Homicides in psychiatric hospitals: Absence of evidence or evidence of absence?

Background: Highly publicised cases of homicide in a psychiatric hospital have raised concerns about the safety of such hospitals. Aims: To identify individual case reports of homicides by inpatients within psychiatric hospitals in order to update a 2011 study. Methods: A systematic search of the academic literature between 2010 and 2020, information seeking from service leaders in each state and territory of Australia and in New Zealand, and a search of public records in Australia and New Zealand. Results: The literature search revealed only one recent paper describing a homicide by a patient in a psychiatric ward. Contact with forensic psychiatrists across Australia and New Zealand yielded four cases of inpatient homicide that took place between 2010 and 2017 in Australia, and none in New Zealand. Public record searching did not add to this count. This compares to 11 inpatient homicides by 10 patients between 1985 and 2011. Conclusions: Homicides in psychiatric hospitals seem to remain rare, however, there is no consistent central documentation of these events in Australasia so it is hard to be confident about the figures. Internationally, there is similarly little centralisation of evidence. Standardised methods of recording and reporting such deaths might assist the understanding and prevention of homicides in psychiatric hospitals. [ABSTRACT FROM AUTHOR]