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Treatment engagement and violence risk in mental disorders
- Arpan Dutta (3 November 2006)
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Arpan Dutta, ST1 (pilot) SHO Psychiatry
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arpandutta{at}o2.co.uk Arpan Dutta
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Dear Sir, Dr. Elbogen and colleagues (2006) presented a questionnaire study looking at community violence and patients beliefs about psychiatric treatment. The study contains some issues that probably do not allow it to be generalisable to the British population. It looks at sample of 1011 patients from publicly funded institutions. It excludes the elderly and speakers of languages other that English or Spanish And looks at all psychiatric diagnoses. 48% of all homicides in England & Wales are committed by people with mental illness, 16% are committed by ethnic minorities. The study noted the black and ethnic minority population represented 26% of the episodes of serious violence reported, and this did not include homicide. It would have also excluded any of the prison population. Between 41.5% and 49.5% had a diagnosis of schizophrenia or psychotic disorder, and this represented 29% of the group that committed serious violent offences. This compares with 7% of people who committed homicide in England and Wales. More importantly the National Confidential Enquiry into Suicide and Homocide by people with mental illness found that only 11% had contact with mental health services in the last twelve months. Therefore looking at the population who had been selected had at least one contact with mental health services in the last six months is subject to selection bias and would not be a population that would most warrant effort to help. Substance misuse represented 50% of the patients committing serious violence, but only 5 and 6 % of those committing homicide in England and Wales were related to alcohol and drug dependence respectively. These issues raise the question that although this is well planned and thought out study, do the results apply firstly to the British population, and secondly do they apply to the prevention of the most serious of violent crimes – homicide? A comparative study in England and Wales would need to look at individual psychiatric diagnoses so as to better help clinical practice here. References Elbogen EB, Van Dorn RA, Swanson JW, Swartz MS ,et al. (2006) Treatment engagement and violence risk in mental disorders British Journal of Psychiatry, 189, 354-360 Department of Health (2001) Safety First: five year report of the national cofidential enquiry into suicide and homocide by people with mental illness London: Department of Health Declaration of interest None Dr. Arpan Dutta ST1 (pilot) SHO Psychiatry 5 Boroughs Partnership, Sherdley Unit, Whiston Hospital, Merseyside, L35 5DR |
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