Anti-stigma work has an awkward edge, and the head of Britain’s largest mental-health charity has just named it. In an interview with the Guardian, Dr Sarah Hughes — chief executive of Mind for four years, nearly four decades in the sector — said mental-health organisations have “failed to acknowledge” that a small minority of people with severe mental illness do commit serious violence. Her phrase for the omission is precise: the sector “softened the truth.”
Hughes’s timing is not accidental. The public inquiry into the Nottingham attacks closes this month; it has been examining the events leading up to 13 June 2023, when Valdo Calocane fatally stabbed two 19-year-old students, Barnaby Webber and Grace O’Malley-Kumar, and 65-year-old caretaker Ian Coates. Calocane had been diagnosed with paranoid schizophrenia three years earlier, was sectioned four times in two years, repeatedly refused medication, and had committed a string of violent acts before the killings. He was sentenced in 2024 to an indefinite hospital order.
Why the subject was avoided
Hughes’s explanation is that charities feared the consequences of candour. Addressing violence risk, she says, risked deepening the stigma and discrimination that keep people from seeking care at all — and that stigma in turn “creates a pathway” to a more restrictive system. “We are incredibly frightened of deepening that stigma and discrimination because we know how dangerous it can be,” she told the Guardian, adding that the fear could push policy back toward coercion. She notes the reluctance existed inside Mind itself: “Even within Mind there was a reluctance internally and we had to really talk it through.”
She is not arguing the sector was wrong to worry. She is arguing it drew the wrong conclusion. Most people with mental illness are not violent, and saying so was never the problem; the problem was the implication that the remainder need not be discussed. The consequence, as she frames it, is that public conversation got taken over by people with less interest in the nuance.
What the evidence actually says
Seena Fazel, professor of forensic psychiatry at Oxford, supplied the numbers at a Mind roundtable in Westminster. People with schizophrenia do have an elevated risk of violence compared with the general population, “even after accounting for socioeconomic factors” — but the absolute risk is small, and only a minority will commit a serious violent act. The risk rises with substance misuse, a personal history of violence, or having been a victim of violence. The crucial part is the last one: the treatments already exist and are widely available, and they bring the risk down.
That is the shape of the argument the sector has struggled to make publicly. The elevated relative risk is real and uncomfortable. The absolute risk is small. And the modifiable part is a question of access and follow-through, not of character — which is precisely the ground on which mental-health advocates are strongest.
The families
Emma Webber, whose son Barnaby was killed, said she welcomed the statement. “I do feel like danger to others has almost been deliberately quietened down in the conversation in the past,” she said, arguing charities could use their authority to make the difficult point rather than avoid it. She also drew the line that Hughes draws: “the vast majority of people with mental health issues in this country are completely safe … but if somebody’s dangerous, they’re dangerous.” Her conclusion is a systems one — had the risks in Calocane’s case been properly understood, she believes the killings would not have happened.
What comes next
Hughes wants the government’s forthcoming mental-health strategy to fix the material conditions that make risk unmanageable: enough hospital beds, assertive outreach, and clear accountability and communication between services. Her framing, repeated more than once, is that patient safety and public safety are not a trade-off — the argument that has been losing ground in Britain because the sector left it half-made.
It is a narrower claim than a full-throated admission of failure, and Hughes does not pretend the conversation will be comfortable. She has been a mental-health practitioner who was attacked by patients in psychosis. The point she makes is that the discomfort of discussing it is smaller than the cost of a system that only addresses risk after a crisis. As she puts it, both safety and care are possible “if we want to change our mental health system so people can get the right care before or after reaching crisis point.”