Joan Hoggett suffered 29 knife injuries during a frenzied 50-second attack in the One Stop Shop in Sea Road, Fulwell.
Ethan Mountain was wearing a horror mask and had his hood up when he attacked the 62-year-old on September 5, 2018.
Police and paramedics fought to save her but she was pronounced dead at Sunderland Royal Hospital shortly before midnight.
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Nineteen-year-old Mountain accepted responsibility for her death and was made subject to an an indefinite detention order at Newcastle Crown Court in March 2019.
Mountain, of Heaton Gardens, South Shields, had originally been accused of Mrs Hoggett’s murder but a judge directed the jury to find him not guilty after both prosecution and defence teams accepted he was suffering an abnormality of mind at the time of the killing, which impaired his responsibility.
Sunderland senior coroner Derek Winter opened an inquest shortly after Mrs Hoggett’s death but adjourned it while the court proceedings were under way.
The pandemic has meant further delays but it resumed in the Coroner’s Court at City Hall on Tuesday, August 3.
The hearing was told Mountain had been referred to mental health services and had entered hospital, initially voluntarily, in June 2017.
His condition had deteriorated and he had been sectioned in July, but was released into the community in August with support from Cumbria, Northumberland and Tyne and Wear mental health trust’s early intervention team.
In February 2018, he had requested a reduction in the dose of his anti-psychotic medication. Psychiatrist Dr Tibor Kovacs told the hearing he had advised against reducing the dosage, but as Mountain was an adult and held to be legally competent to make the decision, the team had no power to oppose the move.
They had agreed to cut the dose as the lesser of two evils: “The concern was that it was quite likely he would stop taking anything completely,” said Dr Kovacs.
Asked by barrister Zara Walker, on behalf of Mrs Hoggett’s family, if he had been worried about the reduction leading to a recurrence of Mountain’s problems, Dr Kovacs said even a very low level of medication would still have been helpful: “I was not massively concerned about relapse,” he said.
"My big concern would have been if the medication was stopped. We were happy we were able to manage to negotiate some continuation of the medication.”
The hearing was told Mountain’s mother had said he should not be allowed to reduce his medication: “There were no concerns about his ability to make a decision and the team had no authority to force him to take more than he was willing to do,” said Dr Kovacs.
Mountain had started to miss appointments and the last time he had been seen by a member of the team was on April 11.
Efforts to arrange further appointments had been unsuccessful, with the situation aggravated by the unexpected absence of the team’s care co-ordinator.
Asked by Miss Walker if Mountain’s ‘disengagement’ should have triggered a fresh risk assessment, Dr Kovacs replied: “I think that is a bit beyond the scope of my work.”
An appointment had been arranged but was not due to be held until October.
"I wish there were more contact from more professionals,” said Dr Kovacs. “I would say it was not an ideal situation.”
The inquest heard Mountain had told police he had stopped taking his medication shortly before the attack on Mrs Hoggett, and Dr Kovacs was asked what effect that would have.
"It is very, very difficult to predict what would happen,” he said.
"In the majority of cases, people are okay for a while and they just live a normal life for a while. A minority of people would have no relapse.”
Before today’s hearing began, Mrs Hoggett’s daughter Michele Young read a pen portrait of her mother on behalf of the family.
"My mam lived with Rob, my brother, and Jack, my step-dad,” she said.
"Jack died a number of years ago and was a kind, caring man and she used to describe him as her soul-mate.
"She always said she didn’t brag to work friends about all the things she was proud of regarding her children and step-children, who were more like close friends to her.
"We all loved and respected her. She used to say she saved Jack, she got him up in the morning and get him going after being on his own for so long.”
Family had been the most important thing in Joan’s life: “For as long as were were kids, my man’s favourite thing to do on a Saturday would be to visit her nieces and nephews with boxes of cakes. She would love watching and smiling as everyone decided which cream cakes to choose.
"Christmas was my mam’s favourite time of the year. Each present was wrapped like it was the most fantastic and best gift.”
Joan had been an excellent cook: “Even the simplest of meals looked like Jamie Oliver had prepared it. I was always impressed.
"She had worked in the school kitchens and progressed to being a supervisor as both myself and Rob were growing up.”
"Somehow she always knew if we had eaten our dinner, even though she was in a different school.”
Ms Young told the court: "My mam was shy and reserved a lot of the time. She was also a very smarty-dressed, intelligent woman. I loved her neat handwriting.
"She worked hard all her life, She had had to look after her younger siblings when she was a child and then she had two children herself but she always helped others and cared for people. Mind you, she wouldn’t put up with any stupidity.
“Mam was always fair but firm and loved her family and friends.”