Was Daniel Gonzalez a madman, genuinely suffering from schizophrenia and hearing voices that commanded him to kill, or was a he a cold-blooded killer, high on drugs and drink, who wanted his 15 minutes of fame?

The jury decided yesterday he was bad, not mad, even though it seems likely he will serve out his sentence in Broadmoor high-security psychiatric hospital, where doctors said he was at the highest end of the high-risk scale.

Like the Yorkshire Ripper, Peter Sutcliffe, who was jailed for murder a quarter of a century ago and transferred to Broadmoor within months of the verdict as his mental illness worsened, people with dangerous severe personality disorder present the toughest challenge to the mental health services.

The Gonzalez case is the worst since that of Michael Stone, who in 1996 murdered Lin Russell and her daughter Megan and left Josie, Megan's sister, for dead after attacking the trio while they were walking on a country footpath in Kent.

It was one of the most notorious crimes of the decade committed by a known drug addict who had recently been discharged from a mental hospital and led the incoming Labour government to announce reform of the Mental Health Act to treat people forcibly in the community and lock up high-risk people with dangerous severe personality disorder.

The reforms have been widely attacked for being unworkable, stigmatising mentally ill people as dangerous and failing to improve public safety.

Yesterday the NHS trust responsible for Gonzalez's treatment appeared to side with critics of the reforms by claiming that the murders could not have been "predicted or prevented".

Although Gonzalez had been treated for mental health problems, there was no direct link between his illness and the "shocking attacks", the chief executive of the Surrey and Borders Partnership NHS Trust said. The trust said he had received extensive help but because he was a drug user and had admitted feigning illness, it was "very difficult" to diagnose him precisely.

His mother, Lesley, saw it differently. The problem was not an inadequate law or lack of a diagnosis but inadequate care. She has compiled a 76-page complaint to the NHS. "It is not that the present Mental Health Act has failed but that many professionals failed to implement it. We met individual decent caring professionals but even they could not sustain support. They, like us and Daniel, were failed by a system that is underfunded and incapable of providing joined up care," she says.

Many features of the case are depressingly familiar to previous scandals, all the way back to the notorious 1992 killing of Jonathan Zito by Christopher Clunis, a man diagnosed with paranoid schizophrenia who had been shunted back and forth in the mental health system and seen by 43 psychiatrists in five years. That killing triggered a campaign for reform by his widow, Jayne Zito.

Like Clunis, Gonzalez had frequent contact with doctors and social workers but professionals who found him difficult to engage washed their hands of him. He failed to attend three appointments in a row with one psychiatrist who struck him off his list instead of taking his non-attendance as a warning sign.