ELTIONA Skana is a woman with a history of mental illness and violence who had been treated as a psychiatric in-patient several times over the last five years after being diagnosed with paranoid schizophrenia.

But in the weeks before killing seven-year-old Emily Jones community mental health professionals were satisfied that she was stable and she did not pose a risk to herself or others.

Skana was not seen by a community psychiatric nurse for three months until a last visit, on March 11, by Victoria Fagan. Ms Fagan told the trial that it was so uneventful that she did not make any notes at the time and was shocked when she returned from leave to discover what 30-year-old Skana had done.

"We were all in shock, especially me as I had a good relationship with Eltiona. I thought she was a really nice girl. The fact she had done something so horrific was upsetting," said Miss Fagan.

She recalled that, at that their last meeting in Skana’s home, she had appeared clean and well-kempt and the patient, who had ambitions to become a hairdresser, talked about plans to start college in September.

She had previously attacked her mother and was paranoid about electricity and people watching her but denied currently having any psychotic symptoms or thoughts of harming herself or others.

Skana, of Ernest Street, Bolton, claimed to be taking her anti-psychotic medication, but after Emily’s death a search of her flat revealed a month’s worth of unused tablets.

Albanian-born Skana, whose mother and siblings live in the UK, came to the country in a lorry, claiming asylum on arrival on August 13, 2014. Her sister had paid an agent to smuggle her into the country via Italy and France.

In February 2012 Skana had married and left Albania to live in Kuwait with her husband but in September the following year she ran away and returned to her home country.

However, she did not stay there and in July 2014 she went to Frankfurt in Germany before travelling to the UK the next month.

Skana’s UK asylum application was initially refused but the refusal was later overturned and she was granted leave to remain in the UK until December 2024. She has admitted lying on her asylum application by wrongly claiming she had been trafficked into the UK.

Just seven months after her arrival in England a doctor assessed her as suffering from PTSD but she did not attend a planned cognitive behavioural therapy session and her case was closed.

In July 2015, the extent of Skana’s mental illness became apparent after she was sectioned for the first time under The Mental Health Act at the Royal Bolton Hospital. Her sister had called the police after Skana became distressed and picked up a knife, claiming she feared she was going to be killed by unknown people.

Skana told doctors that her neighbours were plotting to harm her using electricity, she could feel it burning in her body and made threats to injure them.

On several occasions during her stay in hospital she was granted leave from the ward but would run off and had to be returned by police.

When she refused to take oral medication she was given depot injections, a slow-release form of anti-psychotic medication.

She was eventually released back into the community on August 20 and over the next five years she was given injections although, when she complained the side effects were making her unwell, was trusted to take the medication orally. This sometimes led to a relapse when she did not take it.

The trial jury heard how Skana’s mother did not agree with her daughter being given medication and believed in spiritual healing instead.

But on February 12, 2017 Skana was arrested by police and sectioned again after attacking her mother.

Michael Brady QC, told the court how Skana’s mother had visited her and been taken upstairs while her daughter chained the door shut.

“She then began shouting that when she killed her mother then everything would be ok,” he said.

Skana hit her mother over the head with an iron and stabbed her hand before a friend intervened.

It was found that Skana had disconnected the electricity to the boiler, removed lightbulbs and thrown away her television, which she claimed she could hear her neighbours’ voices through.

After being sectioned Skana again left the hospital without leave, this time going to a friend’s house at 5am, asking to see their 13-year-old daughter and making threats.

When the friend asked about her haircut, Skana told her she had cut her hair off “rather than cutting off other people’s heads”.

Skana was taken back to hospital by police and remained there, with periods of leave, until discharge on May 4, 2017

The community mental health team kept in touch with Skana but she generally reported that she did not have psychotic symptoms and her paranoia could be managed with support from her family and avoiding busy places and eye contact.

But on the afternoon of March 22 this year Skana left her home and walked into Bolton, where she bought a set of craft knives and headed for Queens Park.

There she sat on a bench until Emily passed by and she attacked her.

Brave member of the public, Tony Canty who caught and kept hold of her until police arrived, described how she was rambling, talking about pigs, people trying to kill her and shouting about injections, which she claimed were making her ill.

Psychiatrists who examined her after her arrest agreed she had paranoid schizophrenia.

While some concluded that she was delusional at the time and the attack on Emily was random, it was also suggested that Skana had planned the killing and selected Emily as her victim, something which she later told Rampton Secure Hospital nurse Jonathan Pettet.

When he questioned Skana about her feelings in the months after committing the killing she replied: "What do you want me to do cry all the time?

"I killed someone that’s why I am here. It’s been three months. I just want to put it behind me”.

However, in court, Dr Syed Afghan, who is currently treating Skana, conceded that, at the time she made the remarks she was not on anti-psychotic medication and so could have been delusional.

After the killing Greater Manchester Mental Health NHS Trust, which was responsible for caring for Skana in the community, carried out an internal review and concluded that the tragedy could not have been foreseen.

Chief executive Neil Thwaite said; "We extend our deepest sympathies to Emily’s family and everyone affected by this tragic incident.

"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.”