Homicide and mental illness in England
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Homicide by people with mental illness
Homicide by people with mental illness is one of the most sensitive and challenging issues in mental health care, and we recognise the profound impact these tragic events have on families, friends, victims, and the staff involved. Following recommissioning by the Healthcare Quality Improvement Partnership (HQIP), we have resumed the National Confidential Inquiry into Homicide in England, which ceased in 2018.
Defining a “mental health homicide” is complex, as there is no single accepted definition of mental illness, and estimates vary considerably depending on the criteria used. For this reason, the new inquiry will report findings using several definitions and perspectives. While our primary focus will be on homicides committed by patients receiving mental health care who have severe mental illnesses such as schizophrenia, we will also examine cases involving former patients and individuals who have never been under the care of mental health services.
This broader approach will provide a more complete understanding of homicide associated with mental ill health. In addition, we will update previous analyses of the relationships between victims and perpetrators. Further areas for investigation will include people with autism, domestic abuse, young or vulnerable victims, terrorist motives and immigration status.
Frequently asked questions
More information about this work, including how we classify homicide cases, define mental illness and details on what we collect and what we report, can be found within our FAQs.
Data collection restarted in 2026, and initial findings will be reported in Spring 2027.
The aim of the new inquiry is to obtain information to improve patient care and respond to emerging concerns that may impact safety.
The new study includes:
- working with families who have experienced homicide;
- an initial focus on patients with schizophrenia and related psychoses;
- the collection of information from independent investigations;
- resuming data collection on homicide followed by suicide;
- exploring the possibility of earlier notification of patient homicide to reduce delays in reporting.
Our most recent publication summarises the recommissioning of the homicide inquiry:
What we do
We obtain information on homicide from the Home Office and the police. For people who have been in touch with mental health services, we ask their care team to complete a questionnaire. We also obtain information from HM Courts, when psychiatric assessments had been undertaken before the trial. This allows us to collect data on people who have not been in recent contact with services, or who have never had contact but were mentally ill at the time of the offence.
You can find out about our full methodology by following the links below:
Homicide data collection stages
Stage 1: National homicide conviction data.
Stage 2: Obtain information on previous criminality.
Stage 3: Identification of mental health patients.
Stage 4: Detailed data collection via questionnaire.
Stage 5: Collection of psychiatric court reports.
Evidence and guidance around homicide and mental illness
Numbers and rates
How often do patients with mental illness commit homicide in the UK?
In 2006-2016, NCISH was notified of an average of 518 homicide convictions per year, an average of 546 victims per year.
An average of 55 mental health patients per year are convicted of a homicide in England. There are an average 58 people per year who are victims of homicide in England carried out by mental health patients. Of the 50 recent patients who commit homicide per year, around 20 have schizophrenia, though the figure for this diagnosis is over 30 when former patients and those who have never been patients are added.
There was a fall in the homicide rate in England and Wales between 2008 and 2015 in the general population. However, there was an increase in homicide by people with schizophrenia, which suggests more complex factors such as substance misuse may be driving rates.
- Mental disorder in people convicted of homicide: long-term national trends in rates and court outcome.
- Trends in rates of mental illness in homicide perpetrators.
Reporting mental illness by different definitions
Mental illness can be defined in various ways. In our reports we have presented figures based on different definitions, according to:
- Mental illness at the time of the offence, identified through psychiatric assessment as part of court proceedings.
- Outcome in court – verdict of diminished responsibility or hospital disposal.
- Diagnosis of schizophrenia, whether patients, former patients or non-patients.
- Contact with mental health services at some time previously (“lifetime” contact).
- Contact with mental health services within the 12 months before the homicide (current or recent patients).
- A combined group, including all current or previous diagnoses, and any or no contact with mental health services.
There is no single definition of mental illness and the number of “mental health homicides”varies widely according to definition. Including all definitions of mental illness gives a much larger figure. Table 1, taken from our 2006 Avoidable Deaths report, sets out these figures for England and Wales over an approximately 5-year period (April 1999 to December 2003).
Table 1: Rates of mental disorder in all perpetrators convicted of homicide (England and Wales April 1999 to December 2003)
| Definitions | % |
|---|---|
| Mental illness at the time of the offence | 10% |
| Convicted of manslaughter section 2 (diminished responsibility) | 4% |
| Commitment to psychiatric hospital (hospital order) | 6% |
| Lifetime mental disorder | 30% |
| Schizophrenia (lifetime) | 5% |
| Contact with mental health services (lifetime) | 18% |
| Contact with mental health services within 12 months of the offence | 9% |
Diagnosis of psychosis
Are people with specific diagnoses more at risk? What is the link between schizophrenia and homicide?
Patients who perpetrate homicide have a range of diagnoses. The most common are schizophrenia, personality disorder and affective disorders. The risk of committing acts of violence is increased where there is co-occurring substance use. To prevent serious violence by patients with schizophrenia, mental health services should focus on drug and alcohol use, whether treatment was received as planned, and maintaining patient contact.
Guidance
See the NICE guidance on Psychosis and schizophrenia in adults: prevention and management and the NICE guidance on Coexisting severe mental illness and substance misuse.
The role of alcohol and drugs
What is the link between substance use and homicide?
Between 2006 and 2016, 608 patients were convicted of homicide. 71% of these patients had a history of alcohol use and 77% had a history of drug use. A co-occurring diagnosis of mental illness and substance use increases the risk of homicide. A public health approach to homicide would highlight alcohol and drugs before severe mental illness.
Guidance
See the NICE guidelines on coexisting severe mental illness and substance misuse.
Characteristics of people who have committed homicide
Our evidence
This collection of papers examines the different characteristics of people who have committed homicide.
- Homicide perpetrated by older people.
- A population-based study of juvenile perpetrators of homicide in England and Wales.
- Multiple homicide: a descriptive study of serial homicide and mass murder in England and Wales.
A focus on victims of homicide
How many people are victims of homicides committed by mental health patients each year in the UK? Who are the victims of homicide by people with mental illness?
An average of 58 people are victims of homicide by mental health patients each year. Victims are most commonly acquaintances (47%), family members (20%) or spouses and partners (18%); approximately 16% are strangers. This collection of papers describes the characteristics of victims and their relationship to offenders, with a specific focus on mental illness, as well as the circumstances of the offence.
- Mental illness in people who kill strangers: longitudinal study and national clinical survey.
- Mental Illness and Domestic Homicide: A Population-Based Descriptive Study.
- Homicide of Infants: A Cross-Sectional Study.
- Filicide: Mental Illness in Those Who Kill Their Children.
- The typology of parricide and the role of mental illness: Data-driven approach.
Evidence also suggests that people with mental illness are more likely than people in the general population to be victims of homicide.
Independent investigations after homicide
Our evidence
This collection of reports examines independent investigation processes and presents recommendations based on these investigations. Previous investigation reports contain a number of themes that demonstrate the importance of high-quality and safe care.
- Report of the pilot study examining independent homicide investigations (2007).
- Independent homicide investigations after homicide by people receiving mental health care (2008).
- Independent investigations after homicide by people receiving mental health care (2010).
- Mental health homicide inquiries in England 2010-2023: review of methodology and findings (2025).
Guidance
See the NHS England Guidance to integrated care boards on intensive and assertive community mental health care.
Homicide followed by suicide
Our evidence
There is a lack of research examining mental illness and homicide followed by suicide. Between 2006 and 2016, NCISH were notified of 191 homicide-suicide incidents in England. There were 246 victims in total. Most perpetrators were male. The incidents often followed a relationship breakdown and domestic violence was common. Fifteen (8%) of those who carried out homicide-suicides were identified as patients – around 1 to 2 per year.
- Annual report 2018: UK patient and general population data, 2006-2016 (PDF)
- Homicide-suicide and the role of mental disorder: a national consecutive case series (Social Psychiatry and Psychiatric Epidemiology)
- Understanding homicide–suicide, next steps in research.
- Newspaper reporting of homicide-suicide and mental illness. (Pub Med)
Key findings and recommendations on patient homicide
Can the number of homicides be reduced? What are the areas for improvement in mental health services?
Yes, the number of homicides perpetrated by patients with mental illness can be reduced. To do this, clinical services should focus on addressing co-occurring substance use and severe mental illness and maintain engagement with patients at risk of losing contact with services, or who are not receiving treatment as planned. For patients at risk of losing contact with services, community care should focus on assertive outreach, providing more proactive, intense support to encourage and maintain engagement with treatment.
This report takes a look back on 20 years of data collection by NCISH, providing figures on tragic events and highlighting the priorities for safer services.
Publications
More findings from our previous work are available in our list of publications.
Resources and support
We recognise how much families, friends and staff are deeply affected by these tragic incidents. Below are some resources that you might find helpful.
Support for families, friends and communities
SAMM National (Support After Murder and Manslaughter) provides a range of peer support services to people bereaved by homicide. There is no time limit on becoming a member.
Hundred Families provide information, analysis and support for families affected by mental health homicides in Britain.
Cruse Bereavement Support offers a confidential bereavement support service, including for people who have lost a loved one to homicide.
Winston’s Wish is a childhood bereavement charity providing free online support to children and young people aged 25 and under, including support for families after a death by homicide.
Support for staff, clinicians and NHS Organisations
This guide aims to provide psychiatrists who have been affected by patient homicide with information, to clarify some of the formal processes that can occur with these events and to reduce feelings of isolation or uncertainty. Further resources can also be found on the Royal College of Psychiatrists website, including a postvention framework.
This guide outlines a set of principles and activities to help organisations support families and staff.
Contact Us
+44 (0) 161 306 6000
