How many must die before we learn about the murders of the mentally ill?

There they stood “separated, elegant, impressive, covered by a huge water tower and combined chimney, which rises in a clear and terrifying manner outside the country”. Enoch Powell’s description of the horrors of the Victorian asylums that filled the country until the 1960s heralded the rapid adoption of a policy known as “social care”.

Valdo Calocane, who killed three people in Nottingham last year, was someone who in the past should have been treated in a safe place for paranoid schizophrenia. He was sometimes segregated under the Mental Health Act but in reality he was expected to live in the village, under the care of mental health professionals who had to make sure he was on medication. required.

When the system breaks down, as it did with Calocane, the consequences are dire. A report from the Care Quality Commission has listed a series of common failures and poor decisions by those charged with dealing with people who may be a danger to themselves and others.

Community care represented the biggest political change in mental health in the history of the NHS. It was a process of social change, a political movement, and a movement away from the isolation of mentally ill people towards their integration into society.

This idea, developed with good intentions, was included in the Mental Health Act of 1959, which reflected the changing attitude towards the mentally ill, away from their confinement in the world of straitjackets, locked cells, locked wards and confused prisoners.

New drugs that allow effective treatment and reduce symptoms have also encouraged politicians to believe that patients who would have ended their lives in the institution can be returned to the community. Powell, who gave his water tower speech in 1961 as health minister, called for a torch to be lit under the asylum’s “funeral pyre”. Gradually, the number of beds decreased, from 140,000 in 1959 to 23,000 in special psychiatric hospitals today. Creating long-term associations is no longer recommended.

Calocane was first diagnosed as psychotic in 2020, after he kicked the door of an apartment in his place, something he did more than once. He was repeatedly isolated, and when he was released he was found to be quarrelsome and neglecting his medication. In September 2021, he assaulted a police officer, which led to a warrant being issued for his arrest after he failed to appear in court. That was still special, nine months later, when he made the raids in Nottingham. If he had been caught, his victims might still be alive today.

However, he would eventually be back in the community where ensuring that medication is taken is the biggest issue of all. Although he had regular contact with mental health services, he stopped taking the prescribed treatment and often refused to consult with health professionals. He was even allowed to refuse the doctors’ advice to be given an antipsychotic injection for a long time because he preferred to drink, which was not very effective.

The families of the three who died accused the NHS and the police of having “blood on their hands”, expressing understandable anger and frustration, not because we’ve been here before. More than 30 years ago, an investigation into the murder of singer Jonathan Zito by Christopher Clunis, a schizophrenic psychiatrist living in the city, found similar errors. Zito was stabbed at Finsbury Park Tube station in London.

Her killer had difficulty interacting with mental health services, frequent failure to attend meetings or take medication, and frequent episodes of criminal damage and violence.

This horror story has changed quite a bit. Sir Keir Starmer has promised a judge-led inquiry into what happened in Nottingham, but to what end? Errors are recorded as well as they were in 1992, but now things are getting a little better. A search that produces another idle report will not help anyone. There have been many investigative reports on murders involving the mentally ill in which half of the victims were health professionals or strangers.

Over the decades, many thousands have been returned to society from mental hospitals. Many have no support or support and are often abandoned in dirty beds, hostels, or even on the street. If they are sick, it is impossible for them to get hospital care because many psychiatric beds are closed. Others continue to kill, often relatives and neighbors. Many others die by suicide.

Julian Hendy, a campaigner whose father was stabbed by a stranger in 2007, estimates that around 100 people a year in the UK are killed by someone with a mental illness. Like Calocane, threatening behavior is often ignored, warnings are not passed, and lines of responsibility are unclear. “What we’re seeing is the same recommendations keep coming up over and over again,” Hendy said. “People are trying to work on the principle of not having fewer restrictions. So they are not reliable enough. And they work on the basis of what the patient wants rather than depending on society.”

Concepts of mental illness have changed over the years – and rightly so. The idea of ​​putting people in jails that were derided as “loony pits” is long gone but the new ones have to work. However that would require a network of special shelters rather than the “halfway houses” currently in use and no government is willing to pay for them.

Many people who might have found refuge in the old shelters now end up in prison. In 1992, Mr. Zito’s assassination report said: “If the needs of this small group are not met, social care will be considered a failed strategy.” We cannot allow this to happen. We have no desire to return to the days of locked-down, inhumane, humiliating and undignified institutional care.”

Since most of the settlements have been closed and the lands sold, that is no longer an option, even if today they can be run in a more humane way. But when the alternative fails, the cost cannot be calculated.