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The cases of Valdo Calocane, who stabbed to death three people in Nottingham in 2023, and Axel Rudakubana, who knifed three children to death and injured many more in Southport in 2024, have generated intense but baffled fury about why individuals with such dangerous track records were allowed to roam the streets before murdering their victims.
Devastated families of the dead understandably want somebody held responsible for the loss of those they loved. But we already know in some detail what went wrong and that individuals made culpably wrong decisions. But blaming everything on them simply evades seeking to mitigate or resolve the crisis in the UK’s mental health care.
‘Couldn’t care less in the community’
Over the last half century mental asylums have closed one after another to be supposedly replaced by “care in the community”. Speaking of this, the detective story writer PD James, an administrator in the NHS whose husband was a long-term patient in a mental health hospital, remarked bitterly that “it could best be described as absence of care in a community still largely resentful or frightened of mental illness”. A former health minister, John Hutton, said a better name for it would be “couldn’t care less in the community”.
These are not merely academic questions. Criticism of the NHS treatment of Calocane focuses on the degree to which he was allowed to make judgements about his mental illness, though he denied being ill. Jeremy Coid, professor of forensic psychiatry at Queen Mary University of London, says that mistakes in Calocane’s treatment include “allowing him to disengage from services at times when he was too ill to make rational decisions and when he was paranoid and suffering from acute symptoms”.
The problem is that joining up the dots retrospectively of a mentally ill person’s behaviour before they go on to kill gives a misleading impression of blameworthy failure to detain an obviously dangerous person before they do harm to others.
Psychiatric doctors come under intense pressure from hospital managers to discharge patients prematurely in order to free up desperately needed beds.Many changes suggested for the NHS’s mental health system contained in a new Mental Health Bill now passing through Parliament have the potential to make a badly flawed system even worse, says Professor Coid. He believes that “psychiatry is in a terrible state in the UK”, pointing to a shortage of 13,300 nurses and 963 consultants.
Chronic shortages of staff
My own experience of the NHS mental health system, gained while looking after a relative suffering from schizophrenia, is that the new bill is unrealistic. The problem for many trying to do their best for a sick family member is that they cannot get them into a hospital where they will be safe. A century ago people might be incarcerated for far too long, but today the problem is precisely the opposite and they are discharged too early, often making way for “discharged failures”, who left hospital too early for their treatment to work.
The frightening real world of psychiatric care in the UK is best understood by looking at a timeline drawn up by the Care Quality Commission detailing Valdo Calocane’s [VC] interactions with mental health services in Nottingham on a single day, 22 October 2021, after he had been discharged from hospital:“VC’s family contacted the EIP [Early Intervention in Psychosis] team expressing dissatisfaction at not being informed that he was being discharged. The discharge happened on a Friday with no crisis home treatment team input arranged over the weekend. The EIP team attempted to make a referral to the crisis resolution and home treatment team but they were unable to accept VC due to capacity due to an ‘influx in GP referrals over the weekend’.”
Some of the best, most committed people in Britain work for NHS mental health – but it is a system set up for them to fail.
Further thoughts
A Turkish writer friend told me an anecdote about themselves at that time which perfectly illustrates the anxiety that many feel in this type of increasingly authoritarian state.
Then the passport official popped up beside my friend and said: “I really like your writing. Could I have a selfie with you?” The writer gave a sigh of relief and agreed, but in that moment decided that “if one of my fans almost gives me a heart attack, I can’t stay in Turkey any longer”. They left the country soon afterwards and, so far as I know, have never returned.
These are not classic dictatorships and they do have real elections, but the full weight of the state is deployed to skew the election result towards a cult-like leader and his ruling party by control of the media, state bureaucracy and state money. Once firmly cemented into power by these advantages, regimes become difficult to evict.
The US federal government has two million employees and an annual budget of $7trn (£5.5trn). Once weaponised in favour of the ruling party these will be difficult to resist and opposition will be marginalised; “politics becomes like a soccer match in which the referees, the groundskeepers, and the scorekeepers work for one team to sabotage its rival”. The winner of the game is not in doubt.
The best account of European humiliation that I have read is by Mukul Kesavan in India’s The Telegraph Online.
Cockburn’s Pick
At a moment when there is so much under-informed discussion about mentally ill people making murderous attacks at random, the best book I have read relating to the subject is What We Fear Most: A Psychiatrist’s Journey to the Heart of Madness by Ben Cave.
This is Dispatches with Patrick Cockburn, a subscriber-only newsletter from The i Paper. If you’d like to get this direct to your inbox, every single week, you can sign up here.
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