Discharge of Patient with Paranoid Schizophrenia
A man diagnosed with paranoid schizophrenia was discharged from mental health services months prior to killing three individuals, after healthcare professionals were unable to locate him, a public inquiry has been informed.
Valdo Calocane had been under the care of Nottinghamshire Healthcare NHS Foundation Trust for two years. During this period, he was sectioned on four occasions and had been warned that he might eventually kill someone.
Regarding the decision to discharge Calocane in September 2022, following his failure to attend appointments or maintain contact, NHS trust team leader Emma Robinson stated:
"We couldn't work with him, we couldn't find him at this point."
Several months later, on 13 June 2023, Calocane killed three people in Nottingham.
The Nottingham Inquiry, which is investigating the circumstances surrounding the deaths of Barnaby Webber, Grace O'Malley-Kumar, and Ian Coates, as well as the subsequent events, heard that Calocane was discharged by the trust's Early Intervention in Psychosis (EIP) service due to his non-attendance and lack of communication with the team.
Efforts to Engage Calocane
Emma Robinson, who served as a team leader with the EIP from 2019 to 2022, informed the inquiry that Calocane's care coordinator, Gary Carter, had visited his residence, made telephone calls, and sent a letter, all of which went unanswered.
Tim Moloney KC, representing the families of the victims, questioned Robinson:
"When you discharged, did you think about the risk to the public from this man, who EIP would not visit alone, would not visit at home unless absolutely necessary? Did you consider the risks to the public from that man?"
Robinson responded:
"We did consider that, but we felt that within the time of decision we had no holding powers, we couldn't work with him, we couldn't find him at this point. We just couldn't find him to work with him."
The inquiry was told that Calocane's last contact with the EIP team was a phone call on 16 July, during which he falsely claimed to be abroad.
Moloney asked,
"Had you lost him?"
Robinson replied,
"Yes."
When asked if this was the primary reason for discharging Calocane, Robinson said:
"Yes, because we couldn't find him to treat him or engage him. He was a very difficult person to engage with. I think he needed a more robust service than early intervention could offer. I think in hindsight he needed a team that could do more of that follow-up."
Moloney stated that by discharging Calocane to his general practitioner (GP), the trust effectively "left him to the general public to deal with."
Robinson responded:
"I wouldn't say the general public to deal with. It's not uncommon for us to discharge non-engaging patients, unfortunately, at that time. I think things are very different now."
Rationale Behind Discharge Decision
In a written statement explaining her reasoning for discharging Calocane, Robinson reflected:
"It's dire for me to think this now, but I used to think sometimes - is it worse to have somebody open on caseloads that you're not engaging with? Should we be discharging them instead? What does it look like if something happens and we've got this person open to us and we haven't seen him for months and months and months?"
When asked by Craig Carr, counsel for the chair of the inquiry, to clarify this statement, Robinson said:
"I suppose, from previous experience, I'm worried about how that's looked - that we've got somebody that's open to us, and perhaps we've not been able to treat them for nine months, or find them. So sometimes the decision's better to discharge back to the GP."
Carr suggested this could be interpreted as implying it was preferable to remove someone from the service's caseload if they could not be located.
Robinson added:
"It feels safer to have somebody discharged back to the queue of the GP, than open to a secondary service when we can't engage them, or we can't do anything for them."
Training and Procedures in EIP Team
Carr inquired about the mandatory training required for EIP team members. Robinson explained that all staff at the trust undergo training regardless of their specific area, including basic life support, risk management, record keeping, infection control, mental health act training, mental capacity, and care programme approach training. However, she noted that there was no training specific to early intervention.
When asked whether there was training on managing disengaging patients, medication adherence, or criteria for referral to the community forensic team, Robinson stated that to her knowledge, such training did not exist.
Concerns About Discharge Communication
Inquiry chairwoman, retired senior judge Deborah Taylor KC, highlighted that Calocane's GP received minimal information following his discharge.
Robinson acknowledged this, stating:
"I accept that."
When questioned by Sophie Cartwright KC, representing survivors, whether this was "wholly inadequate," Robinson responded:
"As a discharge letter, you would expect more like you've said, and I wasn't aware of that until part of the evidence of the inquiry."
The inquiry also learned that Nottinghamshire Police were not informed by the trust that Calocane had been discharged from its services.
Discharge Documentation and Follow-Up
Sharon Heath, who became clinical team leader for the EIP south team in 2021 and assumed the team leader role in December 2022, requested that a discharge letter be prepared for Calocane's GP. She anticipated that important documents related to his care, including a risk assessment and care plan, would accompany the letter.
However, these documents were never sent. When asked by Carr whether the documents would have been outdated, Heath confirmed:
"Yes."
