Victims of homicide with mental illness

1. Victims of homicide with mental illness Damian Da Cruz Jenny Shaw The national confidential inquiry into suicide and homicide by people with mental illness Halton and St Helens Research and Development Exposition

2. Outline • Background • Aims • Method • Rates of homicide • Characteristics of victims • Key findings • Limitations • Future research

3. Background • Most research on mental illness and homicide focuses on perpetrators • The risk of being a victim six times higher for people with a mental illness (Hiroeh et al. 2001) • Homicide victimisation over 4 times higher among people who had long-term psychiatric care (Stark et al. 2003)

4. Aims • To estimate the rate of people with mental illness who are victims of homicide • To describe the demographic and clinical characteristics of victims of homicide with mental illness

5. Method 3 year sample of homicides in England and Wales occurring between 2003 – 2005 (1501 victims) Victim data sent out to mental health Trusts in England & Wales Questionnaire completed on those with any contact with secondary care mental health services (N =160) Had contact with services within 12 months of homicide (N =76)

6. Rates of homicide victimisation (England)

7. Characteristics of all victims of homicide (N = 1501)

8. Method of homicide (N=1501)

9. Victims of homicide with mental illness (N=160) • 11% of victims had contact with mental health services • Less likely to be from an ethnic minority (8% vs 24%, p <0.01) • More likely to be killed by a friend or acquaintance (53% vs 36% p <0.01) • Almost twice as likely to be killed by someone who had contact with mental health services at some point in their lives (35% vs. 18%)

10. Offence history of victims *p <0.05 ** p <0.01

11. Primary Diagnosis (N= 147)

12. Clinical characteristics of victims with mental illness • 71% suffered from more than one mental illness • 48% had a previous inpatient admission • 48% were seen by mental health services in the 12 months prior to death

13. Characteristics of victims in 12 month contact (N=76) • Primary diagnosis of schizophrenia (24% vs. 5%, p <0.01) • Five or more inpatient admissions (14% vs. 0%, p <0.01) • Perpetrator who had some previous contact with secondary mental health services (46% vs. 25%, p <0.01) • Perpetrator had contact with secondary mental health services in the previous 12 months (33% vs. 14%, p <0.01) • In 44% of cases psychiatrists admitted to not knowing the vulnerability or risk, or having not considered it

14. Key findings • People in contact with mental health services are more likely to become a victim of homicide • More likely to be killed by a friend or acquaintance • They are more likely to have a criminal record for most types of crime

15. Key Findings • 35 % of those with a mental illness are killed by people who have had some contact with mental health services • 46% of those who had contact in the last 12 months were killed by people who have had some contact with mental health services

16. Why is there an increased risk? • People with mental illness possibly live in more socially deprived areas • Possibly associate with other people who are involved in criminal activity and substance misuse, increasing their risk of victimisation • Victimisation appears to be linked to their association with others who have a mental illness

17. Limitations • Study only includes victims where the perpetrator has been convicted • Did not collect socioeconomic information about the victims • As our definition of mental illness is based on contact with secondary mental health services, the study excludes any patients only seen by their GP

18. Future research • More assessment of the vulnerability of people with mental illness • More research needed into the circumstances surrounding victimisation of people with mental illness including who the victims associate with • Future research into homicide victimisation among people with mental illness needs to control for social deprivation to establish the actual risk posed by mental illness rather than other factors

19. Contact Details The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Centre for Suicide Prevention The University of Manchester University Place Oxford Road, Manchester M13 9PL Telephone: +44 (0) 161-275-8146 Email: damian.dacruz@manchester.ac.uk http://www.medicine.manchester.ac.uk/suicideprevention/