The critical report into the mental health care given to Valdo Calocane – a paranoid schizophrenic who stabbed three people to death in Nottingham last year – is damning.

Before the attack, mental health assessments recorded how he had frequently stopped taking his medication and his behaviour had become increasingly violent. But despite these red flags, the risks he posed were minimal and there had been “a series of mistakes, omissions and misjudgements”, The Care Quality Commission (CQC) found,

Caloocan was insanely confused when he murdered Barnaby Webber, Grace O’Malley Kumar and Ian Coates. Their families say the flaws exposed in the report are worse than previously known, and have been told there will be a public inquiry into the case.

At the centre of the criticism is Nottinghamshire Healthcare NHS Foundation Trust (NHFT), which says it accepts the report’s findings and is working to improve its services.

But several important questions about Waldo Caloocan’s care still remain.

Yes, there are circumstances in which patients with severe mental health illnesses may be forced to take medication.

The CQC report detailed how over the two years that Calocane was being treated by the NHFT he often stopped taking his medication.

Old pills were found in his flat, which were the main treatment for his paranoid schizophrenia.

He also missed several appointments with mental health teams, and his medical records show his violence increased as he became more seriously unwell.

The report said that given this pattern of behaviour, he could have been given depot injections – these deliver a longer-lasting drug – but Calocen consistently denied this.

Mental health workers have to work with patients, balancing their wishes and rights, to ensure they receive the treatment they need.

But more powerful powers can be exercised.

Every time Waldo Calocen reached a crisis he was detained under Section 2 of the Mental Health Act. But if Section 3 was used, the doctor could insist on giving him a depot injection.

It could also lead to him being given a community treatment order (CTO), meaning he could be monitored more closely in the community. Under a CTO, if a patient stops taking their medication or misses too many appointments, they can be recalled to hospital immediately.

The CQC concluded that “these components would have been important in a more robust package of care for Waldo Calocen”.

Yes, and his mother and brother, who live several miles away, say they tried to express concern about his deteriorating mental health.

But they say they felt isolated by professionals who didn’t always listen to them, and by confidentiality rules that limited what could be told to Caloocan’s closest relatives.

The family told BBC Panorama In early 2022, Calocen told his mental health team that he did not want to share information with them.

Many families argue that they know their loved one best and can provide important information about how the disease is affecting that person, and can provide warning when conditions begin to worsen.

Calocen’s family were not alone in this experience – the CQC report says it looked at other cases in Nottinghamshire, and found there were other families who felt deprived of the care their mentally ill relatives received.

Patient privacy laws for mental health patients are the same as for everyone else, with a few exceptions.

Mental Health Act Code of Conduct He said there are circumstances “in which it is both appropriate and important to share a patient’s confidential information with people outside the immediate team treating the patient.”

This includes protecting others from harm or preventing serious crime.

Looking back it is easy to say that more information should have been shared in this situation, but the mental health teams did not have that information.

However, the CQC report says: “It could be argued that the trust could have maintained contact with the family while still maintaining confidentiality.”

It also says: “We can see that since April 2022, when his care moved to a new mental health team, efforts to engage him strongly and to establish contact with his family have reduced significantly.”

We know that mental health services across the UK are under enormous pressure, but we don’t know how much of an impact this had on this case.

Although funding for mental health has increased, it has not kept pace with the growing demand.

Latest NHS figures Figures show that 1.94 million people in England were in contact with mental health services in June this year – an increase of more than 30% in three years.

There are also huge staff shortages. According to the King’s Fund think-tank, there were 28,600 staff vacancies in mental health in September last year – around 19% of the total workforce.

These pressures form the backdrop to Waldo Calocen’s treatment.

in March, CQC publishes a rapid review In which it was said that he had been raising concerns about mental health services in Nottinghamshire for the past five years.

It highlighted staff shortages and long waiting lists for services. The review also identified problems finding enough beds for those who needed to be admitted to hospital, which also impacted other services.

The review said community-based teams were having to manage more complex and seriously ill patients.

It found that “this placed greater risk and pressure on community teams, and their clinical contribution was reduced as they managed the increasing level of distress.”

The CQC’s latest report, which focuses specifically on care at Waldo Caloocan, points to staff shortages in some teams.

• What do we know about Waldo Caloocan?
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• Family members angry at the order to admit them to hospital after triple murder

The NHS report into the case is due out soon, and may provide a clearer picture of how much pressure there was on services.

Investigations are also underway into how police handled the incidents involving Caloocan.

But the families of the deceased believe only a public inquiry that brings all aspects together can provide them with the answers and change they seek.

They say individuals and organisations must be held accountable, and they have been told the public inquiry they are seeking will take place.

Nottinghamshire Healthcare NHS Trust said its thoughts were with all those “whose lives have been completely changed by the attacks.”

He also said he accepted the findings of the CQC report and that Calocan had “made significant improvements to processes and standards” since the assessment.

Panorama – Nottingham attacks: the search for answers

In June 2023, Barnaby Webber, Grace O’Malley-Kumar and Ian Coates were stabbed to death by Waldo Calocen. Reporter Navtej Johal investigated his history of mental ill-health and the care he received.

Watch On BBC iPlayer,