There are many ways of trying to make sense of tragedies involving people with severe mental illness (Nottingham attacks: series of errors led to Valdo Calocane being discharged, review finds, 12 August). Calls for new guidelines, changed legislation, and improved “risk assessment”, while well-meaning, are unconvincing, not least because that’s what’s been happening since the Clunis report 30 years ago. They miss how complex and profound the problems are.
NHS clinicians operate in a context of rationing and scarcity, gaslit by their own organisations with talk of “efficiency savings”, “flow” and “productivity”. This can sound an awful lot like the problem is with staff who are slow, lazy and inefficient. The service values high “churn” and rapid discharge, viewing every inpatient admission as a failure of community care.
