Mental health charities must confront violence risk, says Mind chief

Dr Sarah Hughes has spent nearly four decades in mental health work. For the past four years, she has run Mind, one of Britain's largest mental health charities. And now, as a public inquiry into one of the country's most visible failures of the mental health system prepares to close, she is saying something her sector has largely avoided saying aloud: mental health organisations have failed to reckon honestly with the fact that some people with severe mental illnesses do commit violence.

On 13 June 2023, Valdo Calocane fatally stabbed three people in Nottingham. Two were students—Barnaby Webber and Grace O'Malley-Kumar. The third was Ian Coates, a 65-year-old caretaker. Calocane was later diagnosed with paranoid schizophrenia. In the years before the killings, he had committed multiple violent incidents, refused medication repeatedly, and been sectioned four times in two years. In 2024, he received an indefinite hospital order after admitting three counts of manslaughter on grounds of diminished responsibility and three counts of attempted murder. The public inquiry examining what led to these deaths has heard from local authorities, health professionals, police, and Calocane's family. His mother described the mental health system as "so broken."

Hughes's statement, made exclusively to the Guardian ahead of the inquiry's closure, marks a deliberate shift in how the charity sector speaks about mental illness and violence. She said charities had avoided the subject because they feared it would deepen stigma and discrimination against people with mental health conditions—a fear she understands, having herself experienced violence from people experiencing psychosis during her work as a practitioner. But that avoidance, she argues, has come at a cost. "We, as a charity sector, have failed to acknowledge that violence does happen in some circumstances," Hughes said. "As a sector, [we] have held the narrative that the majority of people don't commit violent crime. However, some do and the consequences are grave." She added that the sector had "softened the truth" in an effort to combat discrimination, and that this had meant difficult topics were "brushed under the carpet."

Emma Webber, whose son Barnaby was killed, welcomed Hughes's statement. She said danger to others had been "almost deliberately quietened down" in public conversation about mental health. "It could be a really powerful voice for the charities to have that difficult conversation, and to not be fearful of saying about the risks of violence toward others, and that people that are mentally ill, like Calocane, can and do go on to kill," Webber said. She emphasised that the vast majority of people with mental health conditions are safe, but argued that if someone is dangerous, that fact cannot be erased. "Had the risks in Calocane's case been understood, then I genuinely believe we wouldn't be having this conversation today."

Seena Fazel, a professor of forensic psychiatry at Oxford University who attended a roundtable Mind held in Westminster to discuss these issues, offered the research perspective. People with schizophrenia do have an elevated risk of violence compared with the general population, he said, even when accounting for socioeconomic factors. But the absolute risk remains small, and only a minority will commit serious violent acts. That risk rises when other factors are present—drug or alcohol problems, a history of violence, or having been a victim of violence. Crucially, Fazel noted, treatments already exist and are widely available that can reduce that risk.

Hughes acknowledged the genuine fear within her sector that naming violence risks could push policy toward more restrictive approaches to mental health care—the kind of institutional confinement that mental health reform has long fought against. "We are incredibly frightened of deepening that stigma and discrimination because we know how dangerous it can be," she said. But she argued this fear has led the sector to abandon necessary conversations. "The public, I think, are more ready [and] we've got to get our act together," she said. Even within Mind itself, she noted, there had been internal reluctance to engage with the topic.

Hughes called for the government's upcoming mental health strategy to improve support and treatment for people with severe mental illnesses while addressing public safety. This means ensuring adequate hospital beds, assertive outreach to patients, and better accountability and communication between services. She framed the challenge not as a choice between patient safety and public safety, but as a problem that requires both. "I hope that by us having these conversations openly we can both make sure that the people we're advocating for know that we're doing this safely with their consent, but equally, the public and families and victims know that we recognise that we have to come together to solve this problem," Hughes said. The question now is whether the sector can sustain this conversation, and whether it will translate into the kind of systemic change that might have altered the course of events in Nottingham.