Utilizing mental health professionals to help prevent the next attacks

Fixated and grievance-fuelled persons: considerations on the dangers of gaps, silos and disconnects

To prevent and mitigate fixated and grievance-fuelled violence, law enforcement has moved towards collaborative policing that seeks to identify and gather information for early and timely responses. At the centrepiece of prevention efforts is the reliance on the identification of risk indicators or warning behaviours. These behaviours are often considered to represent pre-attack signals or accelerating patterns towards violence. However, there remain many challenges to detecting early risk indicators particularly in relation to the processes of information sharing. The current review examines warning behaviour amongst fixated and grievance-fuelled persons, reviewing the myriad of issues that have persisted from the Columbine School Shootings through to the Lindt Café Siege. The analysis considers the challenges that are facing police in seeking to detect and respond to early warning behaviours; specifically examining how gaps, silos and disconnects can inhibit detection and prevention efforts.

Not in Their Right Mind? Right-Wing Extremism Is Not a Mental Illness, but Still a Challenge for Psychiatry

Most research in psychiatry on extremism focuses on the question whether there is a connection between extremism and psychiatric diagnoses. In addition, practitioners are increasingly asked to take part in programs aimed at preventing and countering violent extremism by assessing risk for radicalization. However, an issue that remains largely unaddressed is that the rise of the far right in many countries during the last years poses a challenge for psychiatric services as working with right-wing patients can be a source of conflict for practitioners and patients alike. In this article, we assert that the narrow conceptual scope on psychological vulnerabilities and the practical focus on risk assessment contribute to processes of psychiatrization and limit the scope of research on right-wing extremism in psychiatry. By giving a brief overview of social research into right-wing extremism, the article argues that right wing beliefs should not be conceptualized as an expression of psychological vulnerabilities but rather as attempts to deal with conflict-laden social reality. Thus, a shift of perspective in psychiatric research on extremism is needed. On a conceptional level, the scope needs to be broadened to grasp the interplay of individual and social factors in radicalization with sufficient complexity. On a practical level, it is necessary to further investigate challenges for practitioners and institutions working with right-wing extremist patients.

Fixated Threat Assessment Centers: preventing harm and facilitating care in public figure threat cases and those thought to be at risk of lone-actor grievance-fueled violence

The rediscovery of the importance of mental illness in the risk assessment and management of those who threaten, approach, and harm public figures has led to a new way of dealing with those that threaten public figures. This approach emphasises the role of "fixation" which may be defined as an intense preoccupation pursued to an abnormally intense degree. It integrates a threat assessment paradigm with the literature on stalking. The need for such an approach was highlighted in research on the prevalence of harassment of public figures. Psychiatry has a key role in this approach which sees mental health clinicians and Police work together in Fixated Threat Assessment Centres (FTACs). An FTAC functions by assessing the level of concern and sharing information to facilitate interventions that are often mental health based. The purpose is not the hopeless task of identifying those who will go on to perpetrate serious violence, rather to intervene in the group they emerge from, to prevent harm. As well as decreasing risk to the persons fixated upon, this approach improves care to the mentally disordered people who harass and threaten them and, in doing so, decreases the likelihood of their criminalization while enhancing their quality of life. As expertise in the area has grown, policing and security agencies in several countries have expanded the FTAC model to cover individuals thought at risk of lone-actor grievance-fueled violence, a term that captures both different forms of mass killing and lone actor terrorism.

What should global mental health do about violent extremism?

To prevent radicalization to violence and to rehabilitate returned foreign terrorist fighters, new programs which go by the name of 'preventing and countering violent extremism' are being implemented globally, including in low- and middle-income countries. In some of these countries, global mental health strategies are also being implemented so as to deliver mental health care or psychosocial support to individuals and populations in need. This commentary addresses what global mental health should considering doing about violent extremism. Global mental health should be open to addressing the challenges of violent extremism but should do so based upon existing mental health and public health values, practices, and evidence. Global mental health could help by critically appraising preventing and countering violent extremism practices and by working with multidisciplinary stakeholders to develop new evidence-based and best practice models that are rooted in civil society ownership, community collaboration, broader prevention programing, and non-securitized approaches.