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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.78 n.3 Genebra Mar. 2000 



Community care not to blame for increased offending among the mentally ill



The widespread shift in industrialized countries towards community care for people with schizophrenia is not responsible for an increased rate of criminal convictions in this group over the past 20 years, researchers conclude. Instead, the rise in convictions has been matched by a similar increase in offending in the general population. Paul Mullen of the Victorian Institute of Forensic Mental Health, in Fairfield, Victoria, Australia, and colleagues studied two groups of people with schizophrenia. The first group had all been admitted for first treatment in Victoria before 1975, when institutional care was widespread, the second in 1985, when community care was “becoming the norm”. Each patient was matched by age, sex and place of residence to a control in the community.

In line with other evidence, people with schizophrenia were more likely than controls to be convicted of most criminal offences, and schizophrenic men who had been admitted in 1985 committed more offences than those admitted before 1975. However, there was a similar increase in offending among the community controls. Schizophrenic patients who had also been treated for substance abuse were responsible for a disproportionately high proportion of the offences recorded in this population. “Increased rates in criminal conviction for those with schizophrenia over the last 20 years are consistent with change in the pattern of offending in the general community,” the authors write.1 “This study strongly suggests that whatever the causes of the greater rates of violent and other offending in those with schizophrenia, it has nothing to do with the introduction of community care, nor does it relate to the closure of the old asylums,” comments Mullen.2 “Whatever else offending in those with severe mental illness indicates, it is not that community care has failed nor that we need to reopen mental hospital beds.” The researchers argue in the paper that mental health services should “aim to reduce the raised rates of criminal offending associated with schizophrenia”, but that this will not be achieved by “turning the clock back on community care”.



1 Mullen PE et al. Community care and criminal offending in schizophrenia. Lancet, 2000, 355: 614–617.
2 Lancet, press release, 19 February 2000. Available at