My research focuses on the relationship between mental illness and violent crime, the mental health of prisoners, and violence risk assessment. More recently, I have been investigating how to prevent violence perpetration and suicide in individuals with mental illness. This is funded by the Wellcome Trust as part of a Senior Research Fellowship in Clinical Science.
By applying epidemiological methods, our team has examined a number of key questions in the area of forensic psychiatry and psychology. Using population-based datasets and family-based designs, this work has clarified the contribution of the main neuropsychiatric conditions to violent crime. These studies, supported by systematic reviews, have challenged some widely held beliefs (e.g. that epilepsy causes violence), addressed areas of considerable uncertainty (whether schizophrenia increases risk) and highlighted neglected areas of risk (bipolar disorder, depression, and head injury). In addition, we have clarified modifiable risk factors for violence risk. This work has benefited from novel methods to account for confounding, and collaborations with disease experts and biostatisticians. The research on schizophrenia, bipolar disorder, attention-deficit hyperactivity disorder, and epilepsy has contributed to national clinical guidelines, and work on risk assessment to an Institute of Medicine working party and US Congressional Research Service report.
In prison health, our research has focused on the prevalence of mental disorders, addictions, and suicide risk. The work in suicide risk has applied new methods (e.g. interviewing near-lethal suicide attempts), and population-based datasets to study secular trends and risk factors. I have given evidence on older prisoners’ health to the UK Justice Select Committee and the Prisons Minister. This work has contributed to the recent WHO Handbook on Prison Health and WHO report on Preventing Suicide, and assisted in formulating prison policy in England and Wales.
We have also investigated adverse outcomes in released prisoners, including rates and risk factors for premature mortality and repeat offending, prediction models and associations with major psychotropic medications.
Prevention research has focused on two areas: improving violence and suicide risk assessment, and investigating the real-world effects of medications on adverse outcomes using population datasets and novel designs. To date, we have studied the major classes of psychotropic medications (antipsychotics, mood stabilisers, antidepressants, psychostimulants, medications for substance use disorders) and widely prescribed medications (varenicline and gabapentinoids).
My principal collaborations are with the Medical Epidemiology and Biostatistics Department at the Karolinska Institute, Department of Primary Care Health Sciences at Oxford University, the Centre for Suicide Research in the department, and more recently Universities of Birmingham, Manchester, Edinburgh, and Melbourne, Kings College London, and Simon Fraser University.
I am a member of the UK's Independent Advisory Panel on Deaths in Custody. I am Section Editor for Forensic Psychiatry for BMC Psychiatry and Evidence-Based Mental Health, on the international advisory board of The Lancet Psychiatry, and previously sat on the advisory committee of the South Central RfPB committee and was the external examiner for the Forensic Psychiatry MSc at IOPPN.
I was the expert forensic psychiatrist appointed by the UN-sponsored Khmer Rouge Tribunal to assess the fitness to plead and stand trial of the defendants in Case 002.
Clinical work includes sessions for Oxford Health NHS Foundation Trust as a visiting psychiatrist at a local prison. Previously I worked in low and medium secure hospital settings. I was appointed consultant forensic psychiatrist in 2003.
More broadly, I have tried to communicate our group's research findings with the general public and clinical colleagues. For media work and podcasts, see: http://www.psych.ox.ac.uk/research/forensic-psychiatry
Our risk calculators for violent crime (for prisoners, individuals with severe mental illness, and forensic psychiatric patients) and for suicide in severe mental illness can be found at: https://oxrisk.com/
