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People who had mental health or substance use disorders when they were given community orders were three times more likely to die prematurely, and particularly from suicide, accidents, drug overdose, or homicide, compared to those without any psychiatric diagnoses.

Anonymous woman sitting on the floor with her head down © Shutterstock

Suicide was the leading cause of death among those given community sentences and was disproportionately prevalent in younger people, according to research by Oxford University, King's College London and the Karolinska Institute in Sweden, published in journal The Lancet Regional Health - Europe.

The researchers found that most deaths were preventable and emphasised the importance of offering treatment for substance misuse and other psychiatric disorders as part of community sentences.

Based on data from more than 109,000 people given community sentences in Sweden from 1991 to 2013, of which just over 41% had a psychiatric or substance use disorder, the study showed:

  • In the five years after their sentence 2,497 individuals died, of which 1,853 (63%) had a substance use or other psychiatric disorder.
  • This group was three times more likely to die of an external cause (for example road accidents, homicide, accidental overdose or suicide) than those given a community sentence who did not have psychiatric or substance use disorders. 
  • They were also more than two times as likely to die of any cause (which could include illnesses such as cancer or heart disease).
  • The leading cause of death among the whole group was suicide at 20 per cent, with most suicides occurring in people in their late 20s. Rates of suicide among those given community orders were 11 times higher for women and four times higher for men compared to suicide rates in general population in Sweden.

Lead author Dr Denis Yukhnenko, from Oxford University’s Department of Psychiatry, said:

Most of these deaths were from external causes and are potentially preventable. Suicide was the leading cause of death in our cohort, disproportionately affecting younger individuals and those with psychiatric disorders.

“These findings underscore the importance of using community supervision as an opportunity to offer evidence-based treatment targeting substance misuse and other psychiatric disorders in sentenced individuals.

“Sweden has a freely accessible healthcare system, but in countries where there are more barriers to receiving quality medical care, the association between psychiatric disorders and mortality is likely to be even higher."

Co-author Seena Fazel, Professor of Forensic Psychiatry at Oxford, said: “Consistently high rates of premature mortality have been reported in individuals who receive community sentences, but few studies have explored risk factors for these rates.

“Our study found that substance use and other psychiatric disorders were significantly associated with increased mortality in individuals, in particular from external causes.

“We advocate for more focus on assessing the mental and physical health effects of community sentencing.”

The paper follows another study by the authors suggesting psychiatric disorders are also an important modifiable risk factor for re-offending in those receiving community sentences.