1. 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

2. 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.

3. Measurements of mental disorder England (2004-2014) Number% Abnormal mental state5799% Mental disorder (lifetime)1,63926% Schizophrenia3696% Patients66211% Sec2 Manslaughter (Diminished Responsibility)3045% Hospital order3526% © 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.

4. Number of homicides in the UK by definition of mental disorder (1998-2014) © 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.

5. 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 What has happened to schizophrenia? © 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.

6. 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. Schizophrenia © 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.

7. Tackling stigma

8. Proportion of homicide by strangers in the UK © 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.

9. 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.

10. 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.

11. 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 in- patients. 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.

12. Public health issues

13. 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. Public health: alcohol and drugs © 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.

14. Sharp instruments are the most common method used in homicide Public health education: knives © 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.

15. Public health: knives & guns Violence Reduction Unit, Scotland, policies targeted: o No Knives Better Lives (NKBL) campaign; o Education/schools; o Social / attitudinal change; o Carrying weapons; o 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 © 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.

16. Specific groups & new methodologies

17. NCISH homicide papers © 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Website: http://www.manchester.ac.uk/nci Like us on Facebook https://www.facebook.com/pages/Centre-for-Mental-Health-and-Safety Follow us on Twitter https://twitter.com/NCISH_UK