The horrific killing of Bolton schoolgirl Emily Jones could not have been predicted and 'came out of the blue', an inquest has heard.
The seven-year-old was stabbed to death as she rode her scooter through Queens Park in Bolton on March 22, 2020. Eltiona Skana, a diagnosed paranoid schizophrenic, slit Emily's throat with a craft knife she had bought from a pound shop earlier that day.
Skana, who was 30 at the time of the attack, was later sentenced to life in prison after being convicted of manslaughter, by means of diminished responsibility.
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More than three years on from the horrific Mother's Day killing, an inquest is being held into Emily's death. The psychiatrist responsible for Skana's treatment in the lead up to the attack gave evidence on the second day of the hearing at Bolton Coroner's Court today.
Dr Raj Dangi said he remained 'baffled' by her actions on that fateful day.
"I have still not been able to understand why someone would behave in such a horrendous way towards an innocent little girl," he told the hearing.
"There was nothing to indicate that in the preceding days she was floridly psychotic. It just came out of the blue."
The inquest has previously heard that Skana was sectioned twice before, in 2015 and 2017, following relapses of her schizophrenia. On the second occasion, she locked her mother in a bedroom before attacking her with an iron.
However, Dr Dangi told the inquest it was not possible to determine whether Skana's actions on the day of Emily's killing were caused solely by her being 'in the grip of psychosis'. He said he believed she may have had been suffering from an undiagnosed mental health condition at the time, such as a personality disorder.
Dr Dangi said he first met Skana in June 2019 - less than a year before the attack. She was 'well presented' and did not appear to be suffering from serious psychosis, he said.
In August of that year, the inquest heard that he agreed to change anti-psychotic Skana's medication from injection to tablets at her request.
During an appointment the next month, Dr Dangi said Skana reported feeling paranoid that people were talking about her and staring. She said she regularly wore sunglasses in public to avoid people looking at her, he added.
By March 2020 - just weeks before killing Emily - Dr Dangi said Skana was reporting struggling to sleep - a potential sign of a relapse of her schizophrenia.
Dr Dangi said he was aware that Skana posed 'significant risks' to others when psychotic, but said he 'would have not done anything differently' with her treatment.
Victoria Fagan, Skana's care co-ordinator at the time of the killing, told the inquest she was not consulted on the decision to change Skana's medication.
She said she told Dr Dangi she disagreed with the move as it would have made it harder to monitor whether Skana was taking her medication.
Ms Fagan said that before meeting Skana for the first time in November 2018, a colleague warned her about the signs of her relapsing. However, Ms Fagan said she always found Skana to be 'warm' and 'easy to engage with'.
She added that she did not know that Skana was not taking her medication and had not witnessed any signs that she was relapsing.
"To me, she appeared stable," said Ms Fagan. "She was a young woman looking forward to her future."
She said she knew Skana was 'risky' in the event of a relapse, but added: "I would not have thought she would have done what she did to Emily. I was devastated."
The inquest, which is expected to last for nine days, continues tomorrow.
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