Mullen P E, Burgess P, Wallace C, Palmer S, Ruschena D
Victorian Institute of Forensic Mental Health, Australia.
Lancet. 2000 Feb 19;355(9204):614-7. doi: 10.1016/S0140-6736(99)05082-5.
The introduction of community care in psychiatry is widely thought to have resulted in more offending among the seriously mentally ill. This view affects public policy towards and public perceptions of such people. We investigated the association between the introduction of community care and the pattern of offending in patients with schizophrenia in Victoria, Australia.
We established patterns of offending from criminal records in two groups of patients with schizophrenia over their lifetime to date and in the 10 years after their first hospital admission. One group was first admitted in 1975 before major deinstitutionalisation in Victoria, the second group in 1985 when community care was becoming the norm. Each patient was matched to a control, by age, sex, and place of residence to allow for changing patterns of offending over time in the wider community.
Compared with controls, significantly more of those with schizophrenia were convicted at least once for all categories of criminal offending except sexual offences (relative risk of offending in 1975=3.5 [95% CI 2.0-5.5), p=0.001, in 1985=3.0 [1.9-4.9], p=0.001). Among men, more offences were committed in the 1985 group than the 1975 group, but this was matched by a similar increase in convictions among the community controls. Those with schizophrenia who had also received treatment for substance abuse accounted for a disproportionate amount of offending. Analysis of admission data for the patients and the total population of admissions with schizophrenia showed that although there had been an increase of 74 days per annum spent in the community for each of the study population as a whole, first admissions spent only 1 more day in the community in 1985 compared with 1975.
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. Deinstitutionalisation does not adequately explain such change. Mental-health services should aim to reduce the raised rates of criminal offending associated with schizophrenia, but turning the clock back on community care is unlikely to contribute towards any positive outcome.
精神病学领域引入社区护理后，普遍认为这导致了严重精神疾病患者犯罪增多。这种观点影响了针对这类人群的公共政策及公众认知。我们调查了澳大利亚维多利亚州社区护理的引入与精神分裂症患者犯罪模式之间的关联。
我们从两组精神分裂症患者的犯罪记录中确定了其终生及首次入院后10年的犯罪模式。一组于1975年在维多利亚州大规模非机构化之前首次入院，另一组于1985年社区护理成为常态时首次入院。根据年龄、性别和居住地点，为每位患者匹配一名对照，以考虑更广泛社区中犯罪模式随时间的变化。
与对照组相比，除性犯罪外，精神分裂症患者因各类刑事犯罪至少被定罪一次的比例显著更高（1975年犯罪相对风险=3.5[95%可信区间2.0 - 5.5]，p = 0.001；1985年=3.0[1.9 - 4.9]，p = 0.001）。在男性中，1985年组的犯罪比1975年组更多，但社区对照组的定罪也有类似幅度的增加。同时患有药物滥用问题的精神分裂症患者犯罪比例过高。对患者及精神分裂症入院总人群的入院数据分析表明，尽管整个研究人群每年在社区度过的时间增加了74天，但1985年首次入院患者在社区度过的时间仅比1975年多1天。
过去20年中精神分裂症患者刑事定罪率的上升与普通社区犯罪模式的变化一致。非机构化不足以解释这种变化。心理健康服务应致力于降低与精神分裂症相关的犯罪率上升，但恢复社区护理之前的状态不太可能带来任何积极结果。
