Transcript National Confidential Inquiry into Suicide and Homicide by People

National Confidential Inquiry
into Suicide and Homicide by
People with Mental Illness
Making Mental Health Care Safer
Annual Report and 20 year Review
2016
Professor Jenny Shaw
Head of Homicide Research
Rates of mental disorder
Rates of mental disorder vary according to definition
© 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.
Measurements of mental disorder
England (2004-2014)
Number
%
Abnormal mental state
579
9%
Mental disorder (lifetime)
1,639
26%
Schizophrenia
369
6%
Patients
662
11%
Sec2 Manslaughter (Diminished Responsibility) 304
5%
Hospital order
6%
352
© 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 homicides in the UK by definition of
mental disorder (1998-2014)
Schizophrenia
Abnormal mental state
100
95
94
92
91
87
90
Patients
87
83
83
79
80
75
68
70
Number of patients
74
72
71
78
72
68
68
64
63
64
67
65
62
60
59
59
57
60
56
53
53
52
51
47
50
44
44
44
42
41
43
41
39
40
36
36
33
32
36
32
32
2010
2011
33
30
30
20
10
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2012
2013
2014
Year of conviction
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What has happened to schizophrenia?
Schizophrenia
• 38 per year in the UK (1998-2014).
• Fallen over the twenty year period.
• Recent rise?
Prison
• 233 (36%) people with schizophrenia received a prison
sentence.
o 136 (79%) also had symptoms of psychosis at homicide
© 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.
Schizophrenia
• 6% of people convicted of
homicide had schizophrenia.
• 56% had been ill for less than
12 months.
• 28% had no previous contact
with mental health services.
• New research: first case-control
study of schizophrenia and
homicide.
© 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.
Tackling stigma
Proportion of homicide by strangers in the UK
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Stranger homicide
• In 24% of homicides the victim
and perpetrator were unknown to
each other.
• Alcohol contributed to the offence
in 54% and drugs in 24%.
• 6% who killed a stranger had
symptoms of mental illness at the
time of the homicide
• 7% were patients.
• Patient stranger homicides fallen
© 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.
Victims of homicide
• 90 patient victims of homicide
between 2003-2005, 30 per
year.
• Patients were 2.6 times more
likely to be a victim of
homicide.
• The most common diagnosis
was schizophrenia (19%).
© 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.
Victims of homicide
• 32% of patient victims were
killed by another patient.
• In 21 cases, the victims and
perpetrators were undergoing
treatment at the same
National Health Service Trust.
• In 3 incidents both were inpatients.
• Routine inquiry about
victimisation, networks.
© 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.
Public health issues
Public health: alcohol and drugs
• Alcohol and drugs contribute to
45% of all homicides in England &
Wales.
• 62% of homicide victims had a
history of alcohol misuse, 56%-drug
misuse.
• Prevention should focus on
individual and public health
measures to influence alcohol and
substance misuse.
© 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.
Public health education: knives
Sharp instruments are the most
common method used in homicide
45%
40%
35%
Percentage
30%
25%
20%
15%
10%
5%
0%
Sharp
instrument
Blunt
instrument
Hitting and Strangulation
kicking
Method of homicide
Firearms
Other
methods
© 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.
Public health: knives & guns
• Violence Reduction Unit, Scotland, policies targeted:
o
o
o
o
o
No Knives Better Lives (NKBL) campaign;
Education/schools;
Social / attitudinal change;
Carrying weapons;
Focus on enforcement of law.
• Countries with lower firearm ownership & more
restricted access experience lower levels of violence.
Source: WHO (2010) Violence Prevention The Evidence
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Specific groups & new
methodologies
NCISH homicide papers
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Homicide-suicide and mental disorder
• Mixed-methods study, data from
coroners and police files.
• 62% had previous mental health
problems.
• 28% visited a GP for
psychological problems within a
month of the incident.
• 12% had been under the care of
mental health services within a
year of the offence.
© 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.
Newspaper reporting of homicide
• Analysis of 12 national
newspapers, tabloid &
broadsheet reporting homicide.
• Having contact with mental
health services did not increase
the likelihood of newspaper
reporting.
• The stigmatizing effect of
reporting may relate more to the
quality of reporting rather than
selective over-reporting.
© 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.
Newspaper headlines
CRAZED: DAD HACKS TODDLER SON
TO DEATH AND THEN KILLS HIMSELF
FOCUS; GROWING MURDER TOLL OF THE
MENTALLY ILL MONSTERS IN OUR MIDST
© 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.
Newspaper reporting of homicide-suicide
• Pejorative language was used to
describe mental illness.
• Accurate reporting essential to
reduce stigma.
• The media should avoid
speculation on people’s mental
state.
© 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.
New methodologies and data sources
• NCISH database
• Online survey of patient experiences
• Focus groups for clinical perspectives
• Document analysis of Serious Untoward
Incident (SUI) reports / case notes
© 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.
National Confidential Inquiry into Suicide and Homicide
by People with Mental Illness
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