Psychiatrist 'unable to section Nottingham killer'

A psychiatrist who decided he could not detain Valdo Calocane under the Mental Health Act after he assaulted a flatmate said the Nottingham attacks killer "wished to take control" during his assessment.

Calocane, who was diagnosed with paranoid schizophrenia in 2020, fatally stabbed Barnaby Webber, Grace O'Malley-Kumar and Ian Coates, and tried to kill three others on 13 June 2023.

In January 2022, police were called when Calocane put a flatmate into a headlock and took him hostage in their flat in Faraday Road, Nottingham.

The following day, Dr Mike Skelton, a consultant psychiatrist, decided Calocane did not pose a serious enough risk to be detained and allowed him to return home.

Skelton, based in the Nottinghamshire Healthcare NHS Foundation Trust crisis team, had been familiar with Calocane having attended meetings discussing his case when he was released from two periods under section under the Mental Health Act at Highbury Hospital in August 2020, and when carrying out a seclusion review in September 2021 following an assault on a police officer.

At this review, Skelton was standing at Calocane's door and asked questions without making eye contact, due to fears of safety to himself and other staff from what he called a "clearly very psychotic" patient, the inquiry was told.

Calocane was described at this review as "guarded, curt, fixed staring and having a hostile edge to him".

However when Skelton assessed him again following the flatmate confrontation in January 2022, the psychiatrist said Calocane had been "polite and calm" and "invited us in to the property", although a police warrant was used to remove him and carry out the assessment, with 15 officers deployed.

Officers wanted to leave after Calocane was taken to the Cassidy Suite at Highbury Hospital for the assessment, but medical staff were concerned about safety and asked officers to stay.

In his assessment, Skelton was aware Calocane had not been on his medication despite his claims he had been taking it as prescribed.

Skelton said: "It's clear that he does make statements and then when he's challenged or we have evidence, that sort of melts away."

The psychiatrist said failing to take medicine was not unusual among patients with schizophrenia and was not a reason for detention - the "net effect of that on the person" is.

Calocane took one tablet in front of Skelton during his assessment, the inquiry heard.

"One tablet doesn't reduce the risk," said Skelton. "The first step was to see was he going to even do that, because if he didn't, he would have been detained immediately."

Factors such as police deciding not to arrest Calocane after the assault on his flatmate, the incident still being under investigation, and Calocane's "composure" all formed part of the decision, Skelton said.

"I went into that assessment expecting that I would be detaining that chap. Based on what we saw he was not detainable under the Mental Health Act," he told the inquiry.

Skelton said the decision to release Calocane to the crisis team and return him to his accommodation was not a "gamble" or influenced by Calocane trying to "dissuade" him from sectioning him.

"We all agreed that this chap would be better off in hospital. But we did not have the legal powers at the time to enforce it based upon the assessment we saw," he said.

"He was able to, and it's very unusual, to push back and you could tell he wished to take control. And I thought it was very unusual, it did stay with me.

"A MHA [Mental Health Act] assessment is based on 'are the criteria met?' And there are not individual elements. Crucially at the time I was not able to elicit acute psychotic symptoms.

"When we concluded the assessment and I concluded he wasn't detainable, the crisis team had to look after him.

"That wasn't comfortable for us. To suggest that we were not aware of the risk, it's not true."

As Calocane was not detained, the university removed the other tenants from the property he was in for their safety, the inquiry heard.

The crisis team monitored Calocane daily on a community plan while gathering evidence about him, and eight days later a further MHA assessment was ordered.

Skelton said: "We saw the chap had been lying to us. We had genuine hard facts we could use."

The inquiry also heard evidence from crisis care practitioner nurse and, from February 2022, team leader Josephine Baker, who visited Calocane on 23 June 2020, between his two spells at Highbury Hospital that year.

In a phone call in the days before the visit, the inquiry was told Calocane said he was not experiencing hallucinations or abnormal thoughts.

But Baker said: "It took him a little bit of time to open up and say that he was hearing voices. He was quite open with the fact but he felt able to manage them now since being discharged.

"It could have potentially have been [an early warning sign of relapse] but I wasn't concerned about him. He was quite open and honest. He was calm and settled."

Calocane was re-admitted to Highbury Hospital in July 2020 under the Mental Health Act.

Baker was also involved in monitoring Calocane over the eight days after Skelton did not detain him and put him under the care of the crisis team in January 2022.

She said: "VC [as Calocane is being referred to at the inquiry] didn't engage well so it was hard to be able to assess the risk that was posed at that time. I couldn't be sure he was taking his medication."

Baker recorded in her notes that Calocane had become "intimidating" and was no longer safe to be treated in the community.

Consultant psychiatrist Dr Kalina Shoilekova, from Cygnet Health Care, also gave evidence to the inquiry on Thursday over Calocane's admission to Cygnet Victoria House, a private hospital in Darlington, County Durham, in September 2021.

He had attacked a police officer during attempts to detain him at Highbury Hospial after breaking into a neighbour's flat while in psychosis.

The Nottinghamshire trust referred him to Cygnet's psychiatric intensive care ward but Cygnet declined as its nursing team was "predominantly female" and due to "the risks presented" by Calocane, the inquiry heard.

Shoilekova said: "There was not enough manpower, and by that I mean male power, to deal with exceptional circumstances which might happen."

A second referral was made three days later, which was accepted. Although no discharge note was provided as Calocane was admitted, a risk assessment that was provided said Calocane was "a polite and gentle, personable young man".

Shoilekova said: "We did not have access to the outpatient case notes. This fragmentation of services is not ever beneficial, not only for the patients, it is not beneficial for the staff.

"It generates a lot more, how can I call it? Detective work, to find the relevant information in the whole ocean of information."

Shoilekova said on admission Calocane was "very suspicious" and likely hearing voices.

But she told the inquiry that Calocane's history of mental illness was "not unusual" and said: "The majority of patients who would write about that, talk about that, never proceed to do such a horrible, horrible act."

While at Cygnet, Calocane was recommended for depot treatment - which involves long-acting, injectable anti-psychotic medication - by his care coordinator Claudia Birtles and by Shoilekova, but he said he would prefer to continue on tablets.

Shoilekova said she expected Calocane to be at the hospital for "at least two to three months" and she told a tribunal during his stay that "if discharged, he will not comply with his medication and will not engage with mental health services in the community".

But he left Cygnet for The Priory Hospital in Arnold, Nottinghamshire, on 1 October 2021.

The inquiry heard The Priory was rated inadequate by health watchdog the Care Quality Commission.

His discharge papers from Cygnet said Calocane posed a high risk of violence and had no intention to take his medication.

Following the killings, Calocane was sentenced to an indefinite hospital order in January 2024, after pleading guilty to three counts of manslaughter on the grounds of diminished responsibility, and to three counts of attempted murder.

The inquiry continues.

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