Ministers of religion are often approached as a last resort when all else fails. When family and friends are in despair, when services are unresponsive, and when risk is escalating, it is frequently the priest, imam, or rabbi who is called. We are two rabbis experienced in care in faith communities, and we have learned what acute mental illness means for us: sitting with congregants, friends, and families at the darkest times of their lives, offering spiritual guidance and practical help.
30 years ago, one of us supported a man who arrived with a large box of papers, saying: “Please store my evidence: there are people out to get me, and you need to keep this safe.” He had left his wife and children and was sleeping in his car, neglecting himself and at risk. It took coordinated work with excellent UK National Health Service (NHS) services to find him and take him to safety. We cannot rely on that standard today. We have first-hand experience of late-night calls from suicidal congregants when the ambulance does not come, when hospitals cannot access records, when there are no named general practitioners, and when the crisis team does not respond.
This pastoral dilemma has clinical consequences. Pastors skilled in spiritual accompaniment cannot provide a place of safety, a medication review, or sustained risk management. In acute psychosis or suicidal crisis, our help is not enough. We stand at the door, unable to enter the room: able to listen, able to offer spiritual guidance, and sometimes to spread a little calm, but unable to substitute for statutory crisis care. Our deepest fear is that when the NHS fails our congregants, we will be the ones conducting the funeral. It is painful to read accounts of the Nottingham Inquiry: why do the same errors keep recurring?1
We ask the clinical community: how can the NHS be rebuilt around responsibility, continuity, and safety—not merely targets—so that those outside the system are not left to hold emergencies they cannot resolve?
Here we begin the Nottingham Inquiry,
On June 13th of 2023, a clinically diagnosed paranoid schizophrenic Valdo Calocane killed three individuals and seriously injured another three more at the Nottingham City Centre. On 22nd April of 2025, it was formally announced that the Nottingham Inquiry will be chaired by Her Honour Deborah Taylor, and on 22nd May of the same year, the Terms of Reference for the Inquiry were formally laid in Parliament.
Dr Tuhina Lloyd, from Nottinghamshire Healthcare NHS Foundation Trust, was the community consultant when Calocane was referred to the Early Intervention in Psychosis team (EIP). This was after his first detention under the Mental Health Act and subsequent discharge from a psychiatric ward at Highbury Hospital in Nottingham.
Lloyd had more than 20 years of experience with patients who had psychosis when Calocane came under her care, the inquiry heard.
Sharon Heath, who is a clinical lead at the NHS trust, had asked for the Nottingham killings not to be discussed. Lloyd, who at the time had almost 150 patients on her caseload, said she only met Calocane once while he was under her care. Speaking about the period when the decision to discharge Calocane was being discussed, Lloyd said: “We had no choice but to do so. We had run out of options.
Calocane was discharged in September 2022, nine months before he carried out the attacks.
Paranoid schizophrenia is no longer a separate diagnosis because mental health experts have updated how schizophrenia is classified. In 2013, the American Psychiatric Association introduced the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). Doctors use this guide to diagnose mental health conditions. It removed subtypes of schizophrenia, including paranoid schizophrenia, disorganized schizophrenia, and catatonic schizophrenia. Instead, all these subtypes are now grouped under the general term “schizophrenia.”
Now begs the question to differ?!
How can the NHS be rebuilt around responsibility, continuity, and safety—not merely targets—so that those outside the system are not left to hold emergencies they cannot resolve?
Ask yourself again,
How can the NHS be rebuilt around responsibility, continuity, and safety—not merely targets—so that those outside the system are not left to hold emergencies they cannot resolve?
Sources;
Pastoral care and unmet need in acute mental health services – The Lancet https://share.google/bHV1EsJXT25yrhOpd
Nottingham triple killer’s consultant denies ‘covering own back’ – BBC News https://share.google/vbJ0CnWa6R6Zv1lfI
What is Paranoid Schizophrenia? Symptoms, Causes, and Treatment https://share.google/6mgylpM72tf2iFKva
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