Background and Inquiry Testimony
A nurse has informed a public inquiry that Valdo Calocane, a mentally ill man who fatally stabbed three individuals and attempted to kill three others, was adept at concealing his psychosis symptoms.
Calocane, diagnosed with paranoid schizophrenia, killed Barnaby Webber, Grace O'Malley-Kumar, and Ian Coates during a series of attacks in Nottingham on 13 June 2023.
Prior to the attacks, Calocane was under the care of Nottinghamshire Healthcare NHS Foundation Trust but was discharged in September 2022 due to a lack of engagement.
During evidence presented to the Nottingham Inquiry, which is investigating the attacks, Claudia Birtles, a mental health nurse, described Calocane as "harder than most [patients]" to assess.
Between May 2020 and February 2022, Calocane was admitted to hospital four times under the Mental Health Act.
Birtles coordinated Calocane's community care for nearly two years, from June 2020 to April 2022, serving as his care coordinator on the Early Intervention Psychosis (EIP) team after his initial psychiatric ward admission in May 2020.
The inquiry heard that in September 2021, following Calocane's third hospital admission, his relationship with Birtles deteriorated.
Calocane appealed his detention to the Mental Health Tribunal, for which Birtles prepared a report detailing his situation.
In this report, accessible to Calocane, Birtles documented his non-compliance with medication and his denial of having a mental illness.
The inquiry revealed that Calocane, referred to as VC during proceedings, informed Birtles he would cease sharing information with her after reading the report.
Following his third discharge in February 2022, Birtles noted during a meeting that there was "no evidence of overt symptoms of psychosis," though Calocane was reluctant to disclose information.
"I've always said it's been so difficult to assess those symptoms with VC, harder than most, because I believe he was quite skilled at hiding them - but again this was my impression on the day."
Care Pathway and Medication Compliance
Birtles admitted she was mistaken in describing Calocane as "polite" and "law-abiding" in the same report, despite his history of violent behavior, including attacking a police officer and breaking into neighbors' homes.
The inquiry was informed that throughout his care, Calocane consistently failed to comply with medication and lacked insight into his illness.
Calocane acknowledged that he stopped taking his medication approximately two weeks after his first hospital discharge.
Despite this, a depot injection, a long-acting antipsychotic medication, was never administered.
After his second hospital admission in July 2021, Calocane's mother, Celeste, inquired about depot medication as a treatment option.
Birtles stated she was content with the plan for Calocane to continue taking tablets, explaining:
"I think we focused a lot on his opportunity to take the tablets again, to demonstrate that he can do it."
She added that Calocane was "still quite early on" in the care pathway at that time.
Later, Birtles suggested depot medication might have been considered during Calocane's third admission but could not recall any specific discussion.
"Everybody knew there was an issue with concordance, everyone suspected it, and then it was confirmed, so it could have been [discussed],"
she said.
Birtles expressed that while she believed administering a depot was appropriate, it would not have necessarily resolved all issues, as some patients remain symptomatic despite treatment.
The inquiry heard that Calocane would have needed to consent to depot medication unless placed under a Community Treatment Order pursuant to section 3 of the Mental Health Act.
Discharge and Aftercare
Calocane was discharged by the NHS Trust to his general practitioner at the Cripps Health Centre in Nottingham in September 2022.
A letter was sent to the GP, but there was no direct communication with the surgery or any individual at the practice regarding Calocane's case, which the inquiry described as "extraordinary."
Birtles agreed that a discussion with the GP would have been "vital."
Rachel Langdale KC, counsel to the inquiry, questioned:
"And it did need fresh eyes didn't it? Because it's frankly absurd that he was discharged in these circumstances, unmedicated and into the community, isn't it?"
Birtles responded:
"I think - I wasn't there for the decision - but I can appreciate that that certainly seems to be the case."
Current Status
Calocane is currently detained under an indefinite hospital order at a high-security facility after pleading guilty to three counts of manslaughter on the grounds of diminished responsibility and three counts of attempted murder.
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