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National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness
Homicide data for England (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
General population homicides: age and
gender of perpetrators
Number of homicides
2500
42%
2000
28%
1500
Male
Female
17%
1000
8%
500
34%
26%
24%
12%
2%
3%
1%
<1%
0
<25
25-34
35-44
45-54
55-64
Age-group
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
65-74
<1%
<1%
75+
Number of homicides
General population homicides: relationship to
perpetrator by gender of perpetrator
2000
1800
1600
1400
1200
1000
800
600
400
200
0
42%
28%
Male
18%
Female
11%
28%
Family member
35%
Spouse/partner
(current or ex)
28%
Acquaintance
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
8%
Stranger
General population homicides: age of victims
by gender of perpetrator
1,400
24%
23%
Number of homicides
22%
1,200
1,000
800
13%
Male
Female
600
8%
400
4%
200
19%
4%
10%
17%
22%
15%
3%
6%
4%
55-64
65-74
8%
0
0-14
15-24
25-34
35-44
45-54
Age-group
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
75+
General population homicides: method of homicide
by gender of perpetrator
2500
Male
Female
39%
Number of homicides
2000
1500
20%
1000
16%
11%
8%
500
6%
49%
28%
7%
10%
3%
3%
0
Sharp instrument Blunt instrument Hitting or kicking
Strangulation
Method of homicide
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
Shooting
Other
Number of homicide convictions in
England & Wales (1973-2011/12)
800
Number of homicides
700
600
Convictions
500
Murder
Manslaughter section 2
400
Other manslaughter
300
Infanticide
200
100
19
74
19
77
19
80
19
83
19
86
19
89
19
92
19
9
19 5
97
/9
20 8
00
/0
20 1
03
/0
20 4
06
/0
20 7
09
/1
0
0
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
Number of perpetrators with mental illness at
the time of offence by gender
80
14%
70
13%
Number of homicide
60
50
11%
10%
9%
9%
9%
8%
Male
Female
8%
40
6%
30
20
10
3%
10%
12%
13%
11%
10%
10%
11%
6%
6%
9%
3%
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
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Number of perpetrators convicted of manslaughter
section 2 (diminished responsibility) by gender
40
18%
Male
Female
35
Number of homicides
30
11%
25
10%
10%
20
9%
9%
9%
8%
7%
15
6%
4%
10
17%
5
10%
10%
3%
7%
3%
3%
7%
10%
13%
13%
0
2001
2002
2003
2004
2005
2006
2007
2008
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
2009
2010
2011
Primary diagnoses of perpetrators committed to
hospital
(based on Inquiry questionnaire data)
6
3
Schizophrenia and other
delusional disorder
12
Affective disorder
4
5
2
Anxiety/phobia/panic
disorder/OCD
Alcohol dependence/misuse
23
Drug dependence/misuse
Personality disorder
115
Adjustment disorder/reaction
Other
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
Primary diagnoses of perpetrators committed to
hospital
(based on psychiatric court report data)
18
Schizophrenia and other
delusional disorder
10
32
4
Affective disorder
Pervasive developmental disorder
37
Alcohol dependence
Drug dependence
Personality disorder
201
Other
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
Number of perpetrators receiving a hospital
disposal by gender
40
12%
12%
35
10%
Number of homicides
10%
30
9%
10%
9%
9%
8%
25
Male
20
Female
5%
4%
15
10
14%
12%
6%
5
12%
6%
10%
6%
10%
12%
10%
2%
0
2001
2002
2003
2004
2005
2006
2007
2008
Year of conviciton
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
2009
2010
2011
Number of perpetrators with a lifetime history
of mental disorder by gender
200
12%
180
11%
Number of homicides
160
140
9%
11%
11%
9%
9%
10%
9%
120
Male
100
Female
6%
80
4%
60
40
13%
11%
10%
12%
11%
8%
10%
9%
20
7%
5%
4%
0
2001
2002
2003
2004
2005
2006
2007
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
2008
2009
2010
2011
Number of homicide perpetrators with a lifetime
history of schizophrenia by gender
45
13%
40
Number of homicides
35 11%
30
12%
11%
11%
9%
8%
9%
9%
25
Male
6%
20
Female
15
6%
10
5
8%
11%
11%
14%
8%
8%
14%
8%
5%
8%
5%
0
2001
2002
2003
2004
2005
2006
2007
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
2008
2009
2010
2011
Number of patient homicides by gender
70
13%
13%
12%
60
11%
Number of homicides
10%
50 10%
8%
8%
40
Male
6%
20
13%
10
Female
5%
30
8%
3%
13%
9%
6%
10%
12%
11%
8%
7%
3%
0
2001
2002
2003
2004
2005
2006
2007
Year of conviction
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
2008
2009
2010
2011
Primary diagnosis of patient homicides
(based on Inquiry questionnaire data)
Schizophrenia and other
delusional disorders
30%
Affective disorders
12%
Alcohol
misuse/dependence
14%
Drug
misuse/dependence
16%
17%
Personality disorder
12%
Other
0
20
40
60
80
100
120
Number of homicides
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
140
160
180
Secondary diagnosis of patient homicides
(based on Inquiry questionnaire data)
14%
Affective disorders
5%
Anxiety/phobia/panic disorder/OCD
24%
Alcohol misuse/dependence
30%
Drug misuse/dependence
18%
Personality disorder
Adjustment disorder/reaction
4%
Other
5%
0
20
40
60
80
Number of homicides
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
100
120
Timing of last contact with mental health services
200
32%
180
Number of homicides
160
26%
140
22%
20%
120
100
80
60
40
20
0
<7 days
1-4 weeks
5-13 weeks
Timing of last contact
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
more than 13wks
Mental health teams’ estimation of risk of violence at
last contact: patient homicides
250
226
193
Number of homicides
200
171
151
150
Long term risk
Immediate risk
100
100
41
50
31
8
0
No risk
Low
Moderate
Risk of violence
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
High
Risk assessment in patient homicides with severe
mental illness and a history of violence
Risk moderate/high
9 cases (11%)
Yes
94 cases (37%)
Risk low/none
74 cases (88%)
Previous violence
Risk moderate/high
10 cases (8%)
No
158 cases (63%)
Risk low/none
116 cases (92%)
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
Factors which could have made homicide less likely:
patient homicides
Mental health teams' views on preventability
Greater availability of psychiatric beds
(3%)
Better staff training in risk assessment
(18%)
Better communication between teams
(17%)
Use of MHA
(5%)
Closer supervision of patient
(22%)
Access to psychological treatment
(8%)
Access to drug services
(8%)
Access to alcohol services
(9%)
Availability of dual diagnosis services
(14%)
Closer contact with patient's family
(21%)
Other factors
(15%)
0
20
40
60
80
Number of homicides
ENGLAND_HOMICIDE (2001-2011)
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.
100
120