A coroner has spoken of missed chances in averting a mental health tragedy when a man killed his caring niece and then himself.
A double inquest heard that Richard Thompson, 66, inflicted knife injuries on the woman, who had arrived to take him on a weekly shopping trip.
Mother-of-two Lisa Butler, 48, had cuts on her arms which suggest that she tried to stave off the blows before Mr Thompson stabbed himself.
He died after cutting his jugular vein. The knife was found between their bodies.
The tragedy happened nine months after Mr Thompson stabbed himself and needed surgery. He was put on anti-psychotic medication and treated in hospital.
After being released, he told medics that he had stopped taking the tablets. He did not take them again before the deaths took place on August 28 last year at his caravan home in Old Mill Lane, Forest Town.
Mrs Butler had told relatives, friends and work colleagues of her concern that he had stopped taking his medication, the inquest heard.
Nottinghamshire’s senior coroner, Mairin Casey, said that even the best health care might not have saved their lives because of the “nature and severity” of Mr Thompson’s injury.
But she said: “We can’t get away from failed opportunities, missed opportunities.”
Medical professionals should have warned Mr Thompson and his niece of the risks of declining to take medication, she said.
The medical team could have discussed giving it the form of an injection, which would have been effective for weeks.
The coroner said: “This was an error of judgement.”
And she suggested that staff should have reviewed Mr Thompson earlier after reports that he “lacked motivation and was going through the motions of daily life”.
Karen Hampson, community service manager for mental health among older people, told the coroner: “Definitely missed opportunities."
Detective Sergeant Rob Wells said police were satisfied that nobody else was involved in the tragedy.
He agreed with the coroner that “it was not just a routine attack, it was a frenzied attack”.
The coroner concluded that Mrs Butler was unlawfully killed and Mr Thompson took his own life.
* The Samaritans run a free 24-hour phone service on 116 123 for people experiencing a range of problems.
