A 'rigorous review' into the mental health service's handling of the woman who killed seven-year-old Emily Jones has found that her actions could not have been 'foreseen'.
Eltiona Skana suffered from paranoid schizophrenia and had delusional thoughts which could sometimes lead to violence but was not seen by any mental health professional for three months in the run up to her fatal assault on a schoolgirl in a public park, a trial was told this week.
She had also switched from injected medication, which could be monitored by nurses, to tablets, which she was expected to take herself, in the months before Emily's death on March 22.
When police searched her home after the killing, they found a 'month's worth' of unused anti-psychotic medication, defence barrister Simon Csoka QC told a jury during the trial.
Skana's community mental health nurse Victoria Fagan was called as a witness during the proceedings and spoke to the court about the treatment of the Albanian woman.
She admitted to having 'concerns' when the 30-year-old's medication was switched away from injected anti-psychotics to tablets in 2019 but said there was 'no change in her presentation' after the swap.
Miss Fagan also told the court that she had met with Skana on December 17, 2019, but then was off sick and did not see her again until March 11 of this year, 11 days before Emily's death.
During those three months nobody else from the mental health service visited Skana.
When Miss Fagan returned she travelled to the woman's home in Bolton and met with her to discuss how she was feeling.
From the meeting she noted ‘no risks reported or observed' and said Skana had denied suffering any psychotic symptoms and did not intend to harm herself or others.
Miss Fagan told the court she had taken not physical notes during the meeting and it was not until March 23, the day after Emily's death, that she added notes about the visit to a digital system.
In court she admitted that this was a mistake but went on to say she had 'absolutely no concerns' over Skana's mental state at the time.
"I thought that she was a really nice girl and how well she appeared," Miss Fagan said.
"The fact that she had done something so horrific was really upsetting."
Following the death of Emily, the Greater Manchester Mental Health NHS Foundation Trust (GMMH), which was responsible for Miss Fagan and the Bolton community mental health team, launched a review of their handling of Skana's treatment.
The chief executive of the trust, Neil Thwaite, said the review found there were 'no markers of deterioration' in the patient's mental state or other behaviour which could have 'foreseen' the killing.
"We extend our deepest sympathies to Emily’s family and everyone affected by this tragic incident," he said.
"We recognise the devastating impact Emily’s death has had on everyone who knew and loved her, and offer our heartfelt condolences to Emily’s parents and family at this sad time.
"We treat incidents of this kind with the utmost seriousness and completed an internal rigorous review.
"Whilst this identified learning for our services, the review found there were no markers of deterioration in Ms Skana’s mental state or behaviour which would have foreseen this tragic event."
Skana has pleaded guilty to manslaughter and will appear in court for sentencing next week.