Homicide by mentally ill falls, but patient suicide rises in England

The number of people killed by mental health patients has fallen to its lowest level in a decade—figures released today show.

Experts suggest the fall in homicide reflects safer patient care and point to the possible effect of better treatment of drug and as well as new legal powers in the community.

But suicides among mental health patients increased with the current economic difficulties a likely factor.

The findings, reported in the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) produced by The University of Manchester, suggest more needs to be done to help mental health patients with debts, housing and employment.

The research team says safety efforts need to focus on patients receiving home treatment where there has been a rise in suicide deaths in recent years. Combined with a fall in the number of inpatient suicides, there are now twice as many suicides under home treatment as in inpatient care.

The report, commissioned by the Healthcare Quality Improvement Partnership on behalf of the NHS England, DHSSPS Northern Ireland, the Scottish Government, the Welsh Government and the Channel Islands, examined homicide and suicide figures for all four countries of the United Kingdom among mental health patients from 2001-2011 (figures for 2011 are provisional).

There were 33 committed by mental health patients in England in 2010—the lowest figure since data collection began in 1997 following a peak in 2006. A similar fall was found for homicide by people with schizophrenia in England (22 in 2010) and for people with symptoms of at the time of offence (England) (36 in 2010)*.

Professor Louis Appleby, Director of the National Confidential Inquiry, said: "It is welcome news that patient homicides are falling and reflects well on the safety measures taken by mental health staff. These are early trends and the precise causes are unknown but they may reflect better care for "dual diagnosis" patients - those with both mental illness and alcohol or drug misuse. The introduction of new Community Treatment Orders may also have played a part."

Provisional figures for suicide showed 1,333 suicides in mental health patients in England in 2011 – up from 1175 in 2010. Patient suicide in Scotland also rose but similar increases in Wales and Northern Ireland were based on small numbers and needed to be treated with caution, researchers said.

Professor Appleby said: "The increase in suicide among patients is in line with an increase in the general population and is mostly likely due to the current economic circumstances. Although these are only early indicators, it would suggest services should try to address the economic difficulties of patients who might be at risk of suicide. Ensuring patients receive advice on debts, housing and employment could make a difference, while improvements in home treatment should now become a priority for prevention. Particular caution is needed with home treatment for patients who live alone or are reluctant to accept treatment."

Other findings in the report include:

  • Opiates are now the main substances taken by patients in fatal overdoses in all countries;
  • Hanging remains the main method for patient suicides (England, Northern Ireland, Wales).

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