NEW YORK, Feb 18 (Reuters Health) -- During the last few decades, there
has been a shift in health care for the mentally ill away from psychiatric
hospitals towards outpatient treatment in clinics. While this
deinstitutionalization has been blamed for various problems, including increases
in homelessness and crime, the move toward community care is not the main reason
for the rise in crimes committed by people with schizophrenia, according to an
Australian study.
In fact, the number of crimes committed by schizophrenics coincides with a
similar increase in crime in the general population, researchers say.
"Those who seek to accuse community care of contributing to such offending
will find no ammunition in our study," Dr. Paul Mullen, of the Victorian
Institute of Forensic Mental Health in Victoria, Australia, and colleagues
report in the February 19th issue of The Lancet.
"To return to a situation in which those individuals in the early stages
of a schizophrenic illness spend extended periods in institutions will require
the clock to be turned back several decades, and its influence on offending, if
any, remains uncertain," the authors state.
The researchers based their conclusions on two sets of people with
schizophrenia in Victoria -- a group hospitalized in 1975, before much
deinstitutionalization occurred there, and another set hospitalized in 1985,
when community care was the norm. They compared the criminal records of these
people with schizophrenia with those of a sample of people of the same sex and
age who lived in the same area.
Criminal convictions were rare in both mentally ill and healthy women, but
schizophrenic men were significantly more likely than other men to be convicted
for all types of crimes except sex offenses, the researchers report. But even
though criminal convictions were more common in schizophrenic men than they had
been in 1985, the number of criminal convictions increased by a similar rate in
men who were not mentally ill.
Overall, the 1985 group of patients with schizophrenia did spend an
average of 74 fewer days in mental hospitals compared with the 1975 group,
according to the report. But patients who were first admitted to a hospital for
mental-health care in 1985 spent an average of only 1 more day in the community
than patients first admitted in 1975.
In a statement, Mullen said that the findings strongly suggest that the
move towards community care is not to blame for the increase in violent and
criminal behavior. "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," he said.
