Mental disorder and clinical care in people convicted of homicide: national clinical survey
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1240 (Published 08 May 1999) Cite this as: BMJ 1999;318:1240All rapid responses
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EDITOR - In examining mental disorder in people convicted of homicide the
study of Shaw et al inevitably excludes those who never come to trial.1
There are two separate groups of killings. Those that remain unsolved and
those where the assailant commits suicide. Whilst the incidence of mental
disorder cannot to determined in the former, homicide-suicide
episodes are examined in the coroner’s court.2-5 Around 10-12% of
homicides in England and Wales have no suspect charged and in 4-5% of
cases the suspect commits suicide before trail. Most of these homicide-
suicide episodes involve the discovery of victim and assailant at the same
time, before the assailant has been arrested. Studies of
these episodes have shown a relatively high rate of mental disorder in the
killer. These are particularly tragic events. The commonest victim is the
female partner of a man, but they can involve the killing of entire
families, or leave children with neither parent. Whilst any homicide is
tragic, it should be remembered that internationally England and Wales has
a low homicide rate. There are between 20-50 episodes a year in England
and Wales. The rate of homicide-suicide has not increased over the last 40
years and convictions under Section 2 of the Homicide Act 1957 have also
remained relatively constant. This is evidence that the increase in rate
in homicide in England and Wales since 1960 (it has nearly doubled) is not
due to an increase in killing by mentally disorder offenders, but to other
factors.
Yours sincerely
Dr C.M.Milroy MD, FRCPath, DMJ
Senior Lecturer in Forensic Pathology
University of Sheffield,
The Medico-legal Centre,
Watery Street,
Sheffield S3 7ES
References
1 Shaw J, Appleby L, Amos T, McDonnell R, Harris C, McCann K et al.
Mental disorder and clinical care in people convicted of homicide:
national clinical survey. BMJ 1999; 318: 1240-4 (8th May)
2 West DJ Murder followed by suicide. London Heinemann 1965
3 Milroy CM. The epidemiology of homicide-suicide. Forensic Sci Int 1995;
71: 117-122.
4 Milroy CM. Reasons for homicide and suicide in episodes of dyadic death
in Yorkshire and Humberside. Med Sci Law 1995; 35: 213-217.
5 Milroy CM, Dratsas M, Ranson DL. Homicide-Suicide in the State of
Victoria, Australia. Am J Forensic Med Pathol 1997; 18: 369
Competing interests: No competing interests
Mental disorder, homicide, alcohol and the millennium
EDITOR- The article from the National Enquiry into Suicide and
Homicide by People with Mental Illness 1 claims a 'substantial rate' of
mental disorder in people convicted of homicide. An abnormal mental state
at the time of offence from their figures is reported in approximately 10%
of all homicide convictions. What in fact emerge as far stronger
associations are drug and alcohol misuse and unemployment.
It is interesting that at the same time clinicians in mental health
services are being exhorted by the government to reduce the numbers of
homicides committed by the mentally ill, the Government has seen fit to
relax the licensing hours over the Millennium. It is likely, given the
data presented, that the number of homicides over this interval will
increase in relation to previous new year holidays.
Perhaps Professor Appleby and his colleagues could collect the figures and
advise the Government accordingly. Will the individual ministers who made
this decision be held responsible for any excess deaths?
E Gralton
Specialist Registrar in Forensic Psychiatry
D McCrindle
Senior House Officer in Psychiatry
Langdon Hospital, Dawlish, Devon, EX7 ONR
1 Shaw J, Appleby L, Amos T, McDonnell R, Harris C, McCann K, et al.
Mental disorder and clinical care in people convicted of homicide:national
clinical survey. BMJ 1999;318:1240-1244. (8 May)
Competing interests: No competing interests