‘Dangerous’ people should not be admitted to specialist beds, warns CEO

Roisin Fallon-Williams, CEO of Birmingham and Solihull Mental Health Foundation Trust, told HSJ her organisation is reviewing care of patients who do have severe mental illnesses.

This includes those similar to Nottingham patient Valdo Calocane, who has paranoid schizophrenia and killed three people in June last year, with BSMHFT’s review taking place as part of national orders following the high-profile case.

However, she said the process had highlighted that there was also a group of people sometimes signposted to mental health services “whose profile is much more about them being dangerous people, not because they’re mentally unwell, but actually they [are exhibiting] behaviours that pose a danger”.

Ms Fallon-Williams said her trust was working with the police to ensure forces were clear “they are not the kind of people we need to admit to our beds, they are the kind of people we need the [police] to support us with, to take them down the judicial route”.

Mr Calocane meanwhile was judged to have been failed by Nottinghamshire Healthcare FT, according to the Care Quality Commission. It said the trust had wrongly minimised risks he posed and poorly planned his care.

On his case, Ms Fallon-Williams added: “We know there are people like [Valdo Calocane] who have psychotic instances [and who] don’t engage.

“We need to think about who is not engaging with us and why, making sure those flags are understood.”

Following the damning report into Mr Calocane’s care, NHS England asked systems to highlight “gaps” in resources for intensive community mental healthcare, and published fresh guidance, including “on what good quality, safe care looks like [including] a review of patient safety”.

Investment needs ‘untangling from the binary’

With a new government and Lord Darzi’s report into the NHS highlighting chronic gaps in mental health services, Ms Fallon-Williams shared her hopes for the future.

She called for a “less binary” approach to mental health investment, warning that typically services will receive money for a particular programme, for example for talking therapies – and be told “this is the model you have to put in place”.

The CEO said: “Often, the reason the investment has been made is because people have said ‘here’s something that’s got a good research base that will work and let’s have it everywhere’, that’s how the investment has come and it’s the only way we’ve been able to get that investment.”

She added: “Untangling us from the binary is going to be the reason we succeed in the future. For me, a [binary approach where] we are told ‘here is the money for talking therapies and here is the model you have to put in place’…. Does that work in all areas and all localities? Probably not… I think we absolutely need to be less binary than [the system] is currently.”

BSMHFT was recently chosen as one of six providers nationally to lead the development of a 24/7 mental health service pilot, funded by NHSE for more than two years. It will see the trust begin a phased opening of a neighbourhood centre to the east of Birmingham, working towards the provision of day and night support to people aged 18 and over with serious mental illness, by spring 2025.

This kind of open-ended investment, Ms Fallon-Williams said, “gives us that opportunity about what can work in one particular neighbourhood, but it will be different in others”.