Nottingham to Southport and Beyond - Mental Health Assessment Problems

 Yesterday, in my home town of Southport, 7-year old Elsie Dot Stancombe was laid to rest. Elsie, as we know, was one of the three children who died during the mass stabbing at a Southport dance class on July 29th. Her two fellow murder victims, Alice da Silva Aguiar, nine, and six-year-old Bebe King, were buried earlier this month. Southport remains a town in mourning. The families of the murdered children will suffer the pain of bereavement for the rest of their lives; the children and adults who survived the attack will have memories that never cease to disturb them; Southport itself will never forget the collective trauma that struck on July 29th - and has remained. 

While we, rightly, focus upon the plight of the victims, I think it worth focussing for a moment upon the perpetrator of this hideous crime: Axel Rudacubana.  Since his arraignment on August 1st, we have heard little of him. This is to be expected, as the police have further inquiries to make and - of interest here - there will be a need for an intense psychiatric assessment. The assessment will determine whether or not Rudacubana has mental health issues that led him to kill, and, if so, he can claim diminished responsibility. Personally, I cannot see any other assessment being made, but it's not my decision. What may come to light are possible failings on the part of the mental health professionals who knew Rudacubana previously. As readers of this blog know, I have looked at many such cases in the past, and it's been the same old story of dangerous mental health patients being allowed out to walk the streets. They kill innocent people, there are inquests, the killers are sent to secure mental health institutions, the mental health mandarins say that "lessons have been learned" - and then it happens again. However, a recent such incident has aroused wider public attention...

On June 13th last year, the man in the photo, Valdo Calocane, killed three people - Barnaby Webber, Grace O'Malley-Kumar and Ian Coates - and injured three others in Nottingham city centre. To the anger of the victims' relatives, who believed he should have been charged with murder, he pleaded guilty to manslaughter with diminished responsibility and was confined to hospital. However, this time the Care Quality Commission (CQC) took an active role. As the BBC say, the CQC report is damning: 

"In the lead-up to the attack, mental health assessments document how he often stopped taking his medication and was showing increasingly violent behaviour. But despite these red flags, the risks he posed were minimised and there was a "series of errors, omissions and misjudgements...".

The families of the victims say the failings highlighted in the report are much worse than they had anticipated. Highly articulate and outspoken, they have been told there will be a public inquiry.
At the centre of the criticism is the Nottinghamshire Healthcare NHS Foundation Trust (NHFT), which says it accepts the findings of the report and is working to improve its services. I have to say here that this is a familiar response from such bodies when these killings occur, but they seem to have little impact. For instance, on August 3rd, in West Ashby, not far from Nottingham, Christine Emmerson was stabbed to death by her son, Shaun Emmerson, a paranoid schizophrenic. As might be expected, as Lincolnshire Police say: 

"Crown Court Judge Simon Hirst, who presided over the trial, has placed an indefinite order with restriction for Emmerson to stay at a secure hospital for treatment until he is deemed fit to stand trial...  It was previously concluded that Emmerson was not fit to enter a plea and to stand trial in criminal proceedings due to a mental disability."

I predict that similar action will be taken in the case of Axel Rudacubana. Perhaps, also, he will be found guilty of manslaughter because of diminished responsibility and, to the chagrin of the families, the survivors and probably the whole of Southport and beyond, not guilty of murder.

Now, in many previous posts, lke the CQC with the Valdo Calocane case, I have criticised the mental health authorities. I stand by those criticisms, but must, in fairness, account for another factor: the fact that the mental health services are overstretched. As the BBC say: 

"The most up-to-date NHS figures, external show that in June this year 1.94 million people were in contact with mental health services in England – an increase of more than 30% in three years.
There are also significant staffing shortages. According to the King’s Fund think-tank, in September last year there were 28,600 staff vacancies in mental health - about 19% of the total workforce."

Faults in the system must be exposed, but we need to ensure that mental health staff - especially those who deal with cases like Calocane and Emmerson - are treated fairly. Otherwise, we might find that fewer and fewer people want to do the job and the situation will become far worse.