Research Interests

Epidemiology of mental illness and violent crime, risk factors for violent crime in mental illness, mental disorders in homicide and sexual offenders, risk factors for repeat offending.
Funded by the Wellcome Trust

Clinical prediction rules and risk assessment for suicide and violence in mental illness, violence risk assessment in prisoners and community offenders. Funded by the Wellcome Trust

Mental health of prisoners, suicidal behaviour in prisoners, risk factors for self-harm and suicide in prisoners, adverse outcomes in recently released prisoners.
Funded by the Wellcome Trust and NIHR

Health needs of older prisoners

Capacity and competence including fitness to plead and stand trial, capacity to complete advance directives, capacity/competence to consent to treatment.
Previously funded by NIHR

Recent media interest in research

Violence risk assessment tool in severe mental illness – ‘a tremendous step forward’: American Council on Science and Health

‘A single concussion’: New York Times

Head injury in children and adolescents: PLoS Science AMA

Risk of violent reoffending in prisoners with mental illness: Guardian

Antidepressants and risk of violent crimes: Guardian

“Schizophrenia associated with increased rates of violence and suicide”: BMJ News

“Mental Illness Can Shorten Lives More Than Chain-Smoking”: National Public Radio

“Medications Cut Violence Among Mentally Ill in Study”: Wall Street Journal

‘Coin-toss justice’: New Scientist

The Drugs Don’t Work? (book review): PLoS Medicine Community Blog

“Brain injury survivors three times more likely to die prematurely”
The GuardianReuters

“Self-harm ‘four times more likely’ in female prisoners”: BBC News

Publications

Latest Publications

Violence and mental illness

Chang Z, Lichtenstein P, Långström N, Larsson H, Fazel S (2016) Association between prescription of major psychotropic medications and violent reoffending after prison release. JAMA 316(17): 1798-1807.

Sariaslan A, Larsson H, Fazel S. (2016) Genetic and environmental determinants of violence risk in psychotic disorders: a multivariate quantitative genetic study of 1.8 million Swedish twins and siblings. Molecular Psychiatry; 21: 1251-1256.

Sariaslan A, Lichtenstein P, Larsson H, Fazel S. (2016) Triggers for violent criminality in patients with psychotic disorders. JAMA Psychiatry; 73: 796-803.

Fazel S, Wolf A, Chang Z, Larson H, Goodwin G, Lichtenstein P. (2015) Depression and violent crime: Swedish population study. Lancet Psychiatry 2: 224-232
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00128-X/abstract

Fazel S, Wolf A, Palm C, Lichtenstein P. (2014) Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. Lancet Psychiatry 1: 44-54.
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70223-8/abstract

Webb RT, Lichtenstein P, Larsson H, Geddes JR, Fazel S. (2014) Suicide, hospital-presenting suicide attempts, and criminality in bipolar disorder: examination of risk for multiple adverse outcomes. J Clin Psychiatry 75(8): e809-16.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226039/

Swanson JW, McGinty EE, Fazel S, Mays VM. (2015) Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Annals Epidemiol 25: 366-375.
http://www.annalsofepidemiology.org/article/S1047-2797(14)00147-1/abstract

Lichtenstein P, Halldner L, Zetterqvist J, Sjölander A, Serlachius E, Fazel S, Långström N, Larsson H. (2012) Medication for Attention Deficit–Hyperactivity Disorder and Criminality. N Engl J Med 367: 2006-14.
http://www.nejm.org/doi/full/10.1056/NEJMoa1203241

Prisoner mental health

Fazel S, Hayes A, Bartellas K, Trestman R. (2016) Mental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry 3: 871-881.

Chang Z, Larsson H, Lichtenstein P, Fazel S (2015) Psychiatric disorders and violent reoffending: a national cohort study of convicted prisoners in Sweden, Lancet Psychiatry 2: 891-900.

Zlodre J, Fazel S. (2012) All-Cause and External Mortality in Released Prisoners: Systematic Review and Meta-Analysis. Am J Public Health 102: e67-e75.
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.300764

Fazel S, Seewald K. (2012) Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis. Br J Psychiatry 200: 364-73.
http://bjp.rcpsych.org/content/200/5/364.full.pdf+html

Fazel S, Baillargeon J. (2011) The health of prisoners. Lancet 377: 956-965.
http://www.sciencedirect.com/science/article/pii/S0140673610610537

Fazel S, Doll H, Långström N (2008). Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 surveys. J Am Acad Child Adolesc Psychiatry 47(9):1010-9.

Prisoner self harm and suicide risk

Marzano L, Hawton K, Rivlin A, Smith EN, Piper M, Fazel S. (2016) Prevention of suicidal behaviour in prisons. Crisis 37: 323-334.

Hawton K, Linsell L, Adeniji T, Sariaslan A, Fazel S (2014) Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet 383: 1147-54.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62118-2/abstract

Rivlin A, Hawton K, Marzano L, Fazel S (2013) Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention. PLoS One 8(7): e68944.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068944

Fazel S, Wolf A, Geddes JR. (2013) Suicide in prisoners with bipolar disorder and other psychiatric disorders: a systematic review. Bipolar Disord 15(5): 491-5. http://europepmc.org/abstract/med/23437982

Marzano L, Hawton K, Rivlin A, Fazel S. (2011) Psychosocial influences on prisoner suicide: A case-control study of near-lethal self-harm in women prisoners. Soc Sci Med 72: 874-883.

Fazel S, Cartwright J, Nott-Norman A, Hawton K (2008). Suicide in prisoners: a systematic review of risk factors. J Clin Psychiatry 69: 1721-1731

Violence risk assessment

Fazel S, Wolf A, Larsson H, Lichtenstein P, Mallett S, Fanshawe TR. (2017) Identification of low risk violent crime in severe mental illness with a clinical prediction tool (Oxford Mental Illness and Violence tool [OxMIV]): a derivation and validation study. Lancet Psychiatry 4: 461-68. PMID: 28479143

Fazel S, Chang Z, Fanshawe T, Långström N, Lichtenstein P, Larsson H, Mallett S. (2016) Prediction of violent reoffending on release from prison: derivation and external validation of a scalable tool. Lancet Psychiatry 3: 535-543

Douglas T, Pugh J, Singh I, Savulescu J, Fazel S. (2017) Risk assessment tools in criminal justice and forensic psychiatry: the need for better data. European Psychiatry 42: 134-137.

J Zhou, K Witt, Y Xiang, X Zhu, X Wang, S Fazel (2016) Violence Risk Assessment in Psychiatric Patients in China: A Systematic Review. Australia and New Zealand Journal of Psychiatry 50(1): 33-45.

Witt K, Lichtenstein P, Fazel S. (2015) Improving risk assessment in schizophrenia: epidemiological investigation of criminal history factors. Br J Psychiatry 206: 424-430.
http://bjp.rcpsych.org/content/early/2015/01/22/bjp.bp.114.144485.abstract

Singh JP, Fazel S, Gueorguieva R, Buchanan A. (2014) Rates of violence in patients classified as high risk by structured risk assessment instruments. Br J Psychiatry 204(3): 180-7.
http://bjp.rcpsych.org/content/204/3/180.short

Singh J, Grann M, Fazel S (2013) Authorship bias in violence risk assessment? A systematic review and meta-analysis. PLoS One 8(9): e72484.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072484

Fazel S, Singh JP, Doll H, Grann M. (2012) Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis. British Medical Journal 345:e4692.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404183/pdf/bmj.e4692.pdf

Suicide in neuropsychiatric conditions

Chesney E, Goodwin GM, Fazel S. (2014) Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 13(2): 153-60.

Witt K, Hawton K, Fazel S. (2014) The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophr Res 154(1-3): 61-7.

Fazel S, Pillas D, Wolf A, Lichtenstein P, Långström N (2014) Suicide, fatal accidents, and other causes of premature mortality in traumatic brain injury: A 41-year Swedish population study. JAMA Psychiatry 71(3): 326-33.

Fazel S, Wolf A, Långström N, Newton CR, Lichtenstein P. (2013) Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study. Lancet, 382(9905): 1646-54.

Forensic Psychiatry

Fazel S, Fimińska Z, Cocks C, Coid J. (2016) Patient Outcomes Following Discharge From Secure Psychiatric Hospitals: Systematic Review and Meta-analysis. Br J Psychiatry 208(1): 17-25.

Fazel S, Wolf A. (2015) A systematic review of criminal recidivism rates worldwide: current difficulties and recommendations for best practice, PloS one, 10;6, e0130390.

Fazel S, Wolf A, Fimińska Z, Larsson H. (2016) Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors. PLoS ONE 11(5): e0155906.

Zlodre J, Yiend, T. Burns & S. Fazel (2016) Coercion, competence, and consent in offenders with personality disorder. Psychology, Crime & Law 22(4): 315-330.

Other Selected Publications

Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. (2015) Selective serotonin reuptake inhibitors and violent crime: a cohort study. PLoS Medicine 12: e1001875.

Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. (2015) Varenicline and risk of psychiatric conditions, suicidal behavior, criminal offending, and transport accidents and offences: population based cohort study. British Medical Journal 350: h2388.

Fazel S, Geddes JR, Kushel M. (2014) The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 384(9953): 1529-40.

Fazel S, Zetterqvist J, Larsson H, Långström N, Lichtenstein P (2014). Antipsychotics, mood stabilizers, and risk of violent crime. Lancet, doi:10.1016/S0140-6736(14)60379-2.

Fazel S, Långström N, Hjern A, Grann M, Lichtenstein P (2009). Schizophrenia, substance abuse, and violent crime. JAMA 301:2016-2023.

Fazel S, Gulati G, Linsell L, Geddes JR, Grann M (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 6(8).   http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000120

Chapters

Fazel S, Bjørkly S (2016) “Methodological Considerations in Risk Assessment Research”, Singh JP, Bjørkly S, Fazel S (eds.) International Perspectives on Violence Risk Assessment (Oxford University Press).

Fazel S. Mental health assessment. In: Cambridge Handbook of Forensic Psychology (Cambridge University Press, 2010)

Fazel S, Chhabra P. Elderly prisoners. In: Psychiatry in Prisons: a comprehensive handbook. Eds. S Wilson, I Cumming (London: Jessica Kingsley Publications, 2010)

Fazel S. Psychiatric aspects of crime and the elderly. In: Oxford Textbook of Old Age Psychiatry, ed. R. Jacoby, C. Oppenheimer et al. (Oxford University Press) 2008

Fazel S. Competence. In: Oxford Textbook of Old Age Psychiatry, ed. R. Jacoby, C. Oppenheimer et al. (Oxford: OUP) 2008

Books

Singh JP, Bjørkly S, Fazel S (eds.) 2016. International Perspectives on Violence Risk Assessment, Oxford University Press.

Other Activities

Section editor, BMC Psychiatry

Section editor, Evidence-Based Mental Health

International advisory board, The Lancet Psychiatry

Co-author of Continuing Professional Education module on Suicides in Prison hosted by the Royal College of Psychiatrists, UK (2015): http://www.psychiatrycpd.co.uk/learningmodules/suicidesinprison.aspx