While the full picture of the Hainault attack is yet to emerge, the early briefings from the Metropolitan police were clear: a key line of inquiry, in terms of possible motive, was whether the suspect has a history of mental ill-health. If the police hunches are correct, the tragedy may turn out to be the latest in a series of high-profile killings that have focused public attention on the adequacy of mental health treatment and care. These include the horrific random killings of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in Nottingham in June 2023 by Valdo Calocane, who had been diagnosed with paranoid schizophrenia but had been “unmedicated and out of touch with psychiatric services for almost 12 months” when he carried out the attacks. That case had worrying similarities to that of Zephaniah McLeod, who stabbed to death 23-year-old Jacob Billington and injured seven others in Birmingham in September 2020. McLeod had been diagnosed with schizophrenia but received no supervision despite 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 hospital where he had been detained under the Mental Health Act after being diagnosed with paranoid schizophrenia. An internet search of similar incidents in the UK throws up many other recent cases: reports of attacks and arrests, court hearings and inquest findings. Julian Hendy, of the charity Hundred Families, says these are all examples of problems with psychiatric care provision not being taken seriously enough – until it is too late. Each tragedy is shocking and appalling in its own way, though there are common themes: medical supervision is often haphazard or barely existent; warnings of the perpetrator’s behaviour (often from family members) are ignored; police and health services fail to share vital information; and substance abuse is often a factor. “The offenders are often people who are dangerous when they are unwell, who can be unwilling or unable to access care,” Hendy says. “They aren’t getting the right treatment. And it’s often only after the event [the attack or killing] that they get 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 provides support to families after mental health-related killings and advises the NHS on what it can learn from such tragedies. Hendy argues there are far too many so-called patient homicides. Although robust up-to-date figures are not available – NHS funding of this research was cancelled in 2019 – he estimates that of about 600 homicides in the UK each year, about 10-20% on average involve a killer who is mentally ill. A study by London’s Violence Reduction Unit of 50 homicides, selected by researchers from Metropolitan police files, found mental illness was a “key factor” in 29 cases. It said most killings were “potentially preventable”. Some killers had withdrawn from treatment and others had untreated mental health problems, it found. While numbers of general homicides have fallen in recent years, there has been a rise in the proportion linked to serious conditions such as schizophrenia-related disorders. Prof Seena Fazel, of Oxford University, says people with schizophrenia are at increased risk of violent and homicidal behaviour. He says about 35 homicides a year in the UK are committed by a person with schizophrenia. Most victims are family members, while the risk of being killed by a severely mentally ill stranger is one in 14m. Prevention is key, and high-quality and consistent medical support would lead to a 50% reduction in these crimes, Fazel estimates. Hendy argues NHS mental health services need to be more proactive and “assertive” in their treatment of severely ill individuals at risk of harming others. Issues around patient consent need to be debated. Above all, he says, “proper care and treatment” is vital if violence and homicides are to be prevented. Meanwhile, NHS mental health services are struggling to cope with resource shortages and increasing demand for care. The Care Quality Commission, the NHS care regulator, said last year there had been a “notable decline” in the quality of care provided by specialist mental health services.