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According to an investigation by Hundred Families, a charity that supports and advocates for families affected by mental health homicides, each year an average of 65 mentally ill people carry out killings. Between 2018-2023, 390 mental health patients in England committed, or were suspected of, murder or manslaughter.
The findings come after an independent report exposed a series of NHS failures in the treatment of Valdo Calocane, a man with schizophrenia who killed three people in Nottingham in 2023.
The cases of killers Calocane and Axel Rudakubana – who stabbed three small girls to death and attempted to kill several others in Southport in 2024 when he was 17 years-old – have sparked fierce debate over the place within wider society of people with severe mental health issues. According to many, it appears they don’t have one.
Calocane and Rudakubana were labelled “evil”, “sadistic” and “cowardly”, amid renewed calls for the reinstatement of the death penalty.
When sentencing Rudakubana to a minimum term of 52 years in January 2025, Mr Justice Goose said: “Many who have heard the evidence might describe what he did as evil, who could dispute it?”
Public opinion on the likes of Calocane and Rudakubana seems clear: they are monsters, capable only of inflicting misery on others. At best, they don’t deserve to live among right-minded people. At worst, they don’t deserve to live at all.
It’s now known that both Calocane and Rudakubana had received treatment for severe mental health issues but stopped engaging with health services before committing their crimes. In the eyes of many – including media commentators, politicians and sizeable swaths of the public – suffering severe mental health illness doesn’t affect someone’s responsibility for their actions.
As a human being, I regard the prevailing narrative around stories such as Calocane’s and Rudakubana’s with a tremendous sense of sadness. As an academic specialising in social and cultural perspectives of mental health, I regard it with a profound sense of frustration – and maybe even failure. Let me try to explain why.
A question of accountability
A key reason why those with severe mental health issues are customarily condemned as wicked and irredeemable is that we continue to believe that a person should invariably be held accountable for their own actions. This is a damagingly simplistic view.
Anyone who has worked in the field of mental health knows there are many cases in which people’s minds, to all intents and purposes, aren’t their own. Those, like Calocane, suffering from an overwhelming condition such as schizophrenia, for example, frequently have no grasp of reality and have hampered moral reasoning.
It’s reasonable to say some people with severe mental health issues can represent a danger to themselves and others. But this doesn’t mean they should be abandoned or “locked up”. What they need is support from mental health systems that are genuinely integrated, effective and reliable.
Calocane and Rudakubana’s victims, their families and all those cruelly affected by their crimes were catastrophically let down in this respect. But so were Calocane and Rudakubana. The notion that the pair “stopped engaging” is a poor excuse for the cataclysmic shortcomings of a system that should be rooted in diligence, outreach and persistent follow-ups.
However uncomfortable the idea, much of the accountability here lies not with the killers – and that, of course, is what they are – but with those who left them unsupported and in a position to devastate others’ lives and their own. Ultimately, it’s the system itself that disengages – sometimes with the most appalling consequences.
When findings alone aren’t enough
Numerous studies have shown how those in the grip of psychosis and similar illnesses don’t choose to be “evil”. They don’t choose to experience horrific delusions about the world around them. They don’t choose to endure hallucinations that tell them to carry out terrible acts.
Yet the broader public seems to have little or no interest in such findings. Alarmingly, the same might be said of many policymakers. Their knowledge and opinions are instead more likely to be shaped by rhetoric and knee-jerk denunciation.
This goes to the heart of a major challenge for academics in my own field and for the research community as a whole: how best to communicate our work and make it truly accessible. We need to accept that research alone is often woefully insufficient.
A few years ago, in collaboration with Aardman Animations, the studio behind household names such as Wallace and Gromit and Shaun the Sheep, I produced a series of short films highlighting young people’s mental health. In months, these films reached an audience of more than 17 million. More recently, in another effort to spread the word, I wrote The Wonders of Doctor Bent, a novel that explores society’s lingering propensity to treat isolated and tormented people with the utmost contempt.
None of this is to say research is pointless – yet it’s surely of limited value if the insights it delivers remain largely unacknowledged, especially where matters of the most extraordinary significance are concerned.
As the unhelpful clamour around mental health and “monsters” drags on, the lesson is both clear and familiar: the best way of having conversations about stigma, responsibility and the cost of abdicating our social obligations to those suffering from severe mental illness is to involve the whole of society. Not just the mental health community, police and the justice system, but the general public as well.
Paul Crawford receives funding from UK Research and Innovation including Arts and Humanities Research Council, Economic and Social Research Council, UKRI Cross Council, The Leverhulme Trust, The British Academy
