UP-TO-DATE RESEARCH – The economic impact of violence perpetration in severe mental illness

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Situation to date:

Calls for increased funding for mental health services require many lines of evidence in support, said Senior, Fazel, and Tsiachristas from University of Oxford in their recent work published in The Lancet Public Health (Impact Factor 11.600).

These include estimates of the economic impact of violence in psychiatric patients, which is currently understudied. Despite the importance of violence perpetration as a clinical outcome, related economic effects on society have rarely been assessed outside the area of substance misuse. Many studies on the economic burden of schizophrenia and bipolar disorder overlooked costs of violence or solely incorporated the costs to criminal justice. The costs of violence are extensive, and the bearers of this economic burden are disparate, including victims, health services, and the criminal justice system as a whole. Consequently, it is necessary to adopt a broad scope when evaluating the costs associated with violence and assessing any preventative interventions.

The study:

The study, published in The Lancet Public Health, by Senior, Fazel, and Tsiachristas, aims to provide a comprehensive estimate of the economic costs of violence perpetrated by people with severe mental illness. By incorporating official governmental estimates for unit costs of crime, it was possible to examine which sectors of society bear the cost of violence, including physical and emotional harm to the victims, lost productivity for victims and costs to health services and to the criminal justice system. Authors completed a retrospective analysis using a prevalence-based modelling approach to estimate the annual economic cost of violent incidents committed by people with severe mental illness in England and Wales between April 2015 and March 2016. They applied a model based on secondary, high-quality data, including the association between violence and severe mental disease, illness prevalence, recidivism, absolute numbers of violent incidents in 2015 and 2016, and costs to society per violent crime. A probabilistic sensitivity analysis enabled the investigators to assess uncertainty surrounding the estimated costs by varying all input parameters simultaneously.


Of a total of 4,507,500 violent incidents in 2015-16 in England and Wales, they estimated that 240,400 (5.3%) were committed by individuals with severe mental illness, with an estimated annual economic impact of £2.5 billion, or 5.3% of the total estimated societal cost of violence. The largest contributor to the cost of violent crime perpetrated by individuals with severe mental illness was the cost of physical and emotional harm to victims (£1.4 billion), followed by lost productivity of victims (£348.0 million), while the combined cost to the police and criminal justice system was £561.3 million and the cost to health services was £136.7 million. The additional cost to secure forensic care was estimated to be £487.7 million.

It was hypothesized that if the recidivism rate of individuals with severe mental illness was reduced to that of people without severe mental illness, the total annual cost to society from violent crime perpetrated by people with severe mental illness would be reduced from £2.5 to £1.8 billion.

Take-home message:

This study suggests that prevention of violence perpetration might have substantial economic benefits that should be considered in decision-making regarding funding and cost-effectiveness of public health initiatives also for individuals with severe mental illness.

Preventing violence and reducing recidivism might lead to cost savings at a governmental and individual level, in addition to clinical and societal benefits, improving both the health of those suffering from severe mental illness and public safety.

Although different countries might show dissimilar patterns of violence and criminal justice responses, influencing the cost per violent crime, stakeholders may focus on generalisable contributors to the estimate of economic impact such as physical and emotional harm to the victim.

Future cost-of-illness and cost-effectiveness studies of severe mental illness should consider including violence perpetration as an adverse outcome. Moreover, they should focus on modifiable risk factors, such as substance misuse, and involve both public health approaches and coordinated efforts across forensic, prison, early intervention and general adult mental health services.


The article full text is available at:



Full reference:

Senior M, Fazel S, Tsiachristas A. The economic impact of violence perpetration in severe mental illness: a retrospective, prevalence-based analysis in England and Wales. Lancet Public Health. 2020;5:e99–106. Published 2020 Feb 1. doi:10.1016/S2468-2667(19)30245-2

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