© 2009 The Royal College of Psychiatrists
Correspondence |
Authors' reply
Mental Health Services, St Vincent's Hospital, 299 Forbes Street, Darlinghurst, Sydney, NSW 2010, Australia. Email: mmbl{at}bigpond.com
Northern Sydney Central Coast Area Health Service, Macquarie Hospital, North Ryde, New South Wales, Australia
Mental Health Services, St Vincent's Hospital, and Clinical Research Unit for Anxiety Disorders, School of Psychiatry, UNSW at St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia
We welcome interest in our study of homicide in England and Wales. However, we disagree with Coid's assertion that the conclusions are illogical because the same social factors that were associated with the increase in homicides by the mentally ill up to the 1970s were present when those homicides declined. There are several possible reasons for decline in homicide by the mentally ill, including the availability of treatment. Coid's assertion that a fall in homicide due to better treatment must mean that the earlier rise was due to deteriorating mental health services is a similar oversimplification.
There has been no change in the law regarding diminished responsibility since 1957. Coid's explanation that the decline in homicide by the mentally ill since the late 1970s was due to a change in the threshold for the verdict of diminished responsibility is not supported by any data. Moreover, a change in threshold for diminished responsibility would not explain the decline in the verdicts of `not guilty due to mental illness', `permanently unfit for trial' and `infanticide'. We also defend the use of legal outcomes to define cases. Given the careful attention paid to homicide matters by the courts, their verdicts are likely to be reasonably sensitive and highly specific.1
Vinkers et al report 8 years of data from The Netherlands, without showing that rates of homicide by the mentally ill have declined over a longer period. However, a lack of a decline in The Netherlands might not be unexpected, as we have found that 40% of homicides in psychotic illness occur before treatment,1 that delay in the initial treatment of schizophrenia is associated with a greater proportion of homicides during the first episode of psychosis2 and that jurisdictions with mental health laws that require a patient to be dangerous before they can receive involuntary psychiatric treatment, such as The Netherlands, have longer delays in the treatment of early psychosis.3
We look forward to a challenge to our findings based on data rather than opinion and speculation.
REFERENCES
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1
- Nielssen O, Large M. Rates of homicide during the first episode of
psychosis and after treatment: a systematic review and meta-analysis.
Schizophr Bull 2008; doi: 10.1093/schbul/sbn144
(Epub ahead of print).
[Abstract/Free Full Text] 2 - Large M, Nielssen O. Evidence for a relationship between the duration of untreated psychosis and the proportion of psychotic homicides prior to treatment. Soc Psychiatry Psychiatr Epidemiol 2008; 43: 37 -44.[CrossRef][Medline] 3
- Large M, Nielssen O, Ryan C, Hayes R. Mental health laws that require dangerousness for involuntary treatment may delay the initial treatment of schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2008; 43: 251 -6.[CrossRef][Medline]
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