A knifeman and diagnosed paranoid schizophrenic who stabbed a university worker to death in a violent stabbing spree in Birmingham missed a psychiatric assessment appointment four days before he struck, a court heard.

The families of the victims of Zephaniah McLeod, who also slashed or stabbed seven other people in September 2020, heard how he had been out of contact with health services since being released from prison that April.

Opening the case at Birmingham Crown Court on Tuesday, Karim Khalil QC said mental health services eventually made contact with McLeod and he had been due a “face-to-face” assessment with a psychiatrist but “refused” to attend.

Instead, during the home visit on September 3, a new date was set – but it was set for three weeks after his deadly assault.

Before he could be assessed, McLeod launched a violent series of attacks in the city centre in the early hours of September 6, 2020.

Mr Khalil said: “He armed himself with two large knives and aimed at parts of the body, namely the head, neck and chest where the most severe injuries would be likely to be caused.

“We suggest the fact some victims sustained physical injuries that weren’t as serious was purely by chance, rather than by design.”

McLeod appeared at Birmingham Crown Court on Tuesday for the start of a two-day sentencing hearing.

He had previously admitted the manslaughter of Jacob Billington, a talented musician and Sheffield Hallam University graduate, after stabbing the 23-year-old to death.

McLeod had also admitted four counts of attempted murder, including one attack which left a victim partially paralysed, and three separate offences of wounding with intent to cause grievous bodily harm.

Mr Khalil QC, prosecuting, said McLeod was “well-known to mental health services with a diagnosis of paranoid schizophrenia”.

Mr Justice Edward Pepperall was also told his condition had been “present” since at least 2012.

“He has never before received sustained, effective treatment due to a number of identified reasons including his own lifestyle,” added Mr Khalil.

The court heard how on his release from prison in April 2020, mental health services struggled to trace him, with a psychiatrist giving evidence they were “not informed of his whereabouts”.

It was only when they received a referral from McLeod’s GP that mental health workers were able to see him.

“He was last spoken to on the phone by a mental health nurse on September 3, 2020.

“This was just four days before his arrest for these offences.”

McLeod, of Nately Grove, Selly Oak, Birmingham, 28, carried out the attacks in the space of 90 minutes – getting a cab home to pick up another knife, before returning to the city centre, part-way through his spree.

Mr Billington was fatally stabbed in the neck and shoulder while returning to his hotel after celebrating a friend’s birthday.

The 23-year-old, from Crosby, Merseyside, was attacked alongside close friend Michael Callaghan.

Mr Callaghan, 24, was left gravely injured, suffering a single stab wound to the neck, leaving him partially paralysed down his left side and causing massive blood loss which triggered a stroke.

He is now on a long road to recovery and appeared in court walking unaided to hear the case opening.

The families of both Mr Billington and Mr Callaghan have been present on the first of a two-day sentencing and are expected to make victim personal statements to court.

Members of McLeod’s family were also present.

The court heard statements from the victims, read to court, from several of those injured that night, including Mr Callaghan’s.

He told of suffering a “massive” stroke within 24 hours of the attack, followed by pneumonia, as his life remained in the balance in the first 10 days he was in hospital.

Mr Callaghan, who initially had to placed in an induced coma, was not at first well enough to even be told of news his close friend Mr Billington had died.

He said: “The most immediate consequence of the attack is as I was bleeding out, I was unable to try and help save Jacob.

“My friend saved my life… what’s to say I wouldn’t have been able to do the same?”

He added: “Ever since McLeod murdered my friend… and stuck a knife in my neck, I often wish he had succeeded in killing me and still do sometimes do.”

Mr Callaghan, a medical engineer, told of how he had lost a job he loved, lost the use of his left arm, lost his left-field vision – meaning he can no longer drive – and even lost out on the simple pleasures of going for a “run or jog”.

He added complications from the stroke meant he was left without part of his skull for “442 days”, until it was repaired with a special plate – requiring further surgery.

However, he added that his rehabilitation was underway – he had learned to walk again – and he was “proud” of his progress so far.

Reading her own victim impact statement, Mr Callaghan’s mother Anne Callaghan said her son was “a lovely young man, happy, talented, highly intelligent, well-informed, friendly, courteous, interested in people – his future was assured.

“Now there is a sadness in him that wasn’t there before, visible most of the time and, of course, an uncertain future,” she said.

“I see a steely determination in him… but it is tragic to so rarely see him relaxed and happy.”

She said her son had “enormous strength of character and it gives me great hope”.

“I am confident he will still be a great force for good,” she added, as he sat facing her across the court room.

The hearing continues.