Psychiatrist Unable to Detain Valdo Calocane
A psychiatrist who assessed Valdo Calocane after he assaulted a flatmate stated he was unable to detain him under the Mental Health Act (MHA). Calocane, diagnosed with paranoid schizophrenia in 2020, fatally stabbed three people and attempted to kill three others in Nottingham on 13 June 2023.
In January 2022, police responded to a call after Calocane placed a flatmate in a headlock and held him hostage in their flat on Faraday Road, Nottingham. The following day, Dr Mike Skelton, a consultant psychiatrist with the Nottinghamshire Healthcare NHS Foundation Trust crisis team, assessed Calocane and decided he did not pose a serious enough risk to be detained, allowing him to return home.
Dr Skelton was familiar with Calocane’s case, having attended meetings regarding his release from two previous periods under section of the Mental Health Act at Highbury Hospital in August 2020, and conducting a seclusion review in September 2021 after Calocane assaulted a police officer.
During the 2021 seclusion review, Skelton observed Calocane from the doorway without making eye contact due to safety concerns, describing him as a "clearly very psychotic" patient. Calocane was noted to be "guarded, curt, fixed staring and having a hostile edge to him" at that time.
However, when Skelton assessed Calocane after the flatmate incident in January 2022, he described Calocane as "polite and calm" and noted that Calocane "invited us in to the property". The assessment was conducted with police assistance, involving 15 officers and a warrant to remove Calocane for evaluation. Officers initially wanted to leave after Calocane was taken to the Cassidy Suite at Highbury Hospital, but medical staff requested their presence for safety reasons.
During the assessment, Skelton was aware that Calocane had not been taking his medication despite his claims to the contrary. Skelton stated,
"It's clear that he does make statements and then when he's challenged or we have evidence, that sort of melts away."
He explained that non-compliance with medication is common among patients with schizophrenia and is not, by itself, grounds for detention; rather, it is the overall effect on the individual that matters. Calocane took one tablet in front of Skelton during the assessment, but the psychiatrist noted,
"One tablet doesn't reduce the risk. The first step was to see was he going to even do that, because if he didn't, he would have been detained immediately."
Factors influencing the decision not to detain Calocane included the police decision not to arrest him after the assault, the ongoing investigation, and Calocane’s composed demeanor. Skelton said,
"I went into that assessment expecting that I would be detaining that chap. Based on what we saw he was not detainable under the Mental Health Act."
He emphasized that the decision to release Calocane to the crisis team and allow him to return home was not a gamble or influenced by Calocane’s attempts to dissuade detention. Instead, the team lacked the legal authority to detain him based on the assessment.
"We all agreed that this chap would be better off in hospital. But we did not have the legal powers at the time to enforce it based upon the assessment we saw,"
"He was able to, and it's very unusual, to push back and you could tell he wished to take control. And I thought it was very unusual, it did stay with me."
"A MHA [Mental Health Act] assessment is based on 'are the criteria met?' And there are not individual elements. Crucially at the time I was not able to elicit acute psychotic symptoms.
When we concluded the assessment and I concluded he wasn't detainable, the crisis team had to look after him.
That wasn't comfortable for us. To suggest that we were not aware of the risk, it's not true."
Following the decision not to detain Calocane, the university removed other tenants from the property for their safety. The crisis team monitored Calocane daily under a community plan while collecting evidence, and a further MHA assessment was ordered eight days later.
Skelton stated,
"We saw the chap had been lying to us. We had genuine hard facts we could use."
Evidence from Crisis Care Practitioner Josephine Baker
Josephine Baker, a crisis care practitioner nurse and team leader from February 2022, also provided evidence. She visited Calocane on 23 June 2020, between his two hospital stays that year. Prior to the visit, Calocane had reported no hallucinations or abnormal thoughts during a phone call.
Baker said,
"It took him a little bit of time to open up and say that he was hearing voices. He was quite open with the fact but he felt able to manage them now since being discharged.
It could have potentially have been [an early warning sign of relapse] but I wasn't concerned about him. He was quite open and honest. He was calm and settled."
Calocane was re-admitted to Highbury Hospital in July 2020 under the Mental Health Act.
Baker was also involved in monitoring Calocane during the eight days after Skelton’s assessment in January 2022. She reported,
"VC [as Calocane is referred to at the inquiry] didn't engage well so it was hard to be able to assess the risk that was posed at that time. I couldn't be sure he was taking his medication."
Baker noted in her records that Calocane had become "intimidating" and was no longer safe to be treated in the community.
Admission to Cygnet Victoria House
Consultant psychiatrist Dr Kalina Shoilekova from Cygnet Health Care gave evidence regarding Calocane’s admission to Cygnet Victoria House, a private hospital in Darlington, County Durham, in September 2021. Calocane had attacked a police officer while being detained at Highbury Hospital after breaking into a neighbour’s flat during a psychotic episode.
The Nottinghamshire trust initially referred Calocane to Cygnet's psychiatric intensive care ward, but the referral was declined due to the nursing team being "predominantly female" and concerns about the risks Calocane presented.
Shoilekova explained,
"There was not enough manpower, and by that I mean male power, to deal with exceptional circumstances which might happen."
A second referral was made three days later and accepted. Although no discharge note was provided upon admission, a risk assessment described Calocane as "a polite and gentle, personable young man."
Shoilekova noted that the team did not have access to outpatient case notes, stating,
"This fragmentation of services is not ever beneficial, not only for the patients, it is not beneficial for the staff.
It generates a lot more, how can I call it? Detective work, to find the relevant information in the whole ocean of information."
On admission, Calocane was "very suspicious" and likely hearing voices. Shoilekova described his mental illness history as "not unusual" and said,
"The majority of patients who would write about that, talk about that, never proceed to do such a horrible, horrible act."
High Risk Patient and Hospital Transfers
While at Cygnet, Calocane was recommended for depot medication by his care coordinator Claudia Birtles and Dr Shoilekova, but he preferred to continue with tablets. Shoilekova expected Calocane to remain hospitalized for "at least two to three months" and informed a tribunal that, if discharged, he would not comply with medication or engage with community mental health services.
Calocane was discharged from Cygnet to The Priory Hospital in Arnold, Nottinghamshire, on 1 October 2021. The Priory was rated inadequate by the Care Quality Commission at the time.
Discharge papers from Cygnet indicated Calocane posed a high risk of violence and had no intention of taking his medication.
Legal Outcome
Following the killings in June 2023, Calocane pleaded guilty in January 2024 to three counts of manslaughter on the grounds of diminished responsibility and three counts of attempted murder. He was sentenced to an indefinite hospital order.
Listeners can follow BBC Radio Nottingham on Sounds and BBC Nottingham on Facebook, X, and Instagram. Story ideas can be sent to eastmidsnews@bbc.co.uk or via WhatsApp at 0808 100 2210.
