Mind chief admits mental health sector has failed to address violence risk

Mental health organisations have “failed to acknowledge” the risk of violence posed by a minority of individuals with severe mental illnesses, the chief executive of Mind has stated ahead of the conclusion of the inquiry into the Nottingham attacks.

Dr. Sarah Hughes, who has led the mental health charity Mind for four years and worked in the sector for nearly four decades, stated that charities have avoided addressing the risk of violence because doing so was perceived to increase stigma and harassment against those with mental health conditions.

The inquiry into the Nottingham attacks is examining the events leading up to June 13, 2023, when 19-year-old students Barnaby Webber and Grace O’Malley-Kumar, along with 65-year-old caretaker Ian Coates, were fatally stabbed by Valdo Calocane, who was subsequently diagnosed with paranoid schizophrenia.

In 2024, Calocane was sentenced to an indefinite hospital order after admitting three counts of manslaughter on the grounds of diminished responsibility, as well as three counts of attempted murder.

The public inquiry has heard evidence from various local authorities, including health professionals and police officers, as well as members of Calocane’s family, to assess the “events, acts, and omissions” that led to the killings.

The inquiry heard how Calocane had committed a series of violent incidents in the years preceding the attacks, repeatedly refused medication, and was sectioned four times within a two-year period. During her evidence, Calocane’s mother described the mental health system as “so broken.”

Speaking exclusively to The Guardian, Hughes stated that mental health charities must become more comfortable discussing the risk of violence that can exist from a minority of people with mental health illnesses.

Hughes’s comments follow a roundtable hosted by Mind in Westminster with experts to discuss the role mental health services must play in keeping both the public and patients safe.

“We, as a charity sector, have failed to acknowledge that violence does happen in some circumstances,” she said. “As a sector, we have held the narrative that the majority of people do not commit violent crime. However, some do, and the consequences are grave.”

Hughes added, “My feeling is that we haven’t always been able to articulate the topic of violence and mental health well to the public, and ultimately, we have softened the truth. Stigma and discrimination are incredibly harmful; however, our efforts to reduce them have, at times, meant that some of the most difficult topics have been brushed under the carpet. That is why it is so important to bring together a wide range of experts and experiences to have an open and honest conversation.”

Emma Webber, whose son Barnaby was killed by Calocane, welcomed Hughes’s statement. “I do feel like danger to others has been almost deliberately quietened down in the conversation in the past,” she said.

Webber stated that there had not been enough acknowledgment from mental health organisations regarding the risk of violence.

“It could be a really powerful voice for charities to have that difficult conversation and not be fearful of talking about the risks of violence toward others, and that people who are mentally ill, like Calocane, can and do go on to kill.”

“Obviously, the vast majority of people with mental health issues in this country are completely safe… but if somebody is dangerous, they are dangerous.”

“Had the risks in Calocane’s case been understood, I genuinely believe we wouldn’t be having this conversation today.”

Seena Fazel, a professor of forensic psychiatry at the University of Oxford who attended Mind’s event, stated that a minority of people with mental illnesses perpetrate violent acts, and high-quality research on schizophrenia has “converged on the same picture.”

“People with schizophrenia do have an elevated risk of violence compared with the general population, even after accounting for socioeconomic factors, but the absolute risk is small. Only a minority will commit a serious violent act,” he said.

“That risk increases when other factors are present, particularly drug or alcohol problems, a history of violence, or having been a victim of violence themselves. The important point is that treatments we already have, and which are widely available, can bring that risk down.”

Hughes, who shared that she experienced violence from people experiencing psychosis during her time as a mental health practitioner, said many in the sector feared that addressing these issues could increase stigma and discrimination, potentially leading to dangerous health outcomes.

“We are incredibly frightened of deepening that stigma and discrimination because we know how dangerous it can be,” she said. “This could risk going back to a more restrictive approach. My view is that is not the answer, but stigma creates a pathway to that as being the only solution to this problem.”

Hughes said this meant the sector had “shied away” from difficult conversations around violence. “The public, I think, are more ready, and we’ve got to get our act together,” she said. “Even within Mind, there was a reluctance internally, and we had to really talk it through.”

Hughes stated that Mind is set to introduce its mental health strategy, which will advocate for better support and treatment for those with severe mental illnesses, while also addressing matters of public safety.

This includes ensuring an adequate number of hospital beds, assertive outreach, and improved accountability and communication with services.

“I hope that by having these conversations openly, we can ensure that the people we advocate for know we are doing this safely with their consent, but equally, the public, families, and victims know that we recognize we have to come together to solve this problem,” Hughes said.

“Crucially, there is a role for Mind—and the sector as a whole—to show that patient and public safety are not mutually exclusive. Both are possible if we want to change our mental health system so people can get the right care before or after reaching a crisis point,” she added.

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