Community care and criminal offending in schizophrenia

Background The introduction of community care in psychiatry is widely thoug ht to have resulted in more offending among the seriously mentally ill. Thi s view affects public policy towards and public perceptions of such people. We investigated the association between the introduction of community care and the pattern of offending in patients with schizophrenia in Victoria, A ustralia. Methods We established patterns of offending from criminal records in two g roups of patients with schizophrenia over their lifetime to date and in the 10 years after their first hospital admission. One group was first admitte d in 1975 before major deinstitutionalisation in Victoria, the second group in 1985 when community care was becoming the norm. Each patient was matche d to a control, by age, sex, and place of residence to allow for changing p atterns of offending over time in the wider community. Findings Compared with controls, significantly more of those with schizophr enia were convicted at least once for ail categories of criminal offending except sexual offences (relative risk of offending in 1975=3.5 [95% CI 2.0- 5.5), p=0.001, in 1985=3.0 [1.9-4.9], p=0.001). Among men, more offences we re committed in the 1985 group than the 1975 group, but this was matched by a similar increase in convictions among the community controls. Those with schizophrenia who had also received treatment for substance abuse accounte d for a disproportionate amount of offending. Analysis of admission data fo r the patients and the total population of admissions with schizophrenia sh owed that although there had been an increase of 74 days per annum spent in the community for each of the study population as a whole, first admission s spent only 1 more day in the community in 1985 compared with 1975. Interpretation Increased rates in criminal conviction for those with schizo phrenia over the last 20 years are consistent with change in the pattern of offending in the general community. Deinstitutionalisation does not adequa tely explain such change. Mental-health services should aim to reduce the r aised rates of criminal offending associated with schizophrenia, but turnin g the clock back on community care is unlikely to contribute towards any po sitive outcome.