A spate of murders has put the spotlight on the adequacy of mental health care in the UK

Although the full picture of the Hainault attack has yet to emerge, the first briefings from the Metropolitan Police were clear: a key line of inquiry, in terms of possible motives, was whether the suspect has a history of mental illness.

If police hunches are correct, the tragedy may turn out to be the latest in a series of high-profile murders that have focused public attention on the adequacy of mental health care and treatment.

These include the horrific random murders of Barnaby Webber, Grace OMalley-Kumar and Ian Coates in Nottingham in June 2023 by Valdo Calocane, who had been diagnosed with paranoid schizophrenia but had been off medication and out of contact with psychiatric services for almost 12 months when he went he carried out the attacks.

This case bore disturbing similarities to that of Zephaniah McLeod, who stabbed 23-year-old Jacob Billington to death and injured seven others in Birmingham in September 2020. McLeod had been diagnosed with schizophrenia but received no supervision despite and experiencing delusions and refusing to take medication. .

This month, an inquest in Swansea found serious failings in the NHS care of Daniel Harrison, who killed his father, Dr Kim Harrison, in March 2022 after escaping from the hospital where he had been held in under the Mental Health Act after being diagnosed with paranoid schizophrenia.

An internet search for similar incidents in the UK turns up many other recent cases: reports of attacks and arrests, court hearings and investigative findings. Julian Hendy, from the charity Hundred Families, says these are all examples of problems with the provision of psychiatric care that are not taken seriously enough until it is too late.

Each tragedy is shocking and frightening in its own way, although there are common themes: medical supervision is often haphazard or barely existent; warnings of perpetrators’ behavior (often from family members) are ignored; police and health services do not share vital information; and substance abuse is often a factor.

Offenders are often dangerous people when they’re not well, who may be unwilling or unable to access care, Hendy says. They don’t get the right treatment. And often it’s only after the event [the attack or killing] that they receive the treatment they need.

Hendy set up Hundred Families after his father was killed in Bristol in 2007 in an unprovoked attack by a psychotic man known to local mental health services. It offers support to families following mental health-related murders and advises the NHS on what it can learn from these tragedies.

Hendy argues that there are too many so-called patient homicides. Although no robust up-to-date figures are available, NHS funding for this research was canceled in 2019, it estimates that of around 600 homicides in the UK each year, an average of 10-20% involve a mentally ill killer.

A study by the London Violence Reduction Unit of 50 homicides, selected by investigators from Metropolitan Police files, found that mental illness was a key factor in 29 cases. He said most of the killings were potentially preventable. Some killers had withdrawn from treatment and others had untreated mental health problems, he found.

While the number of overall homicides has decreased in recent years, there has been an increase in the proportion linked to serious conditions such as schizophrenia-related disorders.

Professor Seena Fazel, from the University of Oxford, says people with schizophrenia are at greater risk of violent and homicidal behaviour. It says around 35 homicides a year in the UK are committed by someone with schizophrenia. Most victims are family members, while the risk of being killed by a stranger with a serious mental illness is one in 14m. Fazel estimates that prevention is key, and consistent high-quality medical support would lead to a 50% reduction in these crimes.

Hendy argues that NHS mental health services need to be more proactive and assertive in treating seriously ill people who are at risk of harming others. Issues related to patient consent should be discussed. Above all, he says, proper care and treatment are critical to preventing violence and homicide.

Meanwhile, NHS mental health services are struggling to cope with resource shortages and rising demand for care. The Care Quality Commission, the NHS care regulator, said last year that there had been a marked decline in the quality of care provided by specialist mental health services.