Lucy Letby: Inside the mind of a serial killer – the psychology behind healthcare murderers
“I am a horrible evil person… I AM EVIL I DID THIS.” These were nurse Lucy Letby’s own words, written on a piece of notepaper found by police investigating the deaths of babies on her unit. “I don’t deserve to live. I killed them on purpose because I’m not good enough to care for them.”
Lucy Letby is a serial killer, the most prolific child murderer of modern times in the UK; her name now forever associated with the likes of other medical monsters such as GP Harold Shipman and nurse Beverley Allitt. She is also one of the most prolific female serial killers in British history, alongside the likes of Rose West and Moors murderer Myra Hindley.
After a complex and harrowing trial lasting more than nine months, jurors found her guilty of murdering seven infants and attempting to murder six more – one of them twice – during a year-long period between 2015 and 2016, while working on the Countess of Chester’s neonatal unit.
In pictures taken at work and socially, Letby, 33, is smiling, carefree-looking, apparently happy. You might describe her as someone who looks “nice” or “kind” or “friendly” or like a million other young women, about as far-removed as you could get from the image of a serial killer that would spring to mind for most.
The motivation behind such an horrific killing spree, taking the lives of tiny babies who didn’t stand a chance, is unfathomable – even to some experts who have spent years profiling murderers.
Dr Sohom Das, a consultant forensic psychiatrist whose work takes him into prisons and secure hospitals such as Broadmoor, says Letby doesn’t fit any “typical” killer profiles. Having assessed several women who have killed babies – usually mothers – he also says most are usually driven by psychotic beliefs.
“I’ve seen at least two or three patients who have had delusional beliefs related to schizophrenia, for example, where they believe children are marked by the devil, that they’re somehow saving them from hell or damnation,” he tells Sky News. “Lucy Letby doesn’t fit into that category. I’ve also met serial killers and they tend to be antisocial, angry, they tend to have a long criminal history of violence. Again, Lucy Letby doesn’t fit that kind of motivation.”
Beverley Allitt: ‘Angel of Death’
Dr Das describes the case of Beverley Allitt – the nurse known as the “Angel of Death” who murdered four babies and attempted to kill others in Grantham, Lincolnshire, in 1991 – as “eerily similar” in terms of how the children were attacked. Letby injected air into babies’ bloodstreams and overdosed them with insulin, as did Allitt.
However, he does not believe the motivation to be the same. Allitt drew attention to the babies being ill, he says, and wanted attention herself, while Letby did the opposite.
“[Allitt] had Munchausen by proxy – when someone fakes illnesses in other people, usually their own kids, because they like to be connected to the process of ‘being victims’, they like the empathy and sympathy,” he says. “I don’t think Lucy Letby fits that pattern because she wasn’t trying to seek attention.”
Read more on Lucy Letby:
Parents of twin boys criticise hospital bosses
Nurse may have killed others, families told
Mother fears Letby harmed baby in act of revenge
One theory put forward by the prosecution during her trial was that Letby “sabotaged” the care of one baby boy – one of two triplets she murdered – to get the attention of a doctor she had a crush on.
But Beatrice Yorker, a professor emerita of nursing and criminal justice and criminalistics at California State University in Los Angeles, agrees it does not appear as if the nurse was seeking attention.
She highlights the case of Richard Angelo, a nurse who was convicted of killing four patients and suspected of causing more deaths in New York in 1987. “When they arrested him… he admitted it. He said, ‘I do it for the respect that I get from my nursing and doctor colleagues because I perform very well in a code’ (cardiac arrest)…
“I haven’t read anything about Lucy Letby that indicates she wanted to be the centre of attention, that she enjoyed resuscitation of the infants. She seemed much more clandestine and deceitful. Kind of sadistic, maybe.”
Please use Chrome browser for a more accessible video player
‘They could have stopped her’
Professor Yorker, who has studied more than 130 cases globally of health professionals who kill, says one motive, if not attention, “seemed to be… an act of covert violence or sadism” as the perpetrators found themselves in a position of power.
“They realise that you don’t have to bludgeon somebody, you don’t have to shoot somebody. It is a very powerful way to kill somebody, just to give them a few extra drops of a substance that can make their heart stop. And you don’t even have to prick them with a needle, you inject it into their IV line. That’s a lot of power for people who might have a propensity to kill people or injure people or be violent in a very, very covert way.”
‘Dr Death’ Harold Shipman
Harold Shipman is one of the UK’s most notorious serial killers. A GP in Hyde, Greater Manchester, he was convicted in 2000 of murdering 15 people between 1995 and 1998, but is suspected to have potentially killed as many as 250 between 1975 and 1998.
He had a “God complex”, says Dr Das. “It was like he was deciding whether to let people live or die, almost like mercy killings.” But rather than having a God complex, he believes Letby suffers from low self-esteem and self-confidence, related to depression and anxiety.
“This kind of offence is so rare anyway, but of the times that it has occurred there are so many typical pigeonholes and criteria and oddly to me, Lucy Letby doesn’t fit into any of them,” Dr Das continued. “So to answer the question, what is the motivation? It’s really hard to actually know. When people do things like this and don’t fit into those categories, it’s usually out of some sort of jealousy or some sort of anger.”
Read more:
How the police caught Lucy Letby
The moment of Letby’s arrest
Inside courtroom seven: The story of the nine-month trial
One of the lines in the note by Letby found by police, which was shown to the court during her trial, said she had an “overwhelming fear… I’ll never have children or marry… I will never know what it’s like to have a family… despair”.
“I think at a stretch you could say she was jealous of these happy families,” says Dr Das. “I think maybe [an explanation could be] that she is somehow connected potentially to the emotional process of grieving. She was present when a lot of these babies died, sometimes when they weren’t even her patients, it’s almost like she went out of her way to be part of that. And that’s something I’ve never heard of or seen in my clinical experience, but it’s the only logical answer I can come to.”
Murders by medics not as rare as you might think
Elizabeth Wettlaufer confessed to murders in Canada
In the UK, Shipman is the most well known medical killer, but in recent years there has also been Allitt and others – such as the case of ‘Devil Nurse’ Victorino Chua, who was jailed for life with a minimum of 35 years in 2015, for the murder and poisoning of patients at Stepping Hill Hospital in Stockport, Greater Manchester.
After the Letby verdicts were made public, Cheshire police confirmed they are now investigating whether the nurse could have attacked other children in her care before June 2015.
Professor Yorker says that while killers in the medical profession are rare, her research suggests there may be more than those we know about.
She highlights the “sobering” case of Canadian care home nurse Elizabeth Wettlaufer, whose crimes were only uncovered when she told someone she had been murdering and attempting to murder her elderly patients over a period of nine years.
“She would not have been caught,” Professor Yorker says. “She never did it long enough or enough to raise an index of suspicion where you go, okay, we had five deaths a year and now we’ve got 20. She would just do enough to keep it below the radar of the statisticians and risk managers who look at records and incidents of critical patient incidents and deaths.”
One question raised by Letby’s conviction is about her motivations for becoming a nurse – did she enter healthcare in order to kill? Or did this “dark side” develop only once she had started?
Dr Katherine Ramsland, an expert in serial killers who teaches forensic psychology at DeSales University in Pennsylvania, has seen both cases. “It’s a mix,” she says. “Some view healthcare agencies as places of trust where predators have advantages, others are worn down by the demands and decide to ‘reduce’ the workload or set someone up to make them look bad.”
Some can also develop “a delusional belief that they’re helping a patient”, while others see “easy prey for things like theft or self-empowerment, or even thrill,” she adds.
Is Letby a psychopath?
Please use Chrome browser for a more accessible video player
Letby’s police interview and arrest
A psychopath is someone with an antisocial personality disorder, according to the NHS. This means they are manipulative, lack empathy, and often have a total disregard for the consequences of their actions.
Dr Jane Carter Woodrow, a screenwriter and member of the British Society of Criminology who has written several books about murderers and serial killers, says it would be hard to argue against this in Letby’s case. “How could she not be to be able to do those things,” she says. “It’s the most cowardly act of all killers, [to kill] a child or an elderly person.”
Dr Carter Woodrow says that “once you’ve crossed that line” and “murdered for the first time, I think it gets easier. And you see she feels emboldened as time goes on and the cases kind of escalate, particularly towards the end”.
The fact Letby pleaded not guilty also shows psychopathic traits, she says. “She could have pleaded guilty and not put the parents through this terrible trauma again. She could have spared them all these details they’ve had to sit through.”
During the trial, the jury heard how Letby told one mother, “Trust me, I’m a nurse”, as she killed one baby. She also sent a sympathy card to the parents of another she had murdered.
“I think this was about power,” says Dr Carter Woodrow. “Saying, ‘trust me, I’m a nurse’, all the time knowing what she was going to go and do… it’s like somebody with a card up their sleeve that they’re almost laughing about.”
Please use Chrome browser for a more accessible video player
CPS on Letby’s ‘darker side’ behind ‘angelic smile’
But Dr Das says Letby should not necessarily be classed as a psychopath. “Psychopaths are impulsive, they lack empathy, they don’t care about the rights of other people, they’re very self-serving, self-centred. You could argue she’s all of those things but crucially, a psychopath is really manipulative and deceitful.
“A psychopath does almost everything for a reason, to benefit themselves. So if somehow killing these babies furthered her career, I suppose you could argue at a push that she was a psychopath. But it doesn’t seem like there’s any logical motivation. She’d have some psychopathic traits but I don’t think she’d be a clinical psychopath.
“Psychopaths are also criminally versatile, so a good psychopath can be violent, they lie and they manipulate. They’re often quite fraudulent and they commit other types of offences like robbery, speeding. She never did any of that, she didn’t have any kind of criminal history, there’s no history of aggression. So she just wouldn’t fit into the pattern of what a true psychopath is.”
Dr Das adds that he does not believe Letby is suffering from psychosis and that she knew what she was doing. Dr Ramsland agrees: “She doesn’t seem psychotic, so she would likely have some sense of her behaviour and the way society evaluates it. Whether she would feel remorse is a different question.”
‘High shame, high denial’
The note written by Letby is an example of “high shame, high denial”, says Professor Yorker, something which applies to “child abusers, paedophiles who act out on their interests, and healthcare killers – and it applies to addiction”.
The 12 steps of Alcoholics Anonymous include a step to take each day at a time, she says, because “you can’t cure these high compulsive addictive disorders – you can only deter them or get into recovery where you take it a day at a time. You just say, for this day, I’m not going to act on my urge to drink, or my urge to binge and purge – or my urge to kill.”
While Letby’s note suggested she was admitting the crimes, her denials in court showed otherwise. But Dr Das says it shows “that on some level a part of her does actually feel remorse”. He continues: “People can commit horrible crimes and still feel guilty. In fact, serial killers, especially disorganised serial killers, often battle with this internal kind of conflict, so they feel compelled to go out and kill but they also feel at times guilty of their actions as well. But whatever that part is, it obviously wasn’t present enough for her to tell the truth during a criminal trial.”
Is there any chance someone like this could be rehabilitated?
Dr Ramsland says this would depend on their motivation and psychological state at the time. “Sometimes, healthcare workers are depressed or stressed, so they harm patients as a way to relieve stress or feel empowered. In that case, medication and therapy could assist to improve their behaviour. If they’re highly predatory, however, they’re unlikely to respond well to treatment.”
The difficulties detecting healthcare killers
Serial killer and former nurse Charles Cullen murdered patients over 16 years
In 2022, the story of US serial killer Charles Cullen was dramatised in the Netflix film The Good Nurse, starring Eddie Redmayne and Jessica Chastain.
He killed patients over a 16-year period and eventually admitted to 30 to 40 murders, but the true number is thought to be closer to 400 – which would make him the most prolific serial killer in US history.
Letby started working at the Chester hospital’s neonatal unit just before her 22nd birthday – around four years before the start of the allegations in the trial – and colleagues raised suspicions more than a year before bosses contacted the police.
Click to subscribe to the Sky News Daily wherever you get your podcasts
Professor Yorker says such crimes by healthcare workers may take longer to uncover than say, those by serial killers who stab their victims, as they are usually not as obvious until numbers start stacking up. “We can’t predict, we can’t know why somebody that has antisocial tendencies would cross the line to do this. It makes it really hard to detect.”
Another reason for delays in catching healthcare killers is that society is conditioned to believe certain groups of people are “good”, she says. “For example, the Catholic priesthood, the Boy Scouts. We as a society have been in denial for years where we think really good, upstanding citizens like a Catholic priest or a Boy Scout leader could possibly be molesting children.”
This conditioning can be even higher for women, as women make up such a small percentage of killers, she adds. “This is a feminine form of abuse, even though there are quite a few male doctors and male nurses who engage in healthcare serial killing. We as a society recognise masculine forms of violence – bludgeoning, shooting, stabbing, strangling, raping, those kinds of acts are overtly aggressive. What we as a society do not recognise are the covert or the feminine forms of violence – smothering, injecting, poisoning.”
And while people may think serial killers or psychopaths might stand out, Dr Carter Woodrow says it is often the opposite. “It is not really a question of looking different. It’s looking the same as everyone else – and that’s how you fool people.”
The parents of survivors of the Southport attack have revealed the “untold stories” of how their “hero” children escaped.
Axel Rudakubana, 18, murdered Elsie Dot Stancombe, seven, Bebe King, six, and Alice da Silva Aguiar, nine, in what the chairman of the public inquiry Sir Adrian Fulford called “one of the most egregious crimes in our country’s history”.
Eight children were injured along with two adults at a Taylor Swift-themed class in the Merseyside seaside town on 29 July last year, while 15 others escaped without physical injuries.
The surviving victims and their families have been granted anonymity during the inquiry, with one girl referred to as C3. Her father was the first to give evidence at Liverpool Town Hall on Wednesday.
Alice da Silva Aguiar, Elsie Dot Stancombe and Bebe King were murdered in the attack
Reading a statement on behalf of him and his wife, he told how their daughter was the first girl to escape the scene by running from the Hart Space building and hiding behind a parked car before jumping through an open car door.
“Our nine-year-old daughter was stabbed three times in the back by a coward she didn’t even see,” he said.
“Although she didn’t know what was happening – she knew she had to run. She ran out of the studio door, down the stairs, and out of the building.”
Read more: Southport inquiry as it happened
He said she can be seen “looking scared, confused and pained” in CCTV footage of the incident, adding: “It was troubling for us to see what she had to go through, before either of her parents had arrived at the scene.”
“We are so thankful and proud that despite being critically injured, she was able to make the decisions she did in that terrible moment,” he said.
The girl’s father said his daughter “continues to astound” them with the way she dealt with the attack and her recovery, saying: “It has been inspiring for us to witness.”
Inquiry chair Sir Adrian Fulford at Liverpool Town Hall. Pic: PA
He said she has difficulty sleeping, experiences flashbacks, looks over her shoulder scanning for potential danger when she leaves the house, has a fear of loud noises and has to turn off some songs when they come on the radio.
“Our daughter knows that she is loved,” he said.
“It is through this support and love that she will continue to thrive. We couldn’t be prouder of her. She is our hero.”
Stabbed 33 times
The parents of a girl referred to as C1 told how their “beautiful, articulate, fun-loving little girl” was stabbed 33 times.
After being attacked she escaped the building, but Rudakubana was seen dragging her back inside in CCTV footage played during his sentencing hearing, which drew gasps in court, before she was stabbed 20 more times.
“That is how she became known in this nightmare. The girl that was dragged back in,” her mother said.
Police at the scene. Pic: PA
She thanked the teachers who escaped to call police and flag down help but said: “The most painful of truths for us though, and what has been most devastating to come to terms with, is that there were no adults to help during both of her attacks.
“She was only supported by other children. The courage and strength she found leaves me crushed, but in complete awe.”
She added: “It is these untold stories of remarkable strength and bravery that are missing when we have heard other accounts of this day.”
The mother said the “hours and days that followed the attack were a living hell” and her daughter’s memories – including a concert of her “idol” Taylor Swift – have “been forfeited to make space for the trauma that she carries”.
“We tell her she was brave. How proud we are that she was able to help other girls. How her strength makes us feel strong. How important what she did that day was. She is her own hero. She may be a survivor of this attack, but she is still trying to survive this, every single day,” she said.
Please use Chrome browser for a more accessible video player
‘We need to understand what went wrong’
Attack ‘changed everything’
The mother of a girl referred to as C8 said she was “like any other seven-year-old little girl”, “with an incredible energy” and “full of life”.
But in a statement read out by a legal representative, she said the attack last year “changed everything” when she got a “panicked phone call” from a friend’s mother, who couldn’t find the girls.
“That moment, the sound of fear in her voice and the panic I felt will never leave me,” she said.
“I rushed to the scene and what I saw is something no parent should ever see. My daughter had sustained serious physical injuries including a stab wound to her arm and a cut to her face and chin.”
Please use Chrome browser for a more accessible video player
‘We don’t want Elsie forgotten’
Read more from Sky News:
Infected blood victims ‘waiting to die in limbo’
The fly-tippers turning trash into cash
She said her daughter “remembers the attack vividly” and later told her “she thought it had to be fake, because she couldn’t believe something that terrible could really be happening”.
“Where she was once eager to go off with her friends, she now needs my support if it is somewhere public or unknown,” she said.
“Simple days out now need a level of safety planning that we would never have considered before.”
‘Constant flashbacks’
The mother of a girl referred to as Q, who escaped without being physically injured, told how she arrived to collect her daughter to find “children running from the building, screaming and fearing for their lives”.
In a statement read to the inquiry by a legal representative on her behalf, she said it was “the most horrific experience of my life”.
“What I saw on that day will stick with me forever, I constantly have flashbacks and relive what happened,” she said.
She said her daughter has become “very withdrawn” since the attack and has asked her parents, “How will I ever be normal again?”
Rudakubana was jailed for a minimum of 52 years in January and is being investigated over an alleged attack on a prison officer at Belmarsh prison in May.
The public inquiry, announced by Home Secretary Yvette Cooper in January, is looking into whether the attack could or should have been prevented, given what was known about the killer.
Rudakubana, who was born in Cardiff, had contact with police, the courts, the youth justice system, social services and mental health services, and was referred to the government’s anti-extremism Prevent scheme three times before the murders.
A rapid review into his contact with Prevent found his case should have been kept open and that he should have been referred to Channel, another anti-terror scheme.
C1’s mother said: “She deserves the truth, she deserves accountability. She deserves an apology. Our girls deserve an apology.
“Backed up by the promise that changes will be made and this will not be allowed to happen again.”
UK
Infected blood victims are ‘waiting to die in limbo’ – with hundreds still waiting for compensation
While the politicians talk, so many people come from around the world to try to get across the Channel on small boats. But why?
Why make such a perilous crossing to try to get to a country that seems to be getting increasingly hostile to asylum seekers?
As the British and French leaders meet, with small boats at the forefront of their agenda, we came to northern France to get some answers.
It is not a new question, but it is peppered with fresh relevance.
Over the course of a morning spent around a migrant camp in Dunkirk, we meet migrants from Gaza, Iraq, Eritrea, South Sudan, Sri Lanka and beyond.
Some are fearful, waving us away; some are happy to talk. Very few are comfortable to be filmed.
All but one man – who says he’s come to the wrong place and actually wants to claim asylum in Paris – are intent on reaching Britain.
They see the calm seas, feel the light winds – perfect conditions for small boat crossings.
John has come here from South Sudan. He tells me he’s now 18 years old. He left his war-torn home nation just before his 16th birthday. He feels that reaching Britain is his destiny.
“England is my dream country,” he says. “It has been my dream since I was at school. It’s the country that colonised us and when I get there, I will feel like I am home.
“In England, they can give me an opportunity to succeed or to do whatever I need to do in my life. I feel like I am an English child, who was born in Africa.”
‘England is my dream country,’ John tells Adam Parsons
He says he would like to make a career in England, either as a journalist or in human resources, and, like many others we meet, is at pains to insist he will work hard.
The boat crossing is waved away as little more than an inconvenience – a trifle compared with the previous hardships of his journey towards Britain.
We meet a group of men who have all travelled from Gaza, intent on starting new lives in Britain and then bringing their families over to join them.
One man, who left Gaza two years ago, tells me that his son has since been shot in the leg “but there is no hospital for him to go to”.
Next to him, a man called Abdullah says he entered Europe through Greece and stayed there for months on end, but was told the Greek authorities would never allow him to bring over his family.
Britain, he thinks, will be more accommodating. “Gaza is being destroyed – we need help,” he says.
Abdullah says ‘Gaza is being destroyed – we need help’
A man from Eritrea tells us he is escaping a failing country and has friends in Britain – he plans to become a bicycle courier in either London or Manchester.
He can’t stay in France, he says, because he doesn’t speak French. The English language is presented as a huge draw for many of the people we talk to, just as it had been during similar conversations over the course of many years.
I ask many of these people why they don’t want to stay in France, or another safe European country.
Some repeat that they cannot speak the language and feel ostracised. Another says that he tried, and failed, to get a residency permit in both France and Belgium.
But this is also, clearly, a flawed survey. Last year, five times as many people sought asylum in France as in Britain.
And French critics have long insisted that Britain, a country without a European-style ID card system, makes itself attractive to migrants who can “disappear”.
Read more:
Channel crossings rise 50% in first six months of 2025
French police forced to watch on as migrants attempt crossing
Please use Chrome browser for a more accessible video player
Migrant Channel crossings hit new record
A young man from Iraq, with absolutely perfect English, comes for a chat. He oozes confidence and a certain amount of mischief.
It has taken him only seven days to get from Iraq to Dunkirk; when I ask how he has made the trip so quickly, he shrugs. “Money talks”.
He looks around him. “Let me tell you – all of these people you see around you will be getting to Britain and the first job they get will be in the black market, so they won’t be paying any tax.
“Back in the day in Britain, they used to welcome immigrants very well, but these days I don’t think they want to, because there’s too many of them coming by boat. Every day it’s about seven or 800 people. That’s too many people.”
“But,” I ask, “if those people are a problem – then what makes you different? Aren’t you a problem too?”
He shakes his head emphatically. “I know that I’m a very good guy. And I won’t be a problem. I’ll only stay in Britain for a few years and then I’ll leave again.”
A man from Sri Lanka says he “will feel safe” when he gets to Britain; a tall, smiling man from Ethiopia echoes the sentiment: “We are not safe in our home country so we have come all this way,” he says. “We want to work, to be part of Britain.”
Emmanuel is another from South Sudan – thoughtful and eloquent. He left his country five years ago – “at the start of COVID” – and has not seen his children in all that time. His aim is to start a new life in Britain, and then to bring his family to join him.
He is a trained electrical engineer, but says he could also work as a lorry driver. He is adamant that Britain has a responsibility to the people of its former colony.
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
“The British came to my country – colonising, killing, raping,” he said. “And we didn’t complain. We let it happen.
“I am not the problem. I won’t fight anyone; I want to work. And if I break the laws – if any immigrant breaks the laws – then fine, deport them.
“I know it won’t be easy – some people won’t like me, some people will. But England is my dream.”
-
Sports3 years ago‘Storybook stuff’: Inside the night Bryce Harper sent the Phillies to the World Series
-
Sports1 year agoStory injured on diving stop, exits Red Sox game
-
Sports2 years agoGame 1 of WS least-watched in recorded history
-
Sports2 years agoMLB Rank 2023: Ranking baseball’s top 100 players
-
Sports4 years ago
Team Europe easily wins 4th straight Laver Cup
-
Environment2 years agoJapan and South Korea have a lot at stake in a free and open South China Sea
-
Sports2 years agoButton battles heat exhaustion in NASCAR debut
-
Environment2 years agoGame-changing Lectric XPedition launched as affordable electric cargo bike