Stop blaming the psychiatrist.
The post-mortem of the Valdo Calocane case is currently drowning in a sea of hindsight bias. Politicians and grieving families are pointing fingers at a single clinician who decided not to section a killer years before his rampage. They want a villain. They want a clear point of failure. They want to believe that if a doctor had just signed a piece of paper, three people would still be alive. Don't forget to check out our earlier post on this related article.
They are wrong.
The outrage directed at the "inability to section" misreads how the Mental Health Act actually functions and ignores the brutal reality of modern psychiatry. We are obsessed with the idea that the Mental Health Act is a preventative tool for crime. It isn't. It is a clinical intervention for crisis. Expecting a psychiatrist to be a precognitive law enforcement officer is not just a high bar—it is a logical impossibility that would collapse the entire healthcare system if enforced. If you want more about the history of this, World Health Organization provides an excellent breakdown.
The Myth of the Crystal Ball
The public assumes that "dangerousness" is a static, measurable trait. It’s treated like a blood glucose level—something a doctor can see on a chart and act upon.
In the real world, risk is fluid. I have sat in rooms with patients who look like ticking time bombs on Monday and are perfectly lucid on Tuesday. The "lazy consensus" suggests that because Calocane eventually committed a horrific act, his future violence was an inevitable, readable script. This is what psychologists call "creeping determinism."
The criteria for sectioning under the Mental Health Act require a person to be suffering from a mental disorder of a nature or degree that warrants detention in the interest of their own health, safety, or for the protection of others. But here is the nuance the headlines skip: the "protection of others" threshold is incredibly high for a reason.
If we lowered that threshold to include anyone who might become violent in three years, we would be mass-incarcerating thousands of people who will never actually hurt a fly. Civil liberties aren't just a legal footnote; they are the bedrock of why we don't live in a police state disguised as a hospital.
The Bed Crisis Is the Real Killer
Focusing on the psychiatrist’s decision is a convenient distraction from the systemic rot. Even if that doctor had wanted to section Calocane, where would he have gone?
The UK is currently operating at a bed occupancy rate that frequently exceeds 95%. In many trusts, it hits 100% daily. When you have zero beds, your clinical threshold for "risk" naturally, if unconsciously, rises. You start looking for reasons not to admit because you physically cannot put a body in a room.
Psychiatrists are forced into a "Sophie’s Choice" every single shift. Do you section the man who is hearing voices but still eating, or the woman who is currently standing on a bridge? When the system is starved of resources, the "protection of others" becomes a secondary concern to the immediate "prevention of suicide."
We have traded long-term community stability for short-term crisis management. We don't "fix" people anymore; we stabilize them just enough to clear the bed for the next person in the waiting room. Calocane didn't just "slip through the cracks." He fell through a canyon we spent thirty years digging through underfunding and the shuttering of long-stay facilities.
The Treatment Resistance Trap
Critics argue that "more medication" or "stricter oversight" was the answer. This assumes that psychiatry has a 100% success rate with antipsychotics.
Here is the truth nobody admits: for a significant portion of patients with treatment-resistant schizophrenia, the drugs don't work. Or, they work at the cost of such debilitating side effects—weight gain, tremors, extreme lethargy—that the patient inevitably stops taking them the moment the supervised door closes.
We talk about "community care" as if it’s a robust safety net. It’s actually a frayed piece of twine. A Care Co-ordinator with a caseload of 30 high-risk patients cannot monitor medication compliance in any meaningful way. If a patient is clever enough to mask their symptoms for a twenty-minute check-in, they stay "in the community."
The failure in Nottingham wasn't a failure of clinical judgment. It was a failure of the medical model to account for the fact that some illnesses are currently beyond our ability to manage outside of a locked ward—wards that we have spent decades closing.
Stop Asking "Why Didn't They Section Him?"
The question itself is flawed. It implies that sectioning is a cure. It’s not. It’s a pause button.
Most people sectioned under Section 2 or 3 are released within weeks or months. Unless you are prepared to advocate for the return of the "asylum" model—permanent, indefinite detention for the severely mentally ill—then sectioning Calocane in 2020 would have likely had zero impact on his actions in 2023. He would have been medicated, stabilized, and released back into the same broken community cycle.
If you want to prevent the next Nottingham, stop hunting for a scapegoat in a white coat.
Start demanding the return of institutional capacity. Admit that some individuals cannot be managed in the community. Accept that "risk" is a gamble, and currently, the government is forcing psychiatrists to play with a rigged deck.
The blood isn't on the doctor’s hands. It’s on the hands of every policymaker who pretended you could run a psychiatric system on "good vibes" and "community outreach" while the actual hospitals were being gutted.
Hospitalization isn't a failure of care; the lack of it is. Until we stop treating "detention" as a dirty word and start treating it as a necessary infrastructure, we are just waiting for the next tragedy to occur so we can blame another doctor for not being a psychic.
Fix the system or stop complaining when it breaks.
