As Nigel Abbott left home to meet friends at the pub, his eight-year-old grandson called out from his bedroom: “Goodnight, Grandad, don’t be late for my birthday party tomorrow.”
It was a warm evening in July 2018 and Abbott, 65, was heading to The Oak in Sutton Coldfield to catch last orders, his Friday night tradition for 30 years. It was a five-minute stroll, but he never made it.
Moments after stepping outside, Abbott was attacked as he strolled past the home of 30-year-old Kierran Fletcher, who was in the grip of a psychotic episode.
Abbott was punched, beaten with a spirit level and his own walking stick, then stabbed more than 50 times. The two men had never met before.
In the 12 hours before the attack, Fletcher’s desperate family had contacted an NHS mental health team more than 60 times trying to get him help. A psychiatrist and a nurse wanted the father of two to be detained — sectioned — under the Mental Health Act but there were no beds available.
Advertisement
On the day Abbott was killed there were 16 other people in the Birmingham area who had been “detained” under the Mental Health Act, like Fletcher, but were still out in the community.
During the inquest into Abbot’s death, the coroner wrote to Matt Hancock, then health secretary, as well as the local police and NHS trust, warning that he had recorded nine similar deaths involving mental health patients in the year before the killing and five afterwards, a total of 14.
In all these cases, the coroner highlighted a shortage of section 140 beds — named after the part of the Mental Health Act that requires NHS authorities to provide places for patients in an emergency.
An investigation by The Sunday Times has revealed that since these warnings there have been hundreds more deaths.
We found:
Advertisement
• 233 people across the UK have been killed in the past four years by people with a mental health disorder.
• Repeated warnings from medical professionals and coroners about a shortage of beds for the mentally ill have been missed.
• Patients who are sectioned are being allowed to stay in the community despite doctors saying they posed a risk to themselves or others.
• NHS authorities do not know how many urgent care beds for the mentally ill they are responsible for or where they are.
• Mentally ill patients are being forced to spend days in A&E or sent hundreds of miles away for a bed.
In June last year, Grace O’Malley-Kumar, Barnaby Webber and Ian Coates were killed by Valdo Calocane, a paranoid schizophrenic who had avoided psychiatric help for a year before his rampage in Nottingham city centre.
The NHS says it is juggling the costs of providing community care to prevent patients from falling into crisis while also having enough beds available for those with urgent need.
Claire Murdoch, director of mental health at NHS England, said: “The reality is there is a big treatment gap — even though we are treating one million people more a year, we’re still letting too many people tip into crisis who, if there had been more services sooner, wouldn’t have got to that point. Inpatient services in mental health are running red hot.
“Local areas have to look at whether they have enough beds. But if you open more beds, which are expensive, that means you’re putting more money into the crisis end of care, at the expense of intensive community services that can stop people getting to the point where they need detention.”
Advertisement
England’s care watchdog, the Care Quality Commission (CQC), has asked for powers to assess how the NHS is delivering mental health care. Chris Dzikiti, director of mental health at the CQC, said he had “heard the frustration of staff” about delays when treating patients.
He said patients who were classed as needing to be detained stayed in the community. “These situations can place patients, families and community professionals at risk of harm,” he added.
A mental health nurse in the south of England said he regularly had between ten and 12 people sectioned but still out in the community because of a lack of beds, which he felt was dangerous.
Speaking anonymously, he said: “It is happening all the time. The Mental Health Act is supposed to be a safety net but the public don’t realise it isn’t there any more. We are not keeping these people safe and we are not keeping the community safe.”
Another nurse, who has worked for 11 years in mental health services in the northeast of England, said: “We keep people who we think are a serious risk in their own home sometimes because we simply have nowhere to put them. We don’t have enough staff to manage that risk in the community either.
Advertisement
“I lie awake at night, worried I am going to get a call about one of these patients killing someone or themselves.”
Lade Smith, president of the Royal College of Psychiatrists, said due to a lack of beds, patients were sent hundreds of miles away for a bed in another hospital or a costly private-sector hospital. Some are made to stay for days in A&E or in police stations — environments that can significantly worsen their symptoms. In many cases, mental health teams take the risk of leaving these people in the community.
The escalating crisis
The number of people suffering psychosis, where people lose touch with reality in some way and experience hallucinations or hear voices, is on the increase.
At the start of the year, a record 682,000 patients were taking medication to treat psychosis and related disorders such as schizophrenia. In the same period in 2015, there were 570,000.
While the vast majority of these patients are not violent, some can be a danger to themselves and others.
Advertisement
In 2022-23, more than 51,000 people were detained, according to NHS England. Since the end of the pandemic, the average length of stay for a patient in a mental health unit has gone up from 34 to 54 days because of a decline in the support networks for patients such as housing and social care provision.
Accommodating them can be expensive: a single psychiatric intensive care bed can cost more than £160,000 a year, while in places such as Broadmoor Hospital it can cost more than £350,000 a year.
While the NHS was given an additional £2.3 billion a year for mental health care in 2019, much of that has been spent, with £1 billion going on community services and 30,000 extra staff. The NHS says it is now dealing with a million more cases than in 2017 because mental health has worsened as a result of the pandemic and the cost-of-living crisis. A lack of access to services and a resistance to receiving help can worsen conditions.
NHS England data shows the number of mental health beds available each month has fallen by more than 5,600 since 2010.
Under section 140 of the Mental Health Act, NHS authorities are required to make sure beds in psychiatric wards and secure units are available for cases of special urgency, such as a violent, psychotic patient posing a risk to others.
In 2019, the Department of Health and Social Care (DHSC) warned procedures relating to section 140 were not being implemented properly in many areas of the country.
In a report, the department said: “The guidance relating to Section 140 in the Mental Health Act and the code is not being implemented properly in many areas of the country.
“There is a lack of awareness amongst professionals and organisations of the meaning and responsibilities of Section 140. There is a lack of local Section 140 arrangements agreed by the organisations responsible.”
Responses to freedom of information requests submitted to 110 NHS authorities by the charity Hundred Families, which supports relatives affected by mental health homicides, have revealed how few have a grasp of their legal obligations.
Almost a third (31 per cent) could not provide details on the number or the location of section 140 beds in their region.
And 45 per cent of NHS areas, covering 26 million people across England, could not say what the arrangements were for people who need a section 140 bed to actually receive one.
Julian Hendy, from Leeds, set up Hundred Families after his father, Philip Hendy, 75, was stabbed and killed walking out of a newsagents on a Sunday morning in 2007 by Stephen Newton, who was mentally ill and known to local services.
Hendy said: “Section 140 says in law that health authorities have to provide these beds and they’re not doing it. The consequences are that people are dying avoidably every day.”
Missed warnings and hundreds of deaths
Analysis of court reports and research by Hundred Families has identified 233 reported cases of homicides where mental health was a contributing factor across the UK since January 2020.
The charity has compiled records of mental health killings over 30 years.
Many of the assailants were never charged with murder, or were found not guilty by a jury, and were instead found to have diminished responsibility and given hospital orders.
Many cases reveal how families and friends of the mentally ill have repeatedly tried and failed to warn the authorities of their fears that their loved one would could cause harm, though not all involve a major failing by mental health authorities.
There are cases where the mentally ill patient refused to engage with health workers for months on end, and where serious psychosis was missed.
Hendy said the totals were likely to be an underestimate, as not every case is reported publicly.
The cases include Ryan Lowry, 36, who was unlawfully killed by his cousin Ashley Glennon, who had chased Lowry with an axe, striking him 13 times during an attack in February 2020.
Glennon had a long history of mental illness and had been sectioned eight times. As his mental health worsened, he was taken to a crisis unit but there were no rooms available and instead a care coordinator had a brief conversation with him.
Four coroners in the past six months have issued warnings about failures in mental health services that led to suicides and murders. Three were made in “prevention of future deaths” reports, which highlighted the lack of inpatient and section 140 beds.
The DHSC said it was expanding and improving mental health services. A spokesman added: “Our deepest sympathies remain with those affected by these tragic cases. We are committed to improving the safety of patients detained under the Mental Health Act. Healthcare professionals work on a case-by-case basis to treat individuals, while also protecting them and the public from harm.”
‘There’s no two ways about it: the system caused this’
At first, Gail Abbott, 60, was angry at the man who killed her husband. Fletcher was acquitted of murder but detained indefinitely under a hospital order.
Fletcher, until two weeks earlier a fit and healthy tradesman, had suffered a sudden and dramatic decline in his mental health, his behaviour becoming erratic and bizarre.
He started to believe people were watching him and that a former partner was stalking him — he kept knives under his bed for protection and said he was “the chosen one”. He stopped working and sleeping. His family tried to get him help, but he refused.
Finally, on July 26, Fletcher’s brother convinced him to see a GP, who said he was suffering from an acute psychotic episode and contacted a mental health nurse. Instead of ringing his brother, however, the nurse called Fletcher, who got angry and hung up. Fletcher’s family persisted.
At 11pm, a psychiatrist and a nurse assessed Fletcher at his mother’s house and wanted to detain him under the Mental Health Act, but there were no beds available. The doctor tried to get Fletcher to take medication, but he refused and drove off.
His family believed he would be put in a unit the next day and persuaded him to pack a bag, but behind the scenes a series of mistakes meant his referral was delayed and delayed — no one came to collect him. Between 8am and 8pm, his family rang the NHS mental health team more than 60 times — often no one picked up. At around 10.30pm, Fletcher went into his garden, which is when Abbott walked past. ‘That’s the devil,” shouted Fletcher, and attacked.
Gail Abbott said: “There’s no two ways about it: the system caused this and the system caused two families to become victims.
“Nigel worked so hard. The afternoon he was killed we were discussing retirement,” she said. “Had they done what they should have done, Nigel would be sitting here with me now. Justice for Nigel would be a change to the way the mental health system treats these cases. Mental health kills.”
