Image source, The Nottingham Inquiry

• Dr Karthik Thangavelu - Valdo Calocane's consultant during his final admission to Highbury Hospital in Nottingham in January 2022 - said he knew his patient was not taking his medication
• A bag of pills that had not been taken was previously found at Calocane's address, which pointed to him being non-compliant
• The inquiry heard Calocane was aware he had been missing appointments despite confusion over his address
• Calocane had also only been taking a half dose of his medication
• Thangavelu, who gave evidence to the inquiry via video-link, felt Calocane had "reasonable insight" into his illness and felt "aggrieved" about being taken to hospital
• Thangavelu did not ask Calocane about his hallucinations and said he "should have"
• A depot forcing Calocane to take his medicine by injection was no guarantee of compliance, said Thangavelu
• Thangavelu admitted he had not read Calocane's history in full or requested the notes from his previous admission.
• He felt that Calocane just wanted to get back to his studies so would comply with his treatment when released

We have heard a lot about concordance or non-concordance with medication throughout the inquiry evidence today.

Non-concordance, in this case, refers to non-compliance with medication - not taking medication as prescribed.

The inquiry has heard that Valdo Calocane had a history of non-concordance with his medication throughout his mental health care.

A series of documents are expected to be read into the record of the inquiry after lunch.

Then, we will hear from the younger brother of Valdo Calocane, Elias.

The hearing has stopped for a lunch break. Evidence is expected to start again at 13:45.

The University of Nottingham, where Calocane was a student at the time, was not informed of a visit he made to the campus during his fourth admission in January 2022.

Calocane's fourth admission followed an assault of his flatmate Christopher.

Asked why the university was not informed when Calocane was discharged in February 2022, Thangavelu said he did not believe Calocane had given consent for them to do so.

However, he agreed consent could have been "overridden" if there was a risk to others.

It was only after a mental health support worker at the university rang Calocane that she learned he had been discharged.

Thangavelu said: "In hindsight, we should have got that out."

John Beggs KC, representing Nottinghamshire Police, asked Thangavelu if there was a "reluctance" for medical professionals to contact the police for information.

Thangavelu said: "We used to have a good relationship with the police.

"I think it fell by the wayside at some point, I don't know why but I wouldn't say there was a cultural reluctance, we always wanted to work together."

Image source, PA Media

Straw points out that as Calocane was clearly showing evidence of non-compliance with medicine, this should have been viewed by Thangavelu as being behind his mental health relapse.

Straw said: "Are you giving a misleading picture here to excuse the wrong decision?”

Thangavalu said: "No, I don't know what other concrete evidence people had at that time. We were all speculating that the reason for relapse was non-concordance.

"It may well be, so does somebody who is extremely psychologically stressed, not sleeping at night, working in a warehouse, having university guidelines to meet, just come out of hospital.

"There could be many reasons and we can't just go down one alleyway, we should be keeping an open mind."

Earlier in his evidence, Thangavelu said he believed at the point of discharge that Calocane would engage with services in the "short to medium term".

Straw KC asked: "Were you not concerned what would happen beyond the short to medium term?"

Thangavelu asked: "I think that would be very difficult to foresee, as a prognosis for any patient with schizophrenia, because there are so many dynamic factors, social factors, psychological factors, environmental factors.

"I don't think anyone can see beyond the short to medium term. But that's the very nature of the illness."

Thangavelu said he wanted Calocane to "get well, remain stable, and get on with his life" as he did for all his patients.

Adam Straw KC, who is representing Calocane's mum, Celeste, and brother, Elias, is questioning Thangavelu.

Straw asked: "You would agree wouldn't you, that it was particularly important for someone like [Calocane], not just to rely on his word?"

"Yes I agree," Thangavelu said.

The consultant also agreed it was important to take a longitudinal view, looking at patterns in his history.

Straw said: "You failed to do that didn't you? You took him at his word and failed to identify relapse indicators?"

Thangavelu replied: "I wouldn't agree with that actually. We looked at the previous patterns and this submission was quite different to the previous."

Asked why he did not move Calocane to a Section 3 order, under the Mental Health Act, by Cartwright, Thangavelu said: "Just keeping him on a Section 3 inpatient unit much longer is not going to make him necessarily engaged. In fact it would institutionalise him.

"It largely depends on what matters most to the patient, and for him clearly he wanted to get back to his studies, get on with his life, and what we need to do is support him to achieve those aims."

Sophie Cartwright KC, who is representing the survivors, said this was not a safe discharge as his accommodation was not vetted.

Thangavelu said: "Checking the accommodation is a very fair point.

"Appropriate medical treatment is not just medications. The main aspect of treatment is to get them rehabilitated in the community."

Patrick has now questioned Thangavelu on his decision to discharge Calocane without a depot.

She asked: "Did you not think at any time that he'd failed on three previous chances at concordance? He was never going to be well without compulsion was he?"

Thangavelu replied: "I wouldn't want to write somebody off just like that.

"I'd want to weigh things up and I was looking for reason to go for a forced depot.

"I wouldn't have hesitated if it was very blatantly obviously clear in my head. But I was struggling on that occasion."

Patrick said: "Can I suggest in weighing up, you gave too much of the benefit of the doubt to VC [Calocane] and didn't pay attention to what was in front of you?"

Thangavelu said he considered Calocane's presentation during that fourth admission and said, again, he was largely asymptomatic.

Thangavelu is now being cross-examined about his evidence, with questions about how he looked over Valdo Calocane's notes.

He admitted to Angela Patrick, who is representing the bereaved families, he had not requested notes from Calocane's third admission at hospitals in Darlington and Nottinghamshire.

Asked if he would have read all the notes, Thangavelu said he would only read the notes "he needed to".

Patrick said: "This is a very unwell man, he lacks insight, an appreciation that part of his history when unwell was an intention to hurt others... that's relevant information for you to have had, isn't it doctor?"

Thanagvelu said he had only become aware of the full picture of the notes since the start of the inquiry.

Yesterday, the inquiry heard there was a culture at the time of Calocane's treatment of a "least restrictive" approach to patients, said Carr, who asked if Thangavelu echoed this view.

Thangavelu said: "Having been in this field for 25 years, I have certainly seen many instances where I felt the least restrictive option was available and could have been used, when a more coercive route was taken."

He added since Calocane, his practice had moved more towards coercion.

He told the inquiry the Nottingham attacks were the only instance of homicide following discharge in his professional career, but added there had been suicides.

Carr then asked if psychiatry was "institutionally racist" with an "implicit bias".

Thangavelu said: "I think we all stick to our core principles and ethics and values."

Calocane, the inquiry heard, was admitted under Section 2 of the Mental Health Act during the fourth admission. To be coercively administered depot medication, he would have to have been on a Section 3 admission, so a Community Treatment Order (CTO) could be imposed.

The inquiry heard a Section 2 admission could be converted to a Section 3 if a patient met the criteria.

Asked if he would have imposed a CTO if Calocane had been converted to a Section 3 admission, Thangavelu said: "Not necessarily. It would have given us more time to think and then decide."

He added: "Based on all the factors I considered at that point, I did not think a forced injection could be justified."

Carr asked: "Have you ever discharged someone on a CTO with a condition of depot?"

"Very many times, yes," Thangavelu replied.

Thangavelu told the inquiry he thought Calocane - a former University of Nottingham student - "wanted to get well" and "get through the exams".

He said this was the reason he believed that Calocane would be compliant after his discharge.

He said: "It was one of the main drivers for him to get out of hospital, he was keen to get back to his studies."

Calocane did not want to move to depot medication, the inquiry heard.

Calocane's reported fear of needles was also raised by Carr, who said the killer had been given his Covid-19 jabs.

Asked if depot should have been made a condition of Calocane's discharge, Thangavelu said: "I was trying to convince him somehow and make him agree and he was quite resistant.

"I wasn't attaching it to the condition of discharge, perhaps that wouldn't serve the purpose because he could just get discharged and stop.

"That happens a lot of the time actually, people will have the first dose and won't turn up for the next depot."

Thangavelu had said in his statement that Calocane was also not eligible for depot treatment due to a "lack of incidents on the ward", inquiry team barrister Craig Carr said.

Carr outlined that Calocane had slammed a door on a nurse trying to take observations, and that he had gone on leave by lying about attending university.

Following Calocane's sentencing in 2024, a series of failings emerged by authorities, including the police and mental health services - both of which the killer was known to - prompting calls for a statutory inquiry.

A statutory inquiry means witnesses who are called forward are legally compelled to give evidence under oath.

Evidence in the Nottingham Inquiry began on 23 February this year.

It is being chaired by retired senior judge Deborah Taylor KC - who will listen to all the evidence and draw up her findings as part of a final report.

You can read more about how the inquiry works here.

At the discharge meeting following his fourth admission, Carr said the notes showed Calocane talked about how he had felt "technologies" like a "computer brain interface" were being used on him and "someone outside him was influencing him".

Thangvelu said: "The way it came across was, I was pressing him about thought insertion, illusions of control and so on, and he was saying, 'no I don't have it'.

"Some of these questions are difficult to ask. The way he put it across was it happened some time in the past but he wasn't saying it was happening now or in recent times.

"This was one of his main symptoms, that domain of being controlled."

Thangavelu said he felt the fact he had brought this up on the day of his discharge "might be a sign he was recognising his symptoms more".

The inquiry heard during Calocane's fourth admission, a colleague of Thangavelu contacted his former flatmate Christopher.

It was Calocane's assault of Christopher in January 2022, during a conversation about cleaning, that led to his last admission.

Christopher told the doctor that short, intermittent screams could be heard during the night, coming from Calocane's bedroom. He also said Calocane had entered another flatmate's bedroom in the night, asking if he had heard screams.

Asked if he had explored this with Calocane while he was in hospital, Thangavelu said he did not recall doing so.

Craig Carr asked: "Should you have explored it with him?"

Thangavelu replied: "I think I should have."