Mental health patients at greater risk of becoming victims of homicide

1. When compared to the general public, mental health patients were more than twice as likely to be homicide victims. 

2. A third of the homicides committed against those with mental health issues were perpetrated by another person with mental illness.         

Evidence Rating Level: 4 (Poor)

Study Rundown: Although there has been a great deal of medical literature and mass media investigation into homicides by mental health patients, comparatively little has be reported about them as targets of violence. The investigators in this study explored this latter phenomenon in a large case-series study. The study collected data on every confirmed homicide in Wales and England between January 1, 2003 and December 31, 2005 and then isolated both victims and perpetrators who had had contact with mental health services in the last year. Only recent and current mental health patients were included, which added strength to the study since previous studies had included victims/perpetrators who had been in contact with mental health services at any point in their lives. The study concluded that homicide rate was more than double for mental health patients compared to the general population, and that mental health patients were more likely to be perpetrators than victims. Nonetheless, the rate of violence against mental health patients was also elevated, a result that should prompt further investigations.

The study was funded by Healthcare Quality Improvement Partnership.

Click to read the study in The Lancet Psychiatry

Relevant Reading: Victimization of patients with schizophrenia and related disorders

In-Depth [case-series]: This study explored the association between mental illness and homicide, with particular attention to the mental health patients as homicide victims. The investigators collected homicide data from the Home Office Statistics Unit using the Homicide Index.

1496 homicides were confirmed between January 1, 2003 and December 31, 2005. Of these, 1035 (69%) were men, the median victim age was 35, and most were Caucasian. Of the 90 victims who had mental illness, the demographics mirrored the larger set. Amongst the victims with mental illness, schizophrenia was the most common diagnosis, with affective disorder and drug dependence following. Other risk factors included unemployment and unmarried status. The study found that the homicide victim rate for mental health service users was more than twice as high as the general population (2.34 vs 0.91 per 100,000 population; incidence rate ratio, IRR, 2.6; 95% confidence interval, CI, 1.9-3.4). Of note, 67% of patient victims had their risks assessed by a clinician at their final service contacts. For most patients the risk was judged to be low or absent.

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