Professor Appleby "This is really to do with how mental health staff rate a person as low or high risk."
The study ordered Professor Louis Appleby warned health staff are not identifying patients who are at most at risk of killing someone.
His report for the National Patient Safety Agency found nearly a third of killings are carried out by psychiatric patients who were judged not to be a risk to the public. The victim is usually a family member.
Professor Appleby believed "de-sensitisation", where staff failed to spot the signs because they have seen so many people in the high risk category, was the central cause.
He rejected claims that a lack of resources was also a factor: "This is really to do with how mental health staff rate a person as low or high risk. Sometimes they just become desensitised to the risks they are dealing with."
His report, entitled Avoidable Deaths, was based on research of all homicides and suicides involving people with mental illness over a five-year period. It found on average 52 homicides a year were committed by people who were subject to care in the community. The majority had been assessed by a mental health worker in the days leading up to the killing.
But the report also found a higher death toll from the same group of people committing suicide. Up to 25 people each week who had been assessed as high risk had gone on to take their own lives. The study found too few had received the enhanced support after they left hospital that they needed.
It also highlighted an increasing number of homicides where patients had both a mental illness and a drug or alcohol addiction. Although the number of killings has not increased since the last significant study a decade ago, the findings show efforts to improve care outside of hospital for high risk groups such as schizophrenics has not significantly improved.
The report comes just weeks after an official inquiry into the murder of retired banker Denis Finnegan by paranoid schizophrenic John Barrett in London's Richmond Park which listed a catalogue of failings.
Marjorie Wallace, founder of the charity Sane, said the report confirmed what many in the sector already knew: "It is not a question just of resources or laws but, as has been highlighted, the failure to identify people at risk when all the red alerts were in hindsight flashing. In order to respect the human rights of a patient, it seems you become cold to the pleas and warnings of families that they may be deteriorating and not taking medication. Inquiry after inquiry has shown that a family's calls for help are ignored by staff until it is too late."
Health minister Rosie Winterton, who is currently leading attempts to reform England’s mental health laws, said plans to introduce compulsory treatment orders would help: "One of the problems at the moment is for the small number of people who are detained in hospital. If they are discharged there are some patients who don't continue to take medication, who don't continue to stay in touch with mental health services. At the moment we have no power to be able to say we want people to comply with treatment."
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