Valdo Calocane and the real crisis in mental healthcare
Dr Ken McLaughlin asks whether our desire to view the problems of life through a psychological prism is compromising treatment for those who need it most.
In June 2023, psychiatric patient Valdo Calocane fatally stabbed two university students, Grace O'Malley-Kumar and Barnaby Webber. Later that morning, Calocane also killed Ian Coates, a school caretaker, whose van he stole. Calocane then drove the van into people at a nearby bus stop where several were severely injured. At this point, he was arrested.
Calocane was diagnosed with paranoid schizophrenia three years before the killings, and had been detained under the Mental Health Act on four occasions. Each of his admissions were preceded by assaults or break-ins.
Following his last admission in 2022, the community mental-health team responsible for his aftercare discharged Calocane to his GP because he was allegedly not engaging with them. There was also an arrest warrant issued for him after he failed to appear in court over the assault of a police officer - an assault that occurred as the police supported mental-health professionals to detain him under the Mental Health Act. The police never pursued the warrant.
It would appear from reports that even prior to the subsequent killings, Calocane was a dangerously disturbed individual. His first admission for mental-health treatment came after two incidents when he broke into neighbours' flats, believing his mother was being raped inside. He was arrested, but following a psychiatric assessment was prescribed medication and released from custody. An hour after his release, Calocane tried to get into another flat. The woman inside was so terrified that she jumped from a first-floor window to escape and was severely injured.
According to the medical records, at a July 2020 meeting with health and care professionals while Calocane was ill in hospital, a psychiatrist observed that ‘there seems to be no insight or remorse and the danger is that this will happen again and perhaps Valdo will end up killing someone’.
Understandably, there are now calls to find out how such warnings were ignored and why Calocane was left without specialist mental-health care despite the risks he was deemed to pose. There are also questions as to why the police failed to detain him, given there was a warrant out for his arrest.
Without knowing the full details of the case there are some things we know mental-health services had at their disposal. They could have arranged to reassess Calocane given he had disengaged from services and had stopped taking his medication. Prior to discharge, he could have been given a depot injection, a slow-release anti-psychotic drug that is usually given every two or four weeks. If he was not available or refused to take the subsequent one, he could have been reassessed by his mental-health team. The Mental Health Act is a powerful piece of legislation. For example, S.135 allows the police to force entry to someone’s home if mental-health professionals have concerns over their mental state, and an ‘approved mental health professional’ has obtained a warrant from a magistrate.
Brian Dow, deputy chief executive of the mental health charity Rethink Mental Illness, believes the state of mental healthcare in the UK has made tragic outcomes inevitable: ‘Looking back, it was a question of when, not if. And unless we both invest and change the model of healthcare that we have, so we don't allow these crises to build up and build up, then there's the inevitable risk that this will happen again.’
The key phrase here is ‘looking back’. With hindsight, it is difficult to disagree with that assessment and there is no doubt that the current state of mental healthcare needs to be addressed. Part of the problem, however, is that there is a danger of false positives. For example, how many people deemed as at risk of causing harm end up not harming anyone? How many people would needlessly have their rights curtailed in order to ensure we got someone like Calocane? Risk assessment in psychiatry is certainly not guesswork, but it is not an exact science. The vast majority of psychiatric patients do not pose a risk to anyone. Nevertheless, some do, of which Calocane is a clear and tragic example.
This is not an argument to say Calocane should not have been detained under the Mental Health Act, nor not been subject to some form of robust risk assessment and aftercare once discharged. As I argue in Escaping the Straitjacket of Mental Health, my contribution to the Academy Of Ideas Letters on Liberty series, it is possible to be both a lover of liberty and acknowledge that due to mental disorder or mental incapacity, our rights can justifiably be restricted.
That paragon of liberalism, JS Mill, recognised the need for psychiatric intervention in particular cases. After all, in addition to the harm principle, Mill states that his doctrine of individual freedom should apply only to human beings in the maturity of their faculties - which precludes children and others unable to take care of themselves. In cases where someone is severely psychotic or suffering from dementia, psychiatric coercion, constraint and intervention is not a violation of individual autonomy because the subject, at that point in time, is not autonomous in any moral sense.
Calocane was clearly not well - indeed, he was actively psychotic, which is why he was found guilty of manslaughter on the grounds of diminished responsibility rather than murder after he was assessed by forensic psychiatrists after his arrest. Irrespective of the court’s decision, it is highly likely that Calocane will spend the rest of his life in a high security psychiatric hospital.
The irony is that at a time when we discuss mental health ad nauseum, those who really need help are often neglected. In the case of Calocane, a lack of adequate aftercare led to the tragic deaths of three innocent people. Calocane’s longest hospital admission was only seven weeks. A reduction of available psychiatric beds in recent decades has seen many patients returned to the community sooner than they otherwise would have been due to pressure on bed space. Frontline mental-health care is severely stretched. This is why the trend to portray more and more of us as suffering from some form of mental health problem is itself a problem. Not only does it lead to a conflation of conditions such as Calcone’s with the ups and downs, stresses and strains of everyday life that we will all experience, it redirects resources from those who really do require psychiatric, psychological and social support to those who are being encouraged to view the problems of life through a psychological prism.
Ken will be discussing his Letter on Liberty - Escaping the Straitjacket of Mental Health - at this year’s Battle of Ideas festival.
Dr Ken McLaughlin has over 30 years of experience in social work and social care, working as a senior lecturer in social work and mental health, and in practice as an approved mental health professional and team manager in a social services mental-health team. He is the author of Social Work Politics and Society: from radicalism to orthodoxy. His work has appeared in several academic journals and in spiked. His latest book - Stigma, and its discontents - was published by Cambridge Scholars in 2021.
ESCAPING THE STRAITJACKET OF MENTAL HEALTH
Dr Ken McLaughlin
In his Letter on Liberty, Dr Ken McLaughlin argues that failing to distinguish between mental distress, which requires serious help, and the more mundane, albeit painful, times when we might feel low or anxious, is a problem. Many within the mental-health industry have inadvertently led more people to view themselves through the prism of mental illness, he argues. Ken writes that if we care about helping those in mental distress, and want to protect our freedoms, we need to ensure that we do not swap the literal straitjacket for its metaphorical equivalent.
Excerpt from Escaping the Straitjacket of Mental Health:
‘There is a lot to criticise about the medicalised view of mental distress. However, the approach of these critics 15 - self-styled therapeutic experts, or more accurately, therapeutic entrepreneurs - is more corrosive to liberty. It inadvertently pathologises more aspects of life than the medical approach by blurring the lines between such terms as mental illness, mental distress, mental disorder and mental-health problems in such a way that any problematic human interaction or emotion can be categorised as a psychological problem.’
 |
|
Yes. I couldnt agree more.
I worked as a social worker in an NHS cmht. Not only were we inadequately trained but the resources were not there to help people with social problems. The social/medical model could work but medical dominated and pathologised people who could have been safely treated in another way.
In some ways the people with psychotic illnesses were more straightforward as there was a clear treatment pathway. Obviously they had to be seen regularly. Closing cases due to non-attendance requires a big rethink as policy.
But getting very ill people into the system is not easy because of the sheer numbers of referrals. Its an inexact process.
The people who found life challenges too debilitating - and most had my sympathy - were not adequately catered for. Closing their cases often resulted in insults to staff and sheer panic by patient and family when there was nothing else we could offer, and often a psychiatrist was still available.
Resilience to a very complex changing world cannot be supplied externally by labelling people with non-psychotic illnesses into a mental health vortex. Coping skills need the things we are losing like community, meaningfull activity, feeling needed and loved. And enough money to be well fed and warm.
I don't know where we start.
My fear is that having a mental health problem is becoming even more complicated by the « Munchausen by Proxy » parents who will reap the benefits financially while their child is given extra time & support at school.