Southport attacker Axel Rudakubana was judged by a mental health service to pose no risk to others just six days before he murdered three girls at a dance class, a public inquiry has been told.
Rudakubana, then 17, was discharged from Alder Hey Child and Adolescent Mental Health Services (CAMHS) on 23 July 2024.
On 29 July, he killed Elsie Dot Stancombe, seven, Bebe King, six, and Alice da Silva Aguiar, nine, and attempted to murder 10 others at the Taylor Swift-themed event.
Rudakubana was later jailed for a minimum of 52 years.
Showing a risk assessment form to Liverpool Town Hall on Monday, Nicholas Moss KC, counsel to the Southport Inquiry, said: “We’ll see, soberingly, how close to the attack we now are.”
The form, filled in by CAMHS case manager Kathryn Morris on 23 July last year, noted that Rudakubana could be verbally abusive to his father, Alphonse Rudakubana, and had thrown his phone during a video call.
Another document from the same date, called a Child Young Person (CYP) current view, recorded: “Poses risk to others: None.”
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Mr Moss asked CAMHS clinical lead Dr Vicky Killen: “How far short of acceptable was this assessment of risk, six days before the attack?”
She replied: “Yes, it is unacceptable. There was risk on the record and it should have been recorded in this form.”
Mr Moss asked: “How far short of acceptable? Very far?”
Dr Killen responded: “Very far.”
Consultant psychiatrist Dr Lakshmi Ramasubramanian told the inquiry Rudakubana had attempted to control the narrative of her first appointment with him, which took place over the phone in July 2021.
She said: “He articulated symptoms of anxiety as if he had rehearsed it from a book. It was very apparent that he was trying to convince me and persuade me that he needed medication.”
She added: “He was certainly demanding, argumentative and tried to dictate, I would almost use the word manipulate.”
More from the inquiry:
Top officer fears there could be more Southport-style attacks
Killer’s parents ‘struggled to deal with his violent outbursts’
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Dr Ramasubramanian said she stopped treating Rudakubana after claiming his father had been “intimidating” and “disrespectful” at an appointment.
She said: “This is the very first time in my entire career as a doctor where I have had to request a change of psychiatrist because of how I was made to feel by a parent.
“It is quite unprecedented in my opinion, and I vividly remember the level of distress I went through at the end of the appointment.”
The inquiry also heard from consultant psychiatrist Dr Anthony Molyneux, who said that when he took over treatment in July 2022 he understood Rudakubana posed a “minimal” risk to others.
Dr Molyneux said he was aware Rudakubana had previously taken a knife into school.
But, despite some details being on his patient record, he did not know about other incidents, including Rudakubana attacking a pupil with a hockey stick in school and viewing online content related to terrorism.
Dr Molyneux said it would have been “impossible” to review Rudakubana’s complete patient record and said instead he would have read an assessment letter and expected the family to have told him about it.
He said: “There would appear to be repeated occurrences of the family appearing to, shall we say, stage manage the presentation of information provided to professionals.”
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Asked if his assessment of Rudakubana’s risk would have been “deeply flawed” without knowledge of the previous incidents, he replied: “Let’s just say it would have a significant blind spot.”
Dr Molyneux accepted that a standard operating procedure document for Sefton CAMHS said clinicians should review the whole electronic patient record at each appointment to ensure they were aware of risk factors.
The doctor said Rudakubana presented in appointments as an “unremarkable, sullen, untalkative, gawky teenage boy” and appeared to have a “shopping list” of exactly what medication he wanted.
The inquiry will continue on Tuesday.
