Community care does not increase homicide risk in UK

Fears that the British public is at increased risk from mentally ill patients as a result of care in the community are completely misplaced, according to a study of Home Office criminal homicide statistics published this week.

Researchers at the Institute of Psychiatry, London, examined the statistics for England and Wales between 1957and 1995to find out if homicide has become more frequent as psychiatric services have changed. The results showed that, far from increasing, there was a 3% annual decrease in the proportion of homicide convictions and verdicts of not guilty by reason of insanity involving mentally ill people (British Journal of Psychiatry 1999;174:9-14). Altogether, 35% of homicides were committed by mentally disordered people in 1957; the proportion had remained at under 20% since 1984and had declined further to 11.5% by 1995.

The number of homicides committed by mentally disordered people increased from 41in 1957to 60in 1995(with a peak of 130 in 1972), but the total number of homicides increased from 116 to 522.

The researchers, Professor Pamela Taylor and Professor John Gunn, pointed out that the British public and politicians believed, or were being encouraged to believe through the mass media, that the streets would not be safe unless people with a mental disorder were locked up. Yet to change treatment policy towards 12000-13000 people because of the actions of 40did not make sense, they argued. They stated in their paper: “The public is at risk from 600-700 offences per year recorded by the police as homicide, an additional 300killings by dangerous, drunken or drugged driving and of the order of 3500-4000deaths per year in incidents recorded as accidents on the road. Confining people with a mental illness to hospital to save 40or so lives would be analogous to abolishing private motoring to prevent 4000road deaths.”

The health secretary recently announced proposals to change the current care in the community policy and to increase security for mentally ill people. Professor Taylor said: “One hopes that knee jerk legislation will not happen.”

Previous research has suggested that up to 11% of unlawful killings are committed by people with schizophrenia, and other mental illnesses contribute almost nothing to the figures. Professor Taylor said that it was clearly important to ensure patients had access to modern antipsychotic drugs: “As psychiatrists, we are not as good as we should be at communicating with our patients…and persuading them to take medication.”

Community care has not increased homicides by mentally ill people