Will the Nottingham inquiry help improve mental health services?

The Nottingham Inquiry has heard 57 days of evidence with the aim of obtaining a clear understanding of the events, acts and omissions that led to Valdo Calocane, who had a diagnosis of paranoid schizophrenia, killing three people and seriously injuring three others (see previous post). Closing submissions will be held in September. 

There are substantial rates of mental disorder in people convicted of homicide. But most perpetrators of homicide do not have severe mental illness or a history of contact with mental health services. There is therefore a danger in identifying the mentally ill in general as at risk of homicide. 

The campaigning by the families of the victims of the Nottingham attack to improve mental health services, as well as police services, is welcome. It is worth watching the beginning of the Channel 4 News podcast to understand their perspective. 

It does seem to me that services did not manage the initial presentation of Calocane well when he was a student at Nottingham University. He seems to have received a rather fragmented and dysfunctional input from mental health services leading to him eventually being discharged. This blog has highlighted this rather fragmented and dysfunctional nature of services for some time (see eg. previous post). The government has recently announced another call for evidence for a new mental health strategy to transform mental health care (see press release). 

The Nottingham Inquiry legal team has produced a review of mental health homicides from all publicly available independent reviews of mental health homicides since the conclusion of the Ritchie Report in 1994, together with information from an  a Inquiry questionnaire inviting friends and family to share their experience of mental health homicides. Data, therefore, depends on a case being subject to a publicly available report and/or being volunteered through the Inquiry questionnaire. 96% of cases were not subject to a CTO at the time of the homicide and 92% had never been subject to a CTO. 

I don't think the issue is really about CTOs. They were mistakenly seen as a way to reduce homicide and suicide by patients in mental health services. In many ways, mental health services are still facing the same issues about homicide by psychiatric patients as before Community Treatment Orders (CTOs) were first introduced (see previous post). The focus needs to be on improving services for people. Making them more defensive may well make them worse.