FFollowing the fatal stabbing of two University of Nottingham students and a school caretaker by Valdo Calocane in June last year, police initially affiliated with counter-terrorist officers as they searched for a motive. It soon became apparent that there was, in the normal sense of the word, no motive. Calocane had been diagnosed with paranoid schizophrenia three years earlier and had a history of violence when ill. Grace O’Malley-Kumar, Barnaby Webber and Ian Coates had the tragic misfortune of encountering him on such an occasion.
Nothing can bring those lives back now. But as the judgement of Calocane’s care and treatment by Nottinghamshire Healthcare NHS foundation trust makes it painfully clear that there were steps that could and should have been taken to reduce the risk of such horrors happening again. Analysing why they were not taken, and revising national guidance accordingly, will be fundamental to reducing the risk to public safety from similar cases in the future.
The Care Quality Commission (CQC) investigation found there were a series of “errors, omissions and misjudgments” by mental health services as they dealt with Calocane’s case from May 2020 to September 2022. During that period, during which he was admitted four times, the CQC found that warnings from family members about his deteriorating mental health were not adequately followed up, and that recurring episodes of violence did not lead to a review of treatment or management.
Risk assessments were patchy, inconsistent, understaffed and prone to over-optimism, the review found, given Calocane’s continued lack of understanding of the reality of his condition. Despite increasing failures to attend appointments and evidence that he was not taking his medication when out of hospital, Calocane’s preference for oral medication continued to be respected, when in-hospital injections would have better controlled his symptoms.
Sadly, Calocane was effectively allowed to withdraw from support structures in 2022, when the trust discharged him from mental health services on the grounds of his non-engagement. Damningly, the review notes: “Evidence throughout the course of (Calocane’s) illness and contact with services and police suggested beyond reasonable doubt that he would relapse into troubling symptoms and possibly aggressive… behaviour.” His next contact with medical professionals would be after the murders in June 2023.
These are alarming findings. Balancing the dignity and autonomy of patients with mental health problems with the requirement to act assertively in their own interests and those of the wider community is a complex and challenging task. It is made even more difficult when there is a lack of appropriate human resources, such as the CQC reported in March at an earlier stage of the investigation. In the case of Calocane, the wrong balance was found, with catastrophic consequences.
Lessons must be learned immediately. It may be that proposed changes to the Mental Health Act, announced in the King’s Speech, are now being reviewed in light of the CQC’s findings. In addition, as recommended by the review authors, tougher national standards for dealing with cases of complex psychosis and paranoid schizophrenia must be introduced, recognising what went wrong in Nottingham. Every effort must be made to ensure that the mistakes that made Calocane a threat to public safety are not repeated elsewhere.
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