Patient homicide

The proportion of homicides committed by patients in the UK varied between countries, from 10% in England, 12% in Wales, 14% in Scotland1 and 15% Northern Ireland2.

Prevalence

Who do patients kill?

  • On average, there were 8 stranger homicides by patients per year in England1
  • Across all UK nations, victims were most likely to be acquaintances, family members, or spouses/partners 

Diagnoses

  • The most common diagnoses in patients who committed homicide in England & Wales was schizophrenia3, 4 

Use of CPA and management of risk

  • In England and Wales between April 1997-Dec 20034,264 (69%) patients were not receiving care under enhanced CPA, including 26 (49%) with serious mental illness and previous violence3. This illustrates the under-use of CPA in people at high risk

Lessons for prevention

Services can improve risk management by:

  • Aligning CPA and risk management more closely, ensuring comprehensive assessment of risk at CPA review
  • Ensuring that enhanced CPA is used for high risk groups, including people with severe mental illness who are in the early stages of their illness
  • Jointly reviewing the management of the most high-risk patients with other clinical teams, through local clinical governance

References

1. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Annual Report 2011. (http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci/reports/annual_report_2011.pdf)

2. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Suicide and Homicide in Northern Ireland 2011. (http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci/reports/northern_ireland_full_report_june_2011.pdf) 

3. Five year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.Avoidable Deaths 2006. (http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci/reports/avoidable_deaths_full_report_december_2006.pdf)

4. Meehan J, Flynn S, Hunt IM, Robinson J, Bickley H, Parsons R, Amos T, Kapur N, Appleby L and Shaw J (2006) Perpetrators of homicide with schizophrenia: A national clinical survey in England and Wales. Psychiatric Services, 2006: 57(11); 1648-1651 (http://www.medicine.manchester.ac.uk/mentalhealth/research/suicide/prevention/nci/publications/) Pubmed id:17085616

5. Swinson N, Flynn S, Kapur N, Appleby L, Shaw, J. The use of the care programme approach in perpetrators of homicide. The Journal of Forensic Psychiatry & Psychology. Vol. 21, No. 5, October 2010, 649–659 (http://www.medicine.manchester.ac.uk/mentalhealth/research/suicide/prevention/nci/publications/) DOI:10.1080/14789941003739649