Mental health experts failed to adequately assess the threat posed by the Southport killer, resulting in his release just days before his violent rampage, according to an inquiry.

The public inquiry into Axel Rudakubana’s actions revealed that it was ‘unacceptable’ for him to have been discharged with such an insufficient evaluation of his mental state.

One significant oversight was the lack of a diagnosis for Attention Deficit Hyperactivity Disorder (ADHD), which meant the 17-year-old was not receiving medication that might have helped mitigate his impulsive behavior at the time of the attack.

Rudakubana tragically took the lives of Alice Aguiar, nine, Bebe King, six, and Elsie Stancombe, seven, and left ten others seriously injured in a knife attack during a Taylor Swift-themed dance class on July 29 of last year.

Evidence presented to the inquiry showed that Rudakubana had become increasingly isolated, not leaving his home for five months prior to the incident.

Although he had been prescribed anti-depressants for anxiety, he had ceased taking them and was avoiding contact with his psychiatrist. Additionally, he neglected basic self-care routines, such as showering and eating properly.

But, despite this, the hearing was told that a ‘risk and care’ assessment, prepared by Alder Hey Hospital’s child and mental health services (CAMHS) just six days before he carried out the attack, ruled Rudakubana well enough to be discharged.

The plan noted that the teenager could be verbally abusive towards his father, Alphonse, 49, and had also previously become angry, throwing a mobile phone across a room when his mother, Laetitia Muzayire, 53, pointed it at him during a video call.

Axel Rudakubana’s ‘risk to others’ was inadequately assessed and he was signed off mental health treatment less than a week before his murder spree

Chairman Sir Adrian Fulford is overseeing the public inquiry at Liverpool Town Hall

Bebe King, six, Elsie Dot Stancombe, seven, and Alice da Silva Aguiar, nine, were all murdered in the atrocity on July 29, 2024

It also claimed he had been subject to ‘a couple’ of referrals to the Prevent de-radicalisation programme, crucially adding incorrectly: ‘The latest in connection to Axel speaking with a member of staff about troubles in Palestine and Israel. Axel follows world news and appears to be well informed on these matters.

‘Axel took the latest referral very personally and wanted to know what school staff had recorded about him. Axel’s father eventually showed him the detail of the referral.

‘Axel is upset by the thoughts that school had about him in relation to thinking he is a terrorist threat due to his world knowledge re matters such as Israel and Palestine.’

In fact, Rudakubana had been referred to the Government’s anti-terror programme three times, latterly because he had viewed material on a school computer relating to high school shootings, graphic images of injuries, had asked to see pictures of weapons and severed heads and had also been seen looking at material about the Manchester Arena bombing and London Bridge attack.

The assessment said that an ‘unintentional risk to others’ could be caused from Rudakubana ‘walking in front of traffic’ or because of his ‘impulse or dysregulated emotions’ and added: ‘(This) would be likely to occur as a result of Axel feeling got at, or frustrated by another’s behaviours which might elicit a disproportionate response.’

The report also noted that Rudakubana’s physical health was at risk because of ‘self-neglect’ and weight loss. It said he did not leave home ‘willingly, outside of going to school and occasional trips in the car with his parents to get fast food.’

‘Axel has low Vitamin D due to poor diet and lack of natural sunlight,’ the assessment said. 

‘He also is low in iron. Axel is concerned about his diet and has requested fresh food. Axel complains that his dad is unable to cook well, leading him to be frustrated and upset.’

A knife identical to the one used in the attack carried out by Rudakubana at The Hart Space, in Southport, last July

Rudakubana outside the Hart Space dance studio, in Southport, before he launched his attack which killed three young girls

Nicholas Moss KC, for the inquiry, said the report was ‘soberingly close to the attack’ but made ‘no real attempt to grade the risk to others.’

Dr Vicky Killen, the clinical lead for child and adolescent mental health services (CAMHS) at Alder Hey Hospital agreed that the risk assessment was ‘unacceptable.’

‘There was risk on the record that should have been recalled in this form,’ she said.

Mr Moss said: ‘The risk to others was really not being addressed adequately at all. Would you agree?’

Dr Killen replied: ‘Yes, I think in terms of looking forward, that is something that we would be learning about.’

The inquiry was also told that it took 77 weeks to get Rudakubana a diagnosis for autism, even despite separate referrals being made by his GP and the Acorns School, the pupil referral unit he attended, in August and November 2019.

He was assessed by the forensic children and adolescent mental health service (FCAMHS), which dealt with high-risk young people with complex needs, and they warned he had a ‘lack of awareness of wrongdoing,’ a ‘deficit’ in empathy, failed to recognise fear in other people or ‘see consequences.’

But an administrative mix up meant that, when Rudakubana was finally diagnosed with autism, in December 2020, he was not referred back to FCAMHS. Instead it only resulted in advice to his parents about different services they could access.

A separate diagnosis for attention deficit hyperactivity disorder (ADHD) was also never made, despite a referral by both his doctor, in February 2019, and Presfield School, a specialist school he was supposed to be attending, in June 2023.

His father also raised the issue twice with mental health services – in April 2021 and in January 2023.

But ultimately the referral was rejected in February last year, five months before the attack, because there was insufficient evidence to show ‘significant differences in attention hyperactivity or impulse control,’ the inquiry heard.

Such a diagnosis could have led to the prescription of drugs to reduce impulsivity, improve emotional regulation, lower ‘mental noise’ and distraction, and increase concentration, it was claimed.

Nicholas Bowen KC, for the bereaved families, asked Lynsey Boggan, clinical lead of neuro-developmental services at Alder Hey Hospital, whether these were ‘all things that could have really impacted upon’ Rudakubana’s behaviour and ‘the way that he lived his life?’

‘Yes, potentially,’ Ms Boggan said.

‘And the combination of high intelligence, lack of empathy, fascination with violence, potential conduct disorder and ADHD all add up to a really toxic mix?’ the barrister added.

‘Yes, it is concerning’ Ms Boggan replied.

The inquiry, at Liverpool Town Hall, continues.