re going to kill him,” Arthur said, the court was told.

In response to appeals from another bystander, Fineanganofo reportedly said: “I’m going to go to jail anyway, I might as well kill him” or “I have to kill him because I have to go to jail.”

Fineanganofo also pleaded not guilty by reason of mental health to a series of charges related to alleged incidents in nearby suburbs in the days before Tougher’s murder.

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

Fineanganofo’s lawyer, AJ Karim, said the defense’s position was largely identical to that of the prosecution, including that the physical acts of the crimes had been committed.

The prosecution and defense hired psychiatrists who agreed that Fineanganofo could argue that he knew what he was doing but didn’t know it was wrong.

Forensic psychiatrist Kerri Eagle, hired by the prosecution, determined that Fineanganofo had a mental health problem at the time of the crime and exhibited signs and symptoms of a psychotic illness consistent with a relapse of schizophrenia.

Dr Eagle noted witness evidence describing Fineanganofo as “trance-like, quiet, mumbling, smiling and strange”, the court was told.

McKay said Fineanganofo had previously been accused of assaulting a neighbor in 2021, but instead of being prosecuted, he involuntarily entered treatment for mental health issues.

Hospital records indicated at the time that Fineanganofo had been isolated within his family home for a year with minimal interactions with others, becoming increasingly paranoid of people, including his family.

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