Mental health organisations have "failed to acknowledge" the risk of violence from a minority of people with severe mental illnesses, according to Dr Sarah Hughes, chief executive of the charity Mind, speaking ahead of closing submissions in the inquiry into the Nottingham attacks. Hughes, who has led the organisation for four years and spent nearly four decades in the sector, argues that charities have avoided this conversation due to concerns about increasing stigma around mental health conditions.
The independent inquiry is examining circumstances leading to 13 June 2023, when 19-year-old students Barnaby Webber and Grace O'Malley-Kumar, and 65-year-old caretaker Ian Coates, were fatally stabbed by Valdo Calocane. Calocane was later diagnosed with paranoid schizophrenia. 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 has examined evidence from local authorities, health professionals, police officers, and Calocane's family to assess the "events, acts and omissions" that preceded the killings. Testimony revealed that Calocane had committed multiple violent incidents before the attacks, repeatedly refused medication, and was sectioned four times within two years. During her evidence, Calocane's mother characterised the mental health system as "so broken".
According to the inquiry's schedule, closing submissions are set for 8 and 9 September 2026 at Mary Ward House, London, marking the conclusion of oral proceedings. Mind provided evidence to the inquiry, with its submission highlighting gaps in proactive outreach, culturally competent care, and support for people with serious mental illness who disengage from services.
Speaking exclusively to a national news outlet, Hughes stated that mental health charities must become "more comfortable" discussing the risk of violence that could emerge from a minority of people with mental health conditions. Her remarks follow a roundtable Mind held with experts in Westminster to examine the role mental health services must play in protecting both the public and patients.
"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."
Hughes elaborated that the sector has not articulated the relationship between violence and mental health effectively to the public, and that efforts to combat stigma have sometimes meant difficult topics were avoided.
"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's why it's so important to bring together a wide range of experts and experiences to have an open and honest conversation."
Emma Webber, mother of victim Barnaby Webber, 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, noting that mental health organisations have not sufficiently acknowledged the risk of violence.
Webber argued that charities could play a powerful role by having difficult conversations about violence risks without fear.
"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. Obviously the vast majority of people with mental health issues in this country are completely safe … but if somebody's dangerous, they're dangerous. Had the risks in Calocane's case been understood, then I genuinely believe we wouldn't be having this conversation today."
What does research show about mental illness and violence?
Seena Fazel, professor of forensic psychiatry at the University of Oxford who attended Mind's event, explained that a minority of people with mental illnesses do perpetrate violent acts, and high-quality research on schizophrenia has produced consistent findings.
"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.
Fazel noted that risk increases when additional factors are present, particularly substance abuse, a history of violence, or prior victimisation. Crucially, he emphasised that existing treatments, widely available across the health system, can reduce that risk substantially.
Why have charities avoided this discussion?
Hughes, who experienced violence from people experiencing psychosis during her work as a mental health practitioner, explained that many in the sector fear addressing violence could deepen stigma and discrimination, potentially leading to harmful 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's not the answer, but stigma creates a pathway to that as being the only solution to this problem."
This fear has caused the sector to avoid difficult conversations about violence. Hughes observed that the public may be more ready for such discussions than the sector itself.
"The public, I think, are more ready [and] we've got to get our act together,"she said, adding that
"Even within Mind there was a reluctance internally and we had to really talk it though."
What is Mind proposing?
Mind plans to introduce a mental health strategy calling for better support and treatment for those with severe mental illnesses while addressing public safety. The strategy includes ensuring adequate hospital bed capacity, assertive outreach, and improved accountability and communication between services.
Hughes expressed hope that open conversations would reassure both service users and the public.
"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,"she said.
She stressed that patient and public safety are not opposing goals.
"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 crisis point,"Hughes added.
Context of systemic failures
The inquiry has already examined evidence of systemic failures in Calocane's care, including repeated contact with services and missed opportunities for intervention. According to reporting on the inquiry, three nurses were referred to the Nursing and Midwifery Council over the case. The inquiry also heard that Calocane's illness was described as "unmanaged and untreated" after his release from services, underscoring broader failures across the care system.
The case has prompted wider scrutiny of mental health services. Northumbria Police is investigating Nottinghamshire Healthcare NHS Foundation Trust for corporate manslaughter over its treatment of Calocane. Additionally, families of victims have stated that police failed to inform them that a man who had taken an interest in them had a violent history and mental health problems, with the Independent Office for Police Conduct now investigating the force's handling of the information.
What happens next?
The Nottingham Inquiry will hear closing submissions on 8 and 9 September 2026, after which the chair will prepare the final report and recommendations. The inquiry's final report is expected in 2027 or 2027–2028, with findings and recommendations to follow publication.
Key Facts
- Valdo Calocane killed three people on 13 June 2023 and was sentenced to an indefinite hospital order in 2024 after admitting three counts of manslaughter on grounds of diminished responsibility.
- The independent inquiry examining the case will hear closing submissions on 8 and 9 September 2026, with the final report expected in 2027 or 2027–2028.
- Mind's evidence to the inquiry highlighted gaps in proactive outreach, culturally competent care, and support for people with serious mental illness who disengage from services.
- Research shows people with schizophrenia have an elevated risk of violence compared with the general population, but the absolute risk remains small and can be reduced through available treatments.
- Investigations are ongoing into both the NHS trust's treatment of Calocane and police handling of information about his violent history.
