The short version
- The chief executive of Mind states that mental health charities have historically avoided acknowledging violence risks due to fears of increasing stigma against patients.
- Experts note that while people with schizophrenia face a slightly elevated risk of violence, the absolute number of serious incidents remains small and is often linked to co-occurring factors like substance abuse.
- Survivors of violent attacks involving mentally ill perpetrators argue that open dialogue about these risks is essential for preventing future tragedies and improving system accountability.
Leaders within the mental health advocacy sector are calling for a significant shift in how organizations discuss the potential for violence among individuals with severe mental illnesses. Dr. Sarah Hughes, the chief executive of the charity Mind, stated that the sector has largely failed to acknowledge this risk, primarily because addressing it has historically been viewed as counterproductive to reducing stigma. This internal reckoning is occurring as a public inquiry into the fatal stabbings in Nottingham prepares to conclude its examination of systemic failures.
The inquiry focuses on the events leading up to June 2023, when Valdo Calocane fatally stabbed three people at a university campus. Calocane, who was later diagnosed with paranoid schizophrenia, had a documented history of violent incidents and repeated refusals to take prescribed medication before the attacks. He was sectioned four times within two years prior to the killings. The investigation has gathered testimony from local authorities, health professionals, police officers, and Calocane’s family to assess the specific acts and omissions that contributed to the tragedy.
Hughes argued that mental health charities have shied away from discussing violence because they fear it will fuel harassment and discrimination against people with mental health conditions. She noted that while the sector has successfully promoted the narrative that the vast majority of people with mental illness do not commit violent crimes, this approach has sometimes resulted in softening the truth about those who do. Hughes emphasized that avoiding these difficult conversations has meant brushing critical safety issues under the carpet.
Emma Webber, whose son Barnaby was killed by Calocane, welcomed Hughes’s comments. Webber expressed frustration that the danger posed by some individuals with mental illness has been deliberately quieted in public discourse. She argued that charities need to be less fearful of acknowledging that people with conditions like schizophrenia can and do commit lethal acts. Webber suggested that if the risks associated with Calocane had been properly understood and addressed by the system, the tragedy might have been prevented.
Despite these calls for openness, experts caution against overstating the danger posed by mental illness alone. Professor Seena Fazel of the University of Oxford, who attended a roundtable discussion hosted by Mind, highlighted that research consistently shows only a minority of people with schizophrenia commit serious violent acts. While individuals with schizophrenia do have an elevated risk of violence compared to the general population, the absolute risk remains small when socioeconomic factors are accounted for.
Fazel noted that the risk of violence increases significantly when other factors are present, such as substance abuse problems, a history of prior violence, or having been a victim of violence oneself. He emphasized that existing treatments, which are widely available, can effectively reduce this risk. The challenge lies in ensuring that these interventions are applied consistently and that systems do not fail to identify high-risk individuals who require more intensive support.
Hughes acknowledged the complexity of balancing safety with stigma reduction. She shared her own experiences as a mental health practitioner, noting that she had encountered violence from people experiencing psychosis. However, she warned that fear of deepening stigma could lead to a regression toward more restrictive and punitive approaches to mental health care. Hughes argued that this is not the solution, but rather that stigma itself creates a pathway for such restrictive measures to gain traction.
The ongoing debate highlights a tension within the mental health community between protecting patient rights and ensuring public safety. While advocates stress that most people with mental illness are safe and non-violent, they also recognize that ignoring the minority who pose a risk can have grave consequences. The closure of the Nottingham inquiry is expected to provide further insights into how better coordination and honest dialogue could prevent similar incidents in the future.
As the sector moves forward, there is a growing consensus that open and honest conversations about violence and mental health are necessary. This includes acknowledging the limitations of current systems and the need for more robust support mechanisms. By bringing together a wide range of experts and experiences, stakeholders hope to develop strategies that address both the risks of violence and the harms of stigma without compromising either goal.
Sources behind this briefing
Go to the original reporting
- The Guardian World↗Mental health groups have ‘failed to acknowledge’ risk of violence, says Mind chief
