Mental health patients two times more likely to be victims of homicide

People with mental illnesses are twice as likely to be victims of violent crime compared with those in the general population, according to recent study findings published in The Lancet Psychiatry.

“Historically, society has been more concerned about the risk of patients committing violence than the vulnerability of patients to violent acts,” Louis Appleby, FRCPsych, of the University of Manchester, United Kingdom, said in a press release. “However, our findings show that specialist mental health providers in England and Wales can expect one of their patients to be the victim of homicide roughly every 2 years.”

Appleby and colleagues evaluated 1,496 victims of homicide killed from 2003 to 2005 in England and Wales to determine how frequently victims of homicide have a mental illness, as well as their relationship to the perpetrator.

Within 1 year before their death, 6% (n=90) of the victims had been in contact with mental health services (patient victims). Mentally ill people were two times more likely to be victims compared with the general population (incidence RR=2.6; 95% CI, 1.9-3.4).

Of the 90 patient victims, 17% had convictions for violence and more than one-quarter were a victim of violence within 12 months of their death. Fifty percent of those were killed by an acquaintance, followed by almost one-third by a family member, spouse or partner, and one-fifth by a stranger.

Schizophrenia, affective disorder and drug dependence were the most common diagnoses among patient victims.

Thirty-two percent of patient victims were killed by another person with mental illness (patient perpetrator).

Of 29 patient perpetrators, 86% were male, and 56% of those killed a female.

“Assessing patients for risk of suicide and violence is common practice, but screening for risk of becoming victims of violence is not,” Appleby said. “Understanding that a patient’s risk can depend on the environment they are in — for example their use of alcohol or drugs, or their contact with patients with a history of violence — and properly assessing these risk factors should become a key part of clinical care plans.”

In an accompanying editorial, Alyssa A. Rheingold, PhD, of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston, wrote that risky behaviors could contribute to an increased risk.

“Further exploration of these individual characteristics, their interactions, and their contribution to the risk of homicide is necessary,” she wrote. “However, a full understanding of risk factors for homicide will be difficult to achieve in view of the potential effects of individual, situational-level, and community factors. Research must be undertaken to inform the development of a more comprehensive model to address the multifaceted manner in which individual and environmental characteristics contribute to risk.”

For more information:

Rheingold AA. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)70272-X.

Rodway C. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)70221-4.

Disclosure: Appleby reports financial ties with the Care Quality Commission and the Suicide Prevention Advisory Group at the Department of Health. The study was funded in part by the Healthcare Quality Improvement Partnership.