Seena Fazel

My research focuses on the relationship between mental illness and adverse outcomes, the mental health of people in prison, and risk assessment for suicide and violence. More recently, I have been investigating how to prevent violence perpetration and suicide in individuals with mental illness, and risk stratification in mental illness. This has been funded by the Wellcome Trust as part of a Senior Research Fellowship in Clinical Science, and currently by the NIHR Oxford Health Biomedical Research Centre.

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. We have drawn our attention to suicide more recently, and completed a series of studies examining risk factors for suicide in high risk populations (including those with psychiatric diangoses, head injury, and people in prison).

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 Parliament Justice Select Committee and the Prisons Minister. This prison research has contributed to the 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 for repeat offending, and associations with major psychotropic medications. I gave evidence in 2022 on risk assessment and interventions to reduce reoffending to the UK Parliament Science and Technology Select Committee.

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 (beta-blockers, varenicline, gabapentinoids, statins, isotretinoin, montelukast). This work has been cited in treatment guidelines from the FDA (varenicline), British Association of Psychopharmacology (antipsychotics, antimanics, ADHD medications), APA (antipsychotics), American Academy of Pediatrics (ADHD medications) and a NICE Medicine Evidence Comment (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, and more recently with Universities of Orebro, Manchester, Nottingham, IOPPN, Edinburgh, Helsinki, Berlin, Ghent, Southern Denmark, and Department of Clinical Neuroscience at Karolinska.

I am a member of the UK's Independent Advisory Panel on Deaths in Custody, an arms-length governmental body sponsored by the DHSC, MoJ and Home Office. I am on the international advisory board of The Lancet Psychiatry, section editor for BMJ Mental Health, and previously expert panel menber of South Central RfPB committee and 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 forensic psychiatrist assessing referrals from community and inpatient adult mental health services. Previously I worked as a visiting psychiatrist for 13 years at a local prison, and consultant forensic psychiatrist 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 [OxRec], people convicted of sexual offences [OxRIS], individuals with severe mental illness [OxMIV], and forensic psychiatric patients [FoVOx]), for suicide in severe mental illness (OxMIS), and suicide after a self-harm presentation (OxSATS) can be found at: https://oxrisk.com/