Important questions about Valdo Calocane’s health care

A critical report on the mental health care given to Valdo Calocane – the paranoid schizophrenic who killed three people in Nottingham last year – is damning.

At the time of the attack, a mental health assessment noted how he often stopped taking his medication and exhibited more violent behavior. But despite these red flags, the risks posed can be minimized and there is a “series of errors, omissions and misunderstandings”, The Care Quality Commission (CQC) was found.

Calocane suffers from paranoid delusions when he kills Barnaby Webber, Grace O’Malley Kumar and Ian Coates. His family said the failings contained in the report were worse than previously thought, and had been told there would be a public inquiry.

At the center of the criticism is Nottinghamshire Healthcare NHS Foundation Trust (NHFT), which says it welcomes the report’s findings and is working to improve services.

But some important questions remain about the treatment of Valdo Calocane.

Yes, there are situations where mental health patients, who are very ill, can be forced to take medication.

The CQC report details how during the two years Calocane was treated by the NHFT, he often stopped taking his medication.

Old tablets, which were the main treatment for paranoid schizophrenia, were found in the flat.

He also missed numerous appointments with the mental health team, and his medical records showed increased violence when he was unwell.

Because of this pattern of behavior, the report said he could be given a depot injection – this gives him a long-lasting drug – but Calocane consistently refused.

Mental health staff must work with patients, balancing their wishes and rights with their needs to ensure they get the care they need.

But a stronger force can be used.

Every time Valdo Calocane reaches a crisis, he is detained under Section 2 of the Mental Health Act. But if Part 3 has been used, the doctor can confirm that he has a depot injection.

It will also allow them to be given a Community Treatment Order (CTO), meaning they will be more closely supervised in the community. At CTO, if a patient stops taking their medication or misses too many appointments, they can be taken straight to the hospital.

The CQC concluded “this will be an important component of a stronger treatment package for Valdo Calocane”.

Yes, and his mother and brother, who live miles away, say they are trying to raise concerns about his deteriorating mental health.

But he says he feels shut out by professionals who don’t always listen, and by rules about confidentiality, which limit what he tells Calocane’s closest relatives.

The family told BBC Panorama that in early 2022, Calocane had told the mental health team that he did not want information shared with him.

Many families argue that they know their loved one best and can provide important information about how the illness is affecting them, and warn them when they are deteriorating.

The Calocane family was not alone in this experience – the CQC report said it was seen in other cases in Nottinghamshire, and found other families who also felt excluded from the care of relatives who are mentally ill.

The law on patient confidentiality is the same for mental health patients as it is for everyone else, with some exceptions.

At Mental Health Law Code of Practice said there is a situation “which is both justifiable and important to share the patient’s otherwise confidential information with people outside the team directly treating the patient”.

This includes protecting others from harm or preventing serious crime.

With hindsight, it’s easy to make a case for more information being shared in this situation, but the mental health team didn’t have it.

However, the CQC report said: “It can be assumed that the Trust can continue to engage with families while maintaining confidentiality.”

It also said “We can see that efforts to engage with him assertively and communicate with his family are diminishing” from April 2022 when his treatment moved to a new mental health team.

We know that across the UK mental health services are under huge pressure, but we don’t know how that will affect this case.

Although mental health funding has increased, it has not kept pace with rising demand.

At most up-to-date NHS figures showed that in June this year 1.94 million people had come into contact with mental health services in England – an increase of more than 30% in three years.

There are also significant staff shortages. According to think-tank King’s Fund, in September last year there were 28,600 employees in mental health – around 19% of the total workforce.

That pressure became the background of Valdo Calocane’s treatment.

In March, the The CQC publishes a rapid review which he says has raised concerns about mental health services in Nottinghamshire for five years.

It highlights staff shortages and long waiting lists for services. The review also identified the problem of finding enough beds for people who need inpatient care, which in turn has an impact on other services.

The review said that community-based teams should manage more complex and acutely ill patients.

“This creates greater risk and pressure on the community team, whose therapeutic input decreases while managing the increasing level of the crisis,” he said.

The latest CQC report looks specifically at Valdo Calocane’s treatment of understaffing in some of the teams it reviewed.

An NHS report on these cases is forthcoming, and may provide a clearer picture of the number of pressure services.

There are also ongoing questions about the police’s handling of the incident involving Calocane.

But the families of those killed believe only a public inquiry can bring all the threads together to provide the answers and change they want.

He said that individuals and organizations should be held accountable, and had been told that the public inquiry he had requested would take place.

Nottinghamshire Healthcare NHS Trust said its thoughts were with “all those whose lives are irreplaceable after the attack”.

He also said he welcomed the conclusions of the CQC report and “improved processes and standards” since the Calocane evaluation was carried out.