18 Jun Patients With Mental Illness More Likely To Be Victims of Homicide
MedicalResearch: What are the main findings of the study?
Professor Appleby: “Patients with mental illness are two and a half times more likely to be victims of homicide than people in the general population according to our research published in The Lancet Psychiatry today.
“In this study, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), based at The University of Manchester, examined data on the victims and perpetrators of all homicides in England and Wales between January, 2003 and December, 2005.
We found that during the 3-year study period, 1496 people were victims of homicide, and 6% (90) of them had been under the care of mental health services in the year before their death. A third (29) of these patient victims were killed by other patients with mental illness.
In 23 homicides in which the victim was a mental health patient killed by another mental health patient, the victim and the perpetrator were known to each other either as partners (9, 35%), family members (4, 15%), or acquaintances (10, 38%). In 21 of these 23 cases, both the victims and perpetrators were undergoing treatment at the same National Health Service Trust.
Alcohol and drug misuse (victims 66%, perpetrators 93%) and a history of violence (victims 24%, perpetrators 24%) were common among both patient victims and perpetrators. The study also found that in the 3 years to 2005, 213 mental health patients were convicted of homicide—accounting for 12% of all homicide convictions.”
MedicalResearch: Were any of the findings unexpected?
Professor Appleby: “Historically, society has been more concerned about the risk of patients committing violence than the vulnerability of patients to violent acts. However, our findings show that specialist mental health providers in England and Wales can expect one of their patients to be the victim of homicide roughly every 2 years.”
MedicalResearch: What should clinicians and patients take away from your report?
Professor Appleby: “Assessing patients for risk of suicide and violence is common practice, but screening for risk of becoming victims of violence is not. Understanding that a patient’s risk can depend on the environment they are in—for example their use of alcohol or drugs, or their contact with patients with a history of violence—and properly assessing these risk factors should become a key part of clinical care plans.”
MedicalResearch: What recommendations do you have for future research as a result of this study?
Professor Appleby: “The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness will continue to look at trends and figures for suicide and homicide and hope our findings can be used to inform and improve current medical practice.”
Cathryn Rodway, Sandra Flynn, David While, Mohammed S Rahman, Navneet Kapur, Louis Appleby, Jenny Shaw. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry, June 2014 DOI: 10.1016/S2215-0366(14)70221-4