Psychosis is commonly associated with an elevated risk of violence. This population-based study of people diagnosed with psychosis in New South Wales (n=126,198) found that 15.2 percent committed a violent offence, most commonly within four years following diagnosis. Those who had offended tended to have histories of non-violent offending, to have been diagnosed at a younger age, to have substance-related psychosis and to have several risk factors associated with criminal behaviour. Being subject to a community treatment order was generally associated with a higher risk of violence, but results suggest a delay in violent offending for those subject to these orders.
References
URLs correct as at March 2025
Adily A et al. 2023. Mental health service utilisation and reoffending in offenders with a diagnosis of psychosis receiving non-custodial sentences: A 14-year follow-up study. Australian and New Zealand Journal of Psychiatry 57(3): 411–422. https://doi.org/10.1177/00048674221098942
American Psychiatric Association 2013. Diagnostic and statistical manual of mental disorders, 5th ed. https://doi.org/10.1176/appi.books.9780890425596
Australian Bureau of Statistics 2023. Australian and New Zealand Standard Offence Classification (ANZSOC). https://www.abs.gov.au/statistics/classifications/australian-and-new-zealand-standard-offence-classification-anzsoc/latest-release
Brophy L et al. 2021. The urgent need to review the use of CTOs and compliance with the UNCRPD across Australian jurisdictions. International Journal of Mental Health and Capacity Law (28): 1–75. https://doi.org/https://doi.org/10.19164/ijmhcl.28.1232
Chowdhury NZ et al. 2020. Psychosis and criminal offending: A population-based data-linkage study. Criminal Justice and Behavior 48(2): 157–174. https://doi.org/10.1177/0093854820964834
Churchill R, Owen GS, Singh SP & Hotopf M 2007. International experiences of using community treatment orders. London: Department of Health. https://www.researchgate.net/publication/228452019_International_Experience_of_Using_Community_Treatment_Orders
Corring D, O’Reilly RL, Sommerdyk C & Russell E 2018. What clinicians say about the experience of working with individuals on community treatment orders. Psychiatric Services 69(7): 791–796. https://doi.org/10.1176/appi.ps.201700492
Goulet M-H, Pariseau-Legault P, Côté C, Klein A & Crocker AG 2019. Multiple stakeholders’ perspectives of involuntary treatment orders: A meta-synthesis of the qualitative evidence toward an exploratory model. International Journal of Forensic Mental Health 19(1): 18–32. https://doi.org/10.1080/14999013.2019.1619000
Hachtel H, Harries C, Luebbers S & Ogloff JR 2018. Violent offending in schizophrenia spectrum disorders preceding and following diagnosis. Australian & New Zealand Journal of Psychiatry 52(8): 782–792. https://doi.org/10.1177/0004867418763103
HSiday VA & Scheid-Cook TL 1987. The North Carolina experience with outpatient commitment: A critical appraisal. International Journal of Law and Psychiatry 10(3): 215–232. https://doi.org/10.1016/0160-2527(87)90026-4
Hodgins S & Klein S 2017. New clinically relevant findings about violence by people with schizophrenia. The Canadian Journal of Psychiatry 62(2): 86–93. https://doi.org/10.1177/0706743716648300
Hough WG & O’Brien KP 2005. The effect of Community Treatment Orders on offending rates. Psychiatry, Psychology and Law 12(2): 411–423. https://doi.org/10.1375/pplt.12.2.411
Hwang YIJ et al. 2020. Disengagement from mental health treatment and re-offending in those with psychosis: A multi-state model of linked data. Social Psychiatry and Psychiatric Epidemiology 55(12): 1639–1648. https://doi.org/10.1007/s00127-020-01873-1
Kisely S, McMahon L & Siskind D 2023. Benefits following community treatment orders have an inverse relationship with rates of use: Meta-analysis and meta-regression. BJPsych Open 9(3): e68. https://doi.org/10.1192/bjo.2023.28
Kisely S, Yu D, Maehashi S & Siskind D 2021. A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand. Australian and New Zealand Journal of Psychiatry 55(7): 650–665. https://doi.org/10.1177/0004867420954286
Langeveld J et al. 2014. Treatment and violent behavior in persons with first episode psychosis during a 10-year prospective follow-up study. Schizophrenia Research 156(2–3): 272–276. https://doi.org/10.1016/j.schres.2014.04.010
Li W et al. 2020. Prevalence of aggression in patients with schizophrenia: A systematic review and meta-analysis of observational studies. Asian Journal of Psychiatry 47: 101846. https://doi.org/10.1016/j.ajp.2019.101846
Light E 2019. Rates of use of community treatment orders in Australia. International Journal of Law and Psychiatry 64: 83–87. https://doi.org/10.1016/j.ijlp.2019.02.006
Light E, Kerridge I, Ryan C & Robertson M 2012. Community treatment orders in Australia: Rates and patterns of use. Australasian Psychiatry 20(6): 478–482. https://doi.org/10.1177/1039856212466159
Nielssen O, Large M, Ryan C & Hayes R 2007. Legal implications of the increased risk of homicide and serious violence in the first episode of psychotic illness. Criminal Law and Justice 31: 287–294
Ogilvie JM & Kisely S 2022. Examining the health and criminal justice characteristics for young people on compulsory community treatment orders: An Australian birth cohort and data linkage study. International Journal of Law and Psychiatry 83: 101813. https://doi.org/10.1016/j.ijlp.2022.101813
Pollack DA, McFarland BH, Mahler JM & Kovas AE 2005. Outcomes of patients in a low-intensity, short-duration involuntary outpatient commitment program. Psychiatric Services 56(7): 863–866. https://doi.org/10.1176/appi.ps.56.7.863
Segal SP 2022. Protecting health and safety with needed-treatment: The effectiveness of outpatient commitment. Psychiatric Quarterly 93(1): 55–79. https://doi.org/10.1007/s11126-020-09876-6
Segal SP, Rimes L & Hayes SL 2019. The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration. European Psychiatry 56: 97–104. https://doi.org/10.1016/j.eurpsy.2018.12.001
Vaughan K, McConaghy N, Wolf C, Myhr C & Black T 2000. Community Treatment Orders: Relationship to clinical care, medication compliance, behavioural disturbance and readmission. The Australian and New Zealand Journal of Psychiatry 34(5): 801–808. https://doi.org/10.1080/j.1440-1614.2000.00813.x
Wasser T, Pollard J, Fisk D & Srihari V 2017. First-episode psychosis and the criminal justice system: Using a sequential intercept framework to highlight risks and opportunities. Psychiatric Services 68(10): 994–996. https://doi.org/10.1176/appi.ps.201700313
Whiting D, Gulati G, Geddes JR & Fazel S 2022. Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: A systematic review and meta-analysis. JAMA Psychiatry 79(2): 120–132. https://doi.org/10.1001/jamapsychiatry.2021.3721
Whiting D, Lennox BR & Fazel S 2020. Violent outcomes in first-episode psychosis: A clinical cohort study. Early Intervention in Psychiatry 14(3): 379–382. https://doi.org/10.1111/eip.12901
Winsper C et al. 2013. Pathways to violent behavior during first-episode psychosis: A report from the UK National EDEN Study. JAMA Psychiatry 70(12): 1287–1293. https://doi.org/10.1001/jamapsychiatry.2013.2445