How mental health system failures can be deadly

We need a different approach to mental distress

Valdo Calocane, a black man with paranoid schizophrenia who lived in Nottingham, killed three people last June as a result of his mental health. The tragic deaths have been used by much of the media to paint a picture of a threat from out of control mentally distressed people.

And in particular, produce fear of black men with these conditions. Even the Care Quality Commission report into how the Nottinghamshire NHS trust treated Calocane called his behaviour “threatening and assaultive”.

But Dr Andy Brammer, a social work lecturer and mental health practitioner, says there’s nothing particularly dangerous about black men. And he explains that the racialisation of mental distress comes alongside misconceptions of conditions like schizophrenia.

Andy told Socialist Worker, “What worries me is the conclusions that will be drawn from this situation, and they become a driver in the opposite direction to what’s needed.”

“Calocane fits every profile of scariness,” he added. “There’s a report called Big, Black and Dangerous from 1993 that looks at how black people are more likely to have police involvement in their detainment.

“Institutional racism helps to exacerbate the threat and risk of an individual. A mentally ill person is not a monster, they’re often the victim of circumstances like racism or violence.

“And no one explains what schizophrenia really is. It can be paranoia, hearing voices, hallucinations or creating fear. People are not acting out of badness but reacting to fear.”

Black people are seven times more likely to die than white people following the use of restraint by police. And cops are often quicker to escalate the use of force on black men in a mental health crisis.

People with mental distress are often a threat mainly to themselves and are the victims of violence. In particular they face assaults—sometimes life-threatening—from the police.

Iain Ferguson, author of Politics of the Mind: Marxism and Mental Distress, thinks that Calocane has been made to look “dark and threatening” in descriptions and pictures. “The portrayal reminds me of how Sheku Bayoh, who the police killed in 2015, is painted to justify how he was treated,” he told Socialist Worker.

“Calocane was apparently difficult to engage with. But that’s not unusual in people with severe mental distress. It looks like Calocane was discharged to his GP and allowed to get lost in the system.

“Black people are particularly let down and African-Caribbean men are more likely to be locked up or treated with coercive controls.”

Iain says that crises in society have exacerbated mental health problems. “The Covid and cost of living crises have hugely increased the number of people experiencing mental distress,” he said.

“And on the other side there’s the mental health system in crisis. Not surprisingly the focus of health secretary Wes Streeting is on the individual and individual failings of mental health workers.”

Iain thinks that while there are criticisms of health care staff, “Looking at individual failings ignores the mountain of evidence that this is a broken system in crisis.

“Psychologist teams are full of absences and are understaffed.” Between 2020 and 2022 Nottinghamshire NHS trust hospitalised and released Calocane on four occasions.

Andy says that human behaviour has been turned “into a predictive science”.

“If people follow rules like taking medication then they’re safe—if they don’t we can blame the individual. But that ignores the deeper causes of mental distress. That’s difficult to get across at the moment.”

He added that what happened is “no surprise” after 20 years of massive cuts to provision. “There is a huge pressure to discharge beds early before people are well enough to go home.

“My job is to assess and detain people. But we can sometimes decide someone needs to be in hospital and they still have to wait until a bed becomes available.

“And cuts in community services mean someone like Calocane can’t be managed with an outreach team. These used to be dedicated teams who worked with people who were most difficult to engage with.

“But they don’t exist anymore. They’ve been assimilated into mainstream services.

“Some 20 years ago there were five of these teams in the district where I work, rooted in the local community. But now there’s just hubs in city centres.”

Andy argued, “Rather than being 20 minutes away from people, people have to travel 20 miles. These services are impersonal and uninviting.

“Lots of people are falling through gaps in services. “And third sector services that aren’t statutory, like drop-ins and crisis houses that provide informal support, are the first to go when local authorities implement cuts.

“There’s also a huge crisis in the recruitment of community mental health nurses and social workers. It means caseloads are more difficult to manage, and services have less experienced workers.”

Iain explained that underfunding community care “puts more emphasis on families to get the support needed and the burden of care falls on them”.

“The mental health system isn’t able to respond to people when they first need help. We need more non-medicalised services. Research shows that most of the time people just need someone to talk to.

“But these services have gone. Teams set up to deal with someone’s first episode of psychosis are cut or oversubscribed. When people eventually get help, they are much worse than they need to be.

“Another thing that comes out of all the reports is a lack of coordination. Good care would mean these services coordinate with statutory services.”

Iain said the work that professionals do with someone who  has mental distress is not just about getting them to take their medication. “It’s relationship-based work.

“It means having highly skilled workers with a lot of training. Many in the sector don’t have the time or resources for such complicated work.”

Much of the media is focusing on the community treatment order that could’ve forced Calocane to take his medication. “Research shows these orders don’t make any difference to whether people become unwell or take their medication,” Andy explained.

Iain added, “There are several issues with forcing people to take medication. For some people medication is helpful and families find antipsychotics helpful.

“But the major reason people don’t take them is the side effects are so awful. Medication doesn’t cure psychotic symptoms, it dampens them down.

“It’s a way of managing difficult symptoms. There’s now an international movement that tries to help people with delusions or hearing voices without relying on medication.

“Mental health services have become more controlling and reliant on coercion. But there are other models and approaches.”

Andy says part of the solution is “to understand risk and mental distress in the context of a society where people’s conditions constantly change”.

“People don’t just need their medication monitoring, they need ongoing support and accessibility to services. Individualised blame about who is taking their medication won’t solve anything—and takes responsibility away from society.

“That ignores the nature of the society we live in that creates forms of mental distress.” Andy said one demand has to be “more rights and less control”.

“But the typical neoliberal response will do the opposite. There will be more stigma attached to mental illness and that comes from the media too.”

Stigmatisation means people will be less likely to engage with existing services. “We need to invest more in services that work alongside excluded people and are designed to be accessible.

“People need access to services that support them talking about their fears or helping them to understand things they experience,” Andy added. “Is mental illness a medical problem or a social problem?

“Mental illness arises from social conditions and problems—therefore it needs a social approach.” Iain agrees. “People’s lives are complex. Mental distress is related to something going on, whether in the family and wider, or experiences of racism, sexism or trauma.

“A slogan among service users is more and better services. We need more accessible services and more input from people with mental distress.

“We need to defend what we have and fight against the stigmatisation. And we need to look at what is producing so much mental distress and why the system is so clearly failing to address that.”