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Moving Schizophrenics into the Community Does Not Increase Crime

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Feb. 18, 2000 (Boston) -- Deinstitutionalization of the mentally ill, a trend throughout the world, has brought concern that the population will be at increased risk from violent crime. But an Australian study published in the Feb. 18 issue of The Lancet shows that shifting care of schizophrenic patients into the community is not responsible for rising crime rates.

According to the U.S. Surgeon General's office, the number of people in state and county mental hospitals decreased from a high of about 560,000 in 1955 to below 100,000 by the 1990s. The National Alliance for the mentally ill reports that the availability of psychiatric beds in the U.S. was reduced by more than half from 1986 to 1990.

"There is certainly a trend all over the world toward deinstitutionalization," says Mary Seeman, MD, professor and Tapscott Chair of Schizophrenia Studies at the University of Toronto, who was not involved in the study. She says this has come about as experts have discovered that moving people from long-stay hospitals does not increase relapse rates, suicides, or homelessness.

The study's authors found that people with schizophrenia were more likely in general to be found guilty of crimes, and that those who were first admitted to hospitals in 1985, when community care had become widespread, committed more crimes than those admitted 10 years earlier, when institutionalization was common. But this increase reflected rates in the population at large, they write.

"Our study suggests that the increasing attention now paid to offending and violent behaviors in those with schizophrenia may be more to do with an increased awareness of those phenomena that have long been present than to any recent increases in such behaviors," write authors Paul E. Mullen, DSc, and colleagues.

Mullen, of the Victorian Institute of Forensic Mental Health in Victoria, Australia, and colleagues examined criminal records for two groups of patients with schizophrenia: those admitted to the hospital with a diagnosis of schizophrenia for the first time in 1975 and those whose first admission was in 1985, when the first of the state's large asylums was shut and 19 community-based services were opened. Rates of criminal offenses in these populations were compared with those of people without schizophrenia.

In the study, schizophrenic men from both the 1975 and 1985 groups were more likely than controls to have a criminal record (24% vs. 7.4%), and they had higher rates of criminal convictions than controls in all categories except sexual offenses. The overall patterns of offending from 1975 to 1985, however, did not differ statistically between schizophrenics and controls.

The researchers write that the increased number of convictions in those with schizophrenia in the 1985 group compared with the 1975 group seems to reflect an increase in the general population. "Changes in the pattern of mental health services, with the shift to community care, [were] not marked by any significant change in relative rates of conviction for those first admitted to hospital with schizophrenia."

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