Mentally abnormal offenders: manner of death.

A 23 year follow up of deaths in a population of mentally disordered patients was carried out, and a typical case history is reported. A quarter (71) of the deaths reported were unnatural, verdicts of suicide or accidental death or open verdicts having been recorded. For men in most age groups the proportion of deaths by suicide was two to three times greater than in the general population in 1982; the rate among those aged 25-29 was five times that in the general population. Differences in the rate of unnatural death among diagnostic categories of mental illness were not significant, but the proportion of unnatural deaths among the mentally handicapped will probably eventually be lower than that among psychotic offenders or those with personality disorders. Violent death occurs at an older age in those with affective disorders. Social isolation and alienation add to the handicap of mental disorder in this group of people, and these sometimes difficult but always vulnerable patients must continue to be offered asylum other than prison.