Filicide: A Literature Review June 2009 The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Centre for Suicide Prevention The University of Manchester DISCLAIMER _________________________________________________________ Care was taken to ensure the information is accurate to the best of our knowledge, produced within the timeframe. However, the National Confidential Inquiry cannot take responsibility for any errors or omissions. The reader should refer to the original article, referenced, before making decisions based on the information in this literature review. The document should be used for information purposes only. The views expressed are that of the National Confidential Inquiry team only, and not those of The University of Manchester. CONTACT INFORMATION ___________________________________________________________________ Sandra Flynn, Research Associate, Dr. Kirsten Windfuhr, Senior Project Manager, Professor Jenny Shaw, Professor of Forensic Psychiatry. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University of Manchester, Community Based Medicine, Floor 2, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Tel: +44 0161 275 0700 Fax: +44 0161 275 0712 Email: [email protected] Website: http://medicine.manchester.ac.uk/psychiatry/research/suicide/prevention/nci 1 CONTENTS __________________________________________________________________ LIST OF TABLES 3 CONTRIBUTORS 4 EXECUTIVE SUMMARY 5 PREFACE 7 1.0 AIMS 8 2.0 METHOD OF UNDERTAKING THE LITERATURE SEARCH 9 3.0 DEFINITION OF FILICIDE 10 4.0 BACKGROUND 12 5.0 HOW COMMON IS FILICIDE? 15 5.1 UK filicide 16 5.2 International filicide 16 6.0 WHO COMMITS FILICIDE? 19 6.1 Gender of perpetrator 19 6.2 Age of perpetrator 20 6.3 Marital status 21 6.4 Socio-economic status 21 6.5 Ethnicity 22 7.0 WHO ARE THE VICTIMS OF FILICIDE? 24 7.1 Gender of victim 24 7.2 Age of victim 25 7.3 Method of filicide 26 8.0 WHAT ARE THE CIRCUMSTANCES SURROUNDING FILICIDE? 28 8.1 Altruistic/mercy killing 28 8.2 Unwanted child 29 8.3 Accidental filicide 29 8.4 Retaliation/spousal revenge 30 8.5 Mental illness 31 8.6 Limitations of typologies 36 9.0 IS THERE A LINK TO SUICIDE? 37 10.0 CAN FILICIDE BE PREVENTED? 39 11.1 Child abuse 39 11.2 Mental illness 40 11.3 Wider society 41 11.0 LIMITATIONS OF THE FILICIDE LITERATURE 43 12.0 SURVEILLANCE SYSTEM 44 12.1 Data collection difficulties in Northern Ireland 44 12.2 Data required to provide a surveillance system in Northern Ireland 45 13.0 RECOMMENDATIONS 46 14.0 REFERENCES 48 2 LIST OF TABLES ___________________________________________________________________ Table 1: Definitions of filicide 11 Table 2: Age-specific rate of child homicide per 100,000 population 18 Table 3: Characteristics of filicide and child homicide 23 Table 4: Distribution of filicide typologies 35 3 CONTRIBUTORS _______________________________________________________ The staff at the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness developed this review. It was prepared by Sandra Flynn who critically appraised the literature. Internal peer review was provided by Dr. Kirsten Windfuhr, Dr. Isabelle Hunt, Dr. Roger Webb and Professor Jenny Shaw. 4 EXECUTIVE SUMMARY ___________________________________________________________________ In 2005, Mrs. Madeleine O’Neill killed her 9 year old daughter Lauren, and then took her own life. Mrs. O’Neill had been diagnosed with depression and had been under the care of mental health services in Northern Ireland. In response to the publication of the O’Neill Independent Inquiry (WHSSB & EHSSB, 2007) into the deaths of Madeline and Lauren O’Neill, the Department of Health, Social Services and Public Safety Northern Ireland (DHSSPSNI) commissioned the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) to compile a literature review on filicide. Filicide is the killing of a child by his or her parents. Within the literature there is no single definition of filicide, specifying the age or the relationship of the parties involved (i.e. inclusion or exclusion of stepparents). Without clearly defined parameters, it is difficult to interpret and compare research findings. The lack of clarity also makes it problematic for policy makers to translate the literature in order to inform health and social care workers on assessment of risk. This literature review brings together findings from numerous studies in the UK and internationally. Comparing child homicide rates using data from the World Health Organisation, Northern Ireland has a higher rate of child homicide compared to other countries in the UK, with the exception of infant homicides. Although research into child homicide usually includes victims up to the age of 18 years, analysis in this report has been broken down into 3 age categories: infants, preschool children and children of school age. International research consistently reports that infants are at greater risk of filicide than children in other age groups, with infants being particularly vulnerable to maternal filicide in the first few months of their lives. The first few months following childbirth is an important time for intervention, with the health professional’s active involvement with new mothers. The deaths of preschool children are more often associated with child abuse and neglect. The number of filicides in school children is lower than the other age group. Data from the National Confidential Inquiry for England and Wales has shown that children are more likely 5 to be killed by their father than their mother, but the predominant gender of the perpetrator varies between countries. The majority of perpetrators are biological parents, however a fifth of filicides are committed by the child’s stepfather. Financial difficulties and alcohol and drug misuse are common associated features of these incidents. Explanations as to why a parent might kill their own child have been examined and categorised into typologies. The circumstances under which these tragic incidents occur include mercy killing or altruism, having an unwanted child (including neonaticide), accidental filicide, retaliation or revenge against a spouse and mental illness. Incidents that also involve the perpetrators death, (filicide-suicide), are very rare and are more often motivated by altruism. In cases like that of Madeleine and Lauren O’Neill, the parent’s suicidal feelings are often extended to the child, because they do not want to leave them behind. Many of the risk factors presented in this report are common to families across the United Kingdom. As such it would be unrealistic to presume that all filicides are preventable. However, there are valuable lessons to be learned from these cases. Health workers who have contact with mothers in the early stages of pregnancy, as well as those in contact post-natally, and clinicians who are caring for patients with mental illness who have children, all have a responsibility not only to their patient, but also in safeguarding the children. 6 PREFACE _________________________________________________________ The aim of the literature review is to provide a summary of the key research studies undertaken into cases of filicide, both in the UK and internationally. Six key questions have been asked: How common is filicide? Who commits filicide? Who are the victims of filicide? What are the circumstances surrounding filicide? Is there a link to suicide? Can filicide be prevented? In Northern Ireland, 14 child homicides were reported between 2002 and 2007 (Hall, 2007), it is not clear how many of these were filicide. On average there are 32 filicide incidents per year in England and Wales (NCI, unpublished data). Although these incidents may be infrequent, they do have a devastating impact on family and friends of the deceased. Reviewing the literature on filicide should inform potential interventions not only with these rare events, but the wider issue of violence towards children. 7 1.0 AIMS _________________________________________________________ The purpose of the literature review on filicide is to: • Outline the key areas of debate • Examine the findings from research conducted in this field • Outline any issues relevant to Mental Health and Social Care services • Increase health and social care services knowledge of any potential links or associations between parental mental health disorders and filicide. 8 2.0 METHOD OF UNDERTAKING THE LITERATURE SEARCH _________________________________________________________ Descriptions of filicide date back to biblical times, however, most of the research has been in the last 20 years. Therefore, this literature review shall primarily focus on articles from within this period. The analyses were based on an extensive search of electronic databases available through the University of Manchester. The databases included PubMed (Medline) (years 1980–2008), PsychINFO (1985–2008), the Psychology and Behavioral Sciences Collection, Web of Science (1956–2008), CINAHL (1982–2008), Criminal Justice Abstracts, Criminology: A SAGE Full-Text Collection, Sociological Abstracts, and Sociology: A SAGE Full-Text Collection. Search terms included “filicide,” “infanticide,” “neonaticide”, “familicide”, “fatal child abuse”, and “child homicide”. The key words were also used in a search of the University ‘book’ catalogue. Reference lists from publications were also cross-referenced,