According to Time to Change, over a third of the public think people with a mental health problem are likely to be violent.
Homicide by people who are also patients with mental illness is perceived as contributing to negative public attitudes towards people with mental illness. Tragic and high profile killings by people with mental illness are often used to suggest that somehow so called “normal” people do not commit violent crime and if you do so, you must have a mental illness of some kind. It is a rare for a news story covering a homicide not to at least mention the mental health of the accused perpetrator.
The quotes throughout this post were from the first five news stories that came up when I searched Google for the word “Schizophrenic”. One is from a reader’s comment on the article. I decided not to use any more of these when even one article’s comments contained enough stigmatising language against people with mental illness to fill three textbooks and a toilet wall.
People with a diagnosis of schizophrenia in particular are often viewed as being violent and dangerous. Stigmatising language towards people with mental illness is often used to describe violent crimes where there is no apparent connection of the crime to the perpetrator’s mental health. If you don’t think so, you’re probably some kind of “psycho nutter”.
A paranoid schizophrenic stabbed his mother to death after convincing himself his parents were part of a satanic paedophile ring.
However, people with a severe mental illness are actually more likely to be victims of violence and crime than people in the general population. Where previous studies have investigated victims of homicide, people with a diagnosed mental illness were shown to have a 3-6 times higher risk, with higher risk still for people with diagnoses of alcohol and drug misuse.
Hit by a schizophrenic motorist who claimed voices in his head told him to drink-drive.
The study I’m summarising in this blog was conducted by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI). Their aim was to assess how often victims of homicide were current patients of mental health services.
Data for the case series were collected over four stages:
- Collection of a national sample of homicide victims for whom conviction of a homicide were recorded
- Acquisition of the victims’ offending history
- Identification of patient victims who had been under the care of the mental health services within a year of their death
- Within the aforementioned group; collection of clinical data
The data for all suspected homicide offences in England and Wales between 1st January 2003 and 31st December 2005 were obtained from the Home Office Statistics Unit via the Homicide Index (comprehensive information about all offenses recorded as homicide).
This study only included confirmed victims of homicide. Information about the victims was sent to the main hospital and community National Health Service serving the health district in which the homicide occurred and in cases where the victim had contacted mental health services within the 12 months before their death, a questionnaire was sent to the clinician responsible for the patient’s mental health care. This questionnaire was completed along with members of the mental health team using the physician and team’s personal knowledge and the patient’s notes.
For the homicide perpetrators, the NCI database was used to determine whether they had been in contact with mental health services within the 12 months before their offense. Where contact had been made, a questionnaire was completed in a similar manner as for the victims.
Schizophrenic gunman laughed after shooting policewoman.
- 1,496 confirmed victims of homicide were identified, 69% of whom were male
- The median age of victims was 35 years (range 0−94 years)
- 90 of the homicide victims (6%) had been in contact with mental health services in the 12 months prior to their death. This makes the homicide victim rate for mental health service users more than twice that of the rate in the general population (2.34 vs. 0.91 per 100,000 population)
- More than a quarter of the victims had been subject to violence in the 12 months before their death, as documented in their case notes
- Half of the people who were patients of mental health services and victims of homicide were killed by an acquaintance, a third by a family member, spouse or partner and a fifth by a stranger
- The most common diagnoses for patients of mental health services who were also victims of homicide were schizophrenia, affective disorder and drug dependence
- During the final contact with mental health services for the people who became victims of homicide, the risk for being a victim of violence was assessed in 67% of cases, although for most, the risk was judged as low or absent
- Of the 90 victims of homicide who were also patients of mental health services, 32% were killed by another patient with a diagnosed mental illness
- In the 3 year study period, 213 people with a reported mental illness were convicted of homicide, an average of 71 per year
- The most common diagnosis for perpetrators of homicide who were also patients of mental health services was schizophrenia, 77% of whom had previously been convicted of a violent offense and 93% had co-morbid alcohol or drug misuse or dependence
- The authors concluded that specialist mental health providers in England and Wales can expect one of their patients to be a victim of homicide approximately every two years
- It is likely that the rate of non-fatal violence towards people who are also patients of mental health services is much higher
- Overall, the findings suggest that patients with a mental illness are two and a half times more likely to be victims of homicide than the general population
If you can put the blame on mental illness for this kind of behaviour then you need to be under lock and key as you’re a danger to society.
The study only included victims of homicides that led to a conviction. The sample only contained people who were patients of mental health services and not people with a mental illness who were not under specialist mental health care. It is therefore likely that the study underestimates the true rate of mental illness in victims of homicide. However this should only serve to further highlight the vulnerability of this population.
The study was an observational design and so no causes or causal factors for the findings can be identified. This makes it difficult to make recommendations for the prevention of homicide against people with a mental illness from these findings alone.
The increased risk of people who have a mental illness and are patients of mental health services for being a victim of homicide should underline the need for services to protect such vulnerable adults.
The findings of this study also contain an anti-stigma message. That is to say that people with mental illness are often more likely to be victims of violence than perpetrators of violence. As such the identification of patients with mental illness who are at risk from violence should be an important part of the clinical risk assessment.
The media when reporting violent crime may want to refer to guidance from organisations like Mind and Time to Change, especially when that crime does have an actual connection to a person with a mental illness, Although as we have seen, the headline is more likely to be “Individual with history of mental health victim of crime” than “Individual with history of mental ill health commits crime.”
Rodway C, Flynn S, Rahman MS, Kapur N, Appleby L & Shaw J. Patients with mental illness as victims of homicide: a national consecutive case series. The Lancet Psychiatry 2014;1(2):129−134. [Abstract]
Violence and mental health. Time to Change, website last accessed 26 Aug 2014.
RT @Mental_Elf: People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/26LM3YSMiq
The Mental Elf liked this on Facebook.
Susanne Hart liked this on Facebook.
RT @Sectioned_: Stigma? What stigma? http://t.co/ci95WqTPHZ Mental illness & violence myths persist despite being utter tripe. By @hullodav…
RT @Mental_Elf: Inaccurate beliefs about violence & mental health will lead to stigma & discrimination http://t.co/VDX2ah2LlM
RT @hullodave: People with a mental illness are more likely to be victims of homicide. Me for @Mental_Elf http://t.co/Z7Mal5G7UL
Hi @ProfLAppleby Please add your comments to @hullodave’s blog on your recent @LancetPsych paper http://t.co/VDX2ah2LlM
Some stuff for @Mental_Elf: Patients with mental illness are more likely to be victims of homicide. http://t.co/OWnq34u6ev
According to @TimetoChange over a third of the public think ppl w/ a mental health problem are likely to be violent http://t.co/VDX2ah2LlM
Inaccurate beliefs about violence & #mentalhealth will lead to #stigma & discrimination http://t.co/BPNOlCnb8U via @Mental_Elf @hullodave
Elizabeth Palmer liked this on Facebook.
& some related work: Those with mental illness are more likely to be victims of violence http://t.co/OfQAoPwGH9 via @Quinonostante
Mental Elf: People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/lfn5wleqHY
Patients with a mental illness are 2.5 times more likely to be victims of homicide than the general population http://t.co/VDX2ah2LlM
Deadly stigma: People witha mental illness are more at risk from homicide than the general population. http://t.co/Z7Mal5G7UL
Mentally ill more likely to be victims of homicide than perpetrators http://t.co/YpbjoevWMg
1/3 public think ppl with #mentalhealth problems likely to be violent, but much more likely to be victims of violence http://t.co/FrcVwwT2RS
Nina Lerch liked this on Facebook.
RT @Sectioned_: Hello @ElizabDay *waves*. Here’s some food for thought since you think stigma about mental illness is so over > http://t.co…
RT @Mental_Elf: New @LancetPsych study of how often victims of homicide are current mental health patients http://t.co/VDX2ah2LlM
RT @vaughanbell: People with mental illness are more likely to be victims than perpetrators of murder http://t.co/xYVmIl7CWZ New study cove…
Identifying patients with mental illness who are at risk from violence should be part of any clinical risk assessment http://t.co/VDX2ah2LlM
People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/VKgVARhb8Y via @sharethis
yet another reason to act | Mentally ill more likely to be victims of homicide http://t.co/DAqF1SMrZA
RT @Mental_Elf: Inflammatory headlines about mental health & violence fuel ignorance, stigma & discrimination http://t.co/VDX2ah2LlM http:/…
British study shows people w/a #mentalillness are more likely to be the VICTIMS of violence rather than perpetrators http://t.co/WS74V8Bx8t
RT @hullodave: Think people with mental illness are violent? They’re more likely to be the victims of violence. Me for @Mental_Elf http://t…
Los enfermos mentales es más probable que sean víctimas de homicidios que homicidas ( nuevo estudio) http://t.co/sr6fT64JMT
João Leal liked this on Facebook.
RT @hullodave: Last time: People with a mental illness are more likely to be a victim of violence than be violent. Scienced! http://t.co/Z7…
RT @Mental_Elf: The majority of violent crimes & homicides are committed by ppl who don’t have mental health problems @TimetoChange http://…
RT @Mental_Elf: Don’t miss: People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/…
“@Mental_Elf:Majority of violent crimes&homicides are committed by ppl who don’t have mental hlth probs http://t.co/TvLPrmFiQK“
Mentally ill more likely to be victims of homicide http://t.co/9JSBUxH3ea
People with #mental illness are more likely to be victims of #homicide than perpetrators of homicide http://t.co/dgBX3UYjO5
MT @vaughanbell: People with mental illness more likely to be victims than perpetrators of murder http://t.co/UFuNA1iOSB
Eamonn Duffy liked this on Facebook.
This title seems to be inaccurate. To quote from the abstract of the study in question:
“overall, the risk of patients committing homicide is greater than the risk of being a victim of homicide”.
This seems to directly contradict the claim you make when you write:
“That is to say that people with mental illness are often more likely to be victims of violence than perpetrators of violence.”
Given the extremely high rates of being a murderer (*as well as* being a victim) described in the study, it’s difficult to see why this would change anyone’s mind about the ‘stigma’ of schizophrenics being violent.
[…] http://www.thementalelf.net/publication-types/observational-study/people-with-mental-illness-are-mor… […]
@hullodave Care to respond to this comment on your recent blog? http://t.co/SsaMz7yAeH Ta everso
@Mental_Elf Will do. I’ll do it tonight when I get home as I don’t have a copy of the paper here.
@Mental_Elf Balls in a baguette! I completely forgot about this. Will get to replying this week. Apologies.
Mentally ill more likely to be victims of homicide – The Mental Elf http://t.co/jS9Eq2LWAQ
People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/QCevUNgqc8 via @Mental_Elf
People with mental illness are more likely to be victims of homicide than perpetrators of homicide http://t.co/kCN6eebypF via thementalelf