A series of murders has put a spotlight on the adequacy of mental health care in Britain

Although the full picture of the Hainaut attack is not yet clear, initial briefings from the Metropolitan Police were clear: a key investigation topic, in terms of possible motives, was whether the suspect has a history of mental health problems.

If police suspicions are correct, the tragedy could prove to be the latest in a series of high-profile killings that have focused public attention on the adequacy of mental health care.

These include the horrific random murders of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in Nottingham in June 2023 by Valdo Calocane, who had been diagnosed with paranoid schizophrenia but who had been “off medication and contact for almost 12 years had with psychiatric services”. months” when he carried out the attacks.

That case bore worrying similarities to that of Zephaniah McLeod, who stabbed 23-year-old Jacob Billington to death and injured seven others in Birmingham in September 2020. McLeod had been diagnosed with schizophrenia but was left unsupervised despite being delusional and refusing to take medication. .

One this month research in Swansea found serious failings in the NHS care of Daniel Harrison, who murdered his father, Dr Kim Harrison, in March 2022 after escaping from the hospital where he had been held under the Mental Health Act after being diagnosed with paranoid schizophrenia .

An internet search for similar incidents in Britain turns up many more recent cases: reports of attacks and arrests, court hearings and inquest findings. Julian Hendy, from the charity One hundred familiessays these are all examples of problems with psychiatric care that are not being taken seriously enough – until it is too late.

Each tragedy is shocking and horrific in its own way, although there are common themes: medical supervision is often haphazard or minimal; warnings about the perpetrator’s behavior (often from family members) are ignored; police and health services fail to share vital information; and substance abuse is often a factor.

“The perpetrators are often people who are dangerous when they are not feeling well, and who may not want or cannot access care,” says Hendy. “They are not getting the right treatment. And they often only receive the treatment they need after the event (the attack or murder).”

Hendy founded Hundred Families after his father was murdered in Bristol in 2007 in an unprovoked attack by a psychotic man known to the local mental health service. It provides support to families following mental health-related killings and advises the NHS on what it can learn from such tragedies.

Hendy states that far too many so-called patient murders take place. Although robust, up-to-date figures are not available – NHS funding for this research was halted in 2019 – he estimates that of the approximately 600 murders in Britain each year, on average 10 to 20% involve a killer who is mentally ill .

A study by London’s Violence Reduction Unit into 50 murders selected by researchers from Metropolitan Police files found that mental illness was a “key factor” in 29 cases. It said most killings were “potentially preventable”. Some killers had withdrawn from treatment and others had untreated mental health problems, it emerged.

Although the number of overall homicides has decreased in recent years, there is a to get up in the share associated with serious conditions such as schizophrenia-related disorders.

Prof. Seena Fazel, from the University of Oxford, says that people with schizophrenia are at increased risk of violent and homicidal behavior. He says that in Britain about 35 murders a year are committed by someone with schizophrenia. Most victims are family members, while the risk of being killed by a seriously mentally ill stranger is one in fourteen million. Prevention is key, and high-quality and consistent medical support would lead to a 50% reduction in these crimes, Fazel estimates.

Hendy argues that NHS mental health services need to be more proactive and ‘assertive’ when treating seriously ill people who are at risk of harming others. Issues surrounding patient consent should be discussed. Above all, he says, “proper care and treatment” is crucial if we want to prevent violence and killings.

Meanwhile, NHS mental health services are struggling to cope with resource shortages and increasing demand for care. The Care Quality Commission, the NHS’s healthcare regulator, said last year that there had been one “remarkable decline” in the quality of care provided by specialized mental health care.