There is a risk associated with severe mental health problems and subsequent criminals for violent crime, and a number of reviews have concluded that a diagnosis of schizophrenia or bipolar disorder is associated with a higher risk. A previous elf blog written by Rebecca Syed has debated this risk.
However, the likelihood of being attacked by someone with severe mental health problems is often exaggerated in the media and this can fuel the stigma of illnesses such as psychosis.
What’s more, there is also evidence to suggest that this risk is falling (e.g. Homicide by mental health patients continues to fall, with latest figures at their lowest since 1997).
A recent study published in The Lancet by Dr Seena Fazel and colleagues, aimed to explore whether being prescribed an antipsychotic or mood stabiliser reduced the risk of patients committing violent crime.
The research team conducted a cohort observational study drawing on data from the Swedish national registers. A total sample of 82,647 patients were prescribed an antipsychotic or mood stabiliser. Data was collected for the period 1st July 2005 to 30th June 2010, although periods at the beginning and end of the timeframe were excluded. The primary outcome was conviction for a violent crime.
- 6.5% of men (n=2,657) taking an antipsychotic or mood stabiliser were convicted of a violent crime
- 1.4% of women (n=604) taking an antipsychotic or mood stabiliser were convicted of a violent crime
- Violent crime fell by 45% in those taking an antipsychotic, compared to when not taking one (HR 0.55, 95% CI 0.47 to 0.64)
- Violent crime fell by 24% in those taking a mood stabiliser, compared to when not taking one (HR 0.76, 95% CI 0.62 to 0.93). However, this effect was only significant for people with a bipolar diagnosis
- High doses of antipsychotics had a greater effect, compared to low doses
- Depot medication compared to oral medication also had a greater effect (0.60, 95% CI 0.39 to 0.92)
The authors concluded:
In summary, in this large population-wide study, we recorded reductions in violent crime in patients who were prescribed antipsychotics. Rates of violent crime were also reduced in patients with bipolar disorder who were receiving mood stabilisers. Therefore in addition to the effects of antipsychotics and mood stabilisers on relapse rates, their potential effects on violence and crime should also be taken into account in decisions about management for these groups of patients.
This is the first population based report of the positive effects of antipsychotic medication and mood stabilisers on reducing the risk of a conviction for violent crime. This paper does suggest that there is potential to reduce violent crime in those with schizophrenia and bipolar disorder if they are prescribed medication. But there could be numerous other explanations for this finding, for example:
- If more compliant with medication, is someone more likely to be engaging with community mental health services and therefore getting a variety of other support?
- Does not being prescribed a medication increase risk in other ways, for example indicating intent to commit criminal activity or a worsening social situation?
It is also worth considering whether these findings generalizable to the UK, as convictions in Sweden are not related to diagnosis, as they are in other countries, and this study focused on conviction and prescription rates.
Despite these findings, the preoccupation with violent crime often overlooks the fact that individuals with mental health problems are more likely to be victims of crime than commit it. This preoccupation with violent crime contributes to considerable stigma within our society.
Fazel S, Zetterqvist J, Larsson H, Långström N, Lichtenstein P. Antipsychotics, mood stabilisers, and risk of violent crime. The Lancet, 8 May 2014. DOI: 10.1016/S0140-6736(14)60379-2. [Abstract]
Syed, R. Are you really at risk of attack by someone with schizophrenia? Mental Elf, 24 June 2014.
Banksy picture appears courtesy of: 1000 Words / Shutterstock.com
RT @Mental_Elf: Antipsychotics and mood stabilisers may reduce violent crime http://t.co/1YVqpStFlV
@Mental_Elf @laurevans311 Just wait for forced medication.
Antipsychotics and mood stabilisers may reduce violent crime: John Baker reports on the first population based… http://t.co/pGuKzF76Wz
Does taking an anti-psychotic medication really reduce violent crimes? @Mental_Elf http://t.co/i780hG6CjF
@JohnBaker_UoM @JoeJudgePsy @Mental_Elf The research findings/analysis make for interesting reading & awareness of wider issue of stigma. TY
@Mental_Elf nice article but worried that headlines will perpetuate #stigma #mentalhealth
Hi @seena9 Yr thoughts pls on our blog of your study: Antipsychotics, mood stabilisers & violent crime http://t.co/1YVqpStFlV @JohnBaker_UoM
@Mental_Elf @JohnBaker_UoM Overlooked implication of the study is that violent crime is preventable to a large extent. Important re #stigma
Thanks for your blog comment @seena9 I’ve posted a response: http://t.co/3sbnqXKvKx @JohnBaker_UoM Cheers, André
One implication of the study is that violent crime (and by extension violence) may be preventable to a large extent. Important point regarding #stigma
#Antipsychotics and mood stabilisers may reduce violent #crime http://t.co/tDw27gJZFd
Cohort study finds that violent crime fell by 45% in those taking an antipsychotic, compared to when not taking one http://t.co/Hs5OoHZx0k
@Mental_Elf i’m not surprised by the findings, though there will be some people esp in the mental health community who will dispute this
Thanks @joschizophrenic I hope those who dispute the study findings are happy to share their thinking on the blog http://t.co/1YVqpStFlV
@Mental_Elf i think some people prefer the non med path and like to think their methods are as good if not better than meds
@Mental_Elf it’s not surprising some people don’t like meds because of the side effects they can cause.
Mental Elf: Antipsychotics and mood stabilisers may reduce violent crime http://t.co/nJYtOxAT8K
Cohort study finds that violent crime fell by 24% in those taking a mood stabiliser, compared to when not taking one http://t.co/Hs5OoHZx0k
@Mental_Elf completely in agreement,but we need to educate on prevention & avoid use of mood stabilisers. #relaxation #good diet #active
If “true,” require for mil/corp./#health/law “decision makers”?
“Evidence” re: #antipsychotics lower #violence links” http://t.co/C5nB41YHt6
Studies ignore RX- and #RX_INDUCED_violence: “Evidence” re: #antipsychotics lower #violence links” http://t.co/C5nB41YHt6
Antipsychotics and mood stabilisers may reduce violent crime
Does taking an anti-psychotic or mood stabilizers really reduce violent crimes? @Mental_Elf http://t.co/NJjrNCiO0t
Today @JohnBaker_UoM summarises @TheLancet study of antipsychotics, mood stabilisers & risk of violent crime http://t.co/Hs5OoHZx0k
Don’t miss: Antipsychotics and mood stabilisers may reduce violent crime http://t.co/Hs5OoHZx0k
@Mental_Elf medical marijuana does that with good side effects.
@Mental_Elf or population data from a prescription database may be a proxy indicator of CMHT engagement/support.
@AlexBThomson Please see the comment from @seena9 on the blog, which deals directly with this point http://t.co/Hs5OoHZx0k
@Mental_Elf @seena9 Very illuminating. Thanks.
@Mental_Elf Guess that’s what being too sleepy to get out of bed will do to a person.
Hard to commit violent crime when you have induced indifference or suppressed feelings “@Mental_Elf: http://t.co/yLcb7uPrgB“
Interesting piece, I do wonder thought what the comparison would be with people who have never taken meds. The comparisons are between people actively taking meds and those who have been prescribed but are not actively taking them. Possible effect of erratic medication management? In linking the violence and psychotic disorders one must be cautious though as the paper states than only around 40% of people in the study had a diagnosis of any psychotic disorder. So what are the meds ‘treating’? Possibly, simply arousal. Interesting points made in the blog about other possible factors involved in this, would like to see further exploration. No great leaps made between psychosis and violence though, IMO. @gordonmilson
Join the debate about antipsychotics, mood stabilisers and violent crime http://t.co/Hs5OoHZx0k
Antipsychotics and mood stabilisers may reduce violent crime http://t.co/oCyEGToAL2 via @Mental_Elf
Antipsychotics and mood stabilisers may reduce violent crime http://t.co/4hpcdKw0D1 via @mental_elf http://t.co/SXHoyKhs25
The Mental Elf liked this on Facebook.
Join the debate about antipsychotics, mood stabilisers and violent crime http://t.co/rR5UAFs83Z TY @Mental_Elf
Most popular blog this week? It’s @JohnBaker_UoM Antipsychotics & mood stabilisers may reduce violent crime http://t.co/Hs5OoHZx0k