The research, which is also published by the Department of Health today in a report called Safer Services, has found that many mentally ill patients who commit homicide or suicide had not continued with their medication and had lost contact with healthcare services.
The findings were based on a two-year sample of suicides and an 18-month sample of homicides committed by people with a history of contact with mental health services in England and Wales.
Although nearly 60 per cent of people who committed homicide were mentally ill, they were more likely to be dependent on alcohol or drugs than suffering a severe mental illness. Nearly three-quarters had lost contact with support services at the time of the offence and they were most likely to kill a family member or spouse rather than a stranger.
"The findings for homicide contradict what many people believe about community care," said Professor Louis Appleby, director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, based at the University of Manchester, who conducted the research. "Most people with a mental disorder who committed homicide did not have the kind of severe illnesses such as schizophrenia, but were dependent on alcohol or drugs.
"A health strategy to prevent homicide would be to combine mental health and drug and alcohol abuse services," he said.
The researchers found that out of 10,000 suicides over a period of two years, 24 per cent had been in contact with mental health services in the year before their death.
"We are very concerned about the high risk of suicide among patients who are discharged from hospital because they appear to have made a reasonable recovery," said Professor Appleby. "There is a cluster of suicides in the first three months, but most worryingly these people are more likely to commit suicide in the week after being discharged from hospital. The results tell us that many suicides, although unfortunately not all of them, could be prevented."
The researchers have made 31 recommendations for improving mental healthcare, including setting up a closer link between hospitals and community care services so that high-risk patients can be followed up within 48 hours of leaving hospital, introducing patient "passports" to ensure that information about a patient is transferred between services, and specialist suicide and violence training for all staff in contact with patients at risk.
The recommendations were welcomed by John Hutton, the government minister responsible for mental health. "We are carrying out a root-and-branch review of mental health legislation, and developing a National Service Framework for mental health to be published shortly," he said.Reuse content