Mental disorder and clinical care in people convicted of homicide: national clinical survey

Objectives To estimate the rate of mental disorder in those convicted of ho micide and to examine the social and clinical characteristics of those with a history bf contact with psychiatric services. Design National clinical survey. Setting England and Wales. Subjects Eighteen month sample of people convicted of homicide. Main outcome measures Offence related and clinical information collected fr om psychiatric court reports on people convicted of homicide. Detailed clin ical data collected on those with a history of contact with psychiatric ser vices. Results 718 homicides were reported to the inquiry between April 1996 and N ovember 1997. Of die 500 cases for whom psychiatric reports were retrieved, 220 (44%; 95% confidence interval 40% to 48%) had a lifetime history of me ntal disorder, while 71 (14%; 11% to 17%) had symptoms of mental illness at the time of the homicide. Of the total sample, 102 (14%; 12% to 17%)were c onfirmed to have been in contact with mental health services at some time, 58 (8%; 6% to 10%) in the year before the homicide. The commonest diagnosis was personality disorder (20 cases, 22%; 13% to 30%). Alcohol and drug mis use were also common. Only 15 subjects (18%; 10% to 26%) were receiving int ensive community care, and 60 (63%; 53% to 73%) were out of contact at the time of the homicide. Conclusions There are substantial rates of mental disorder in people convic ted of homicide. Most do not have severe mental illness or a history of con tact with mental health services. Inquiry findings suggest that preventing loss of contact with services and improving the clinical management of pati ents with both mental illness and substance misuse may reduce risk, but cli nical trials are needed to examine the effectiveness of such interventions.