The role of grievance in fatal family violence and implications for the construct of lone actor grievance-fuelled violence.

Introduction: The concept of lone actor grievance fuelled violence assumes that homicides that occur in very different contexts can be thought about in a consistent manner because they share common motivations and resultant emotional states like resentment, outrage or revenge. Fatal family violence has been largely excluded from discussions of lone actor grievance-fuelled homicide, based on the assumption that it is conceptually different. This scoping review examines similarities and discrepancies between the characteristics and motivations of perpetrators of fatal family violence and those who have engaged in lone actor grievance-fuelled homicide outside the family context, and the relevance of the concept of grievance-fuelled violence to fatal family violence. Methods: This study reviewed published case studies and case series, resulting in a dataset of 102 homicide cases from 36 studies, of which there were 38 fatal family violence cases and 64 categorised as lone actor grievance-fuelled homicide. Results: Twenty of the 38 fatal family violence cases were identified as being grievance-fuelled, based on the presence of motivations consistent with definitions in the grievance literature. Whilst there were some offence similarities between the fatal family violence cases (e.g., location of offence), those driven by grievance were more similar to lone actor grievance-fuelled homicide in other ways (e.g., offender's gender and offence methods). In both these categories violence was predominantly motivated by grievance and a desire for revenge, whereas non-grievance fatal family violence cases were predominantly motivated by altruism. Discussion: The motivations that defined behaviour as lone actor grievance-fuelled homicide were equally apparent in a sub-group of fatal family violence, implying that some family violence cases can be integrated into the construct of lone actor grievance-fuelled homicide in future research and theorising.

Assessing and managing threats to commit a massacre.

Lone actor attacks like those at Port Arthur and Parklands High School Florida remain rare events though more frequent year by year. Psychiatrist are unlikely to see such killers either before or after an attack. What they do encountered on occasion are patients threatening to commit such a massacre. These threats need to be taken seriously primarily because they usually indicate significant distress but also because there is a remote chance they may try and act on the threat. Threats state an intention with the chances of enactment depending on the degree of commitment. Commitment is reflected in the level of preoccupation, plausibility, planning and preparation. Most threats have no commitment to act being an end in themselves motivated by such things as the desire to express an emotion, the wish to frighten, the attempt to manipulate others, though just occasionally they are a warning with some level of commitment to act. The assessment of threats to commit a massacre is considered in terms of the motivation and apparent commitment. Those who threaten mass killings also differ significantly from Lone Actor Attackers in their clinical pictures which further assists assessment of risk. There are some where doubts remain about the level of threat they present. The management of this group is discussed.

Public Figure Fixation: Cautionary Findings for Mental Health Practitioners.

Research in western nations has found that pathologically fixated individuals pose a risk of serious harm to public figures, and that many of these fixated persons are mentally ill and require treatment. Over the past decade, integrated fixated threat assessment agencies have been established in western Europe and Australia to specifically assess and manage this group. The current study examines 400 consecutive referrals to a fixated threat assessment center in Queensland, Australia, with a particular focus on the mental health and risk profile of those who engage in inappropriate contact with public office holders. It considers the high proportion of delusional disorders in this cohort, and their identification and management by psychiatric services. The authors conclude with a discussion of the mental health response to this group and impediments to mitigating the risks posed by fixated persons. Copyright © 2016 John Wiley & Sons, Ltd.

Harassment, stalking, threats and attacks targeting New Zealand politicians: A mental health issue.

OBJECTIVE: Due to the nature of their work, politicians are at greater risk of stalking, harassment and attack than the general population. The small, but significantly elevated risk of violence to politicians is predominantly due not to organised terrorism or politically motivated extremists but to fixated individuals with untreated serious mental disorders, usually psychosis. Our objective was to ascertain the frequency, nature and effects of unwanted harassment of politicians in New Zealand and the possible role of mental illness in this harassment. METHODS: New Zealand Members of Parliament were surveyed, with an 84% response rate (n = 102). Quantitative and qualitative data were collected on Parliamentarians' experiences of harassment and stalking. RESULTS: Eighty-seven percent of politicians reported unwanted harassment ranging from disturbing communications to physical violence, with most experiencing harassment in multiple modalities and on multiple occasions. Cyberstalking and other forms of online harassment were common, and politicians felt they (and their families) had become more exposed as a result of the Internet. Half of MPs had been personally approached by their harassers, 48% had been directly threatened and 15% had been attacked. Some of these incidents were serious, involving weapons such as guns, Molotov cocktails and blunt instruments. One in three politicians had been targeted at their homes. Respondents believed the majority of those responsible for the harassment exhibited signs of mental illness. CONCLUSION: The harassment of politicians in New Zealand is common and concerning. Many of those responsible were thought to be mentally ill by their victims. This harassment has significant psychosocial costs for both the victim and the perpetrator and represents an opportunity for mental health intervention.

A model for managing the mentally ill fixated person at major events.

OBJECTIVE: The main risk of serious harm at major public figure gatherings comes not from terrorists or criminal activity but from fixated persons, many of whom have a serious mental illness. This paper reviews a collaborative mental health-police diversionary model for assessing and managing mentally ill individuals who attend major events because of their fixation on a dignitary or some idiosyncratic cause. METHOD: We examine the role of a multidisciplinary fixated threat assessment service during the pre-operational, operational and post-operational phases of major events in Queensland in 2014, including the G20 World Leaders' Summit. The benefits and challenges of this unique approach are reviewed. RESULTS: The royal visit and G20 Finance Ministers' Meeting presented opportunities for the Queensland Fixated Threat Assessment Centre to develop and refine its approach to assessing and managing the threat posed by fixated persons at such events. Based on this experience, we also developed a typology to assist in the assessment of mentally ill people who present at public figure gatherings. In the week prior to the G20 Summit, six fixated people required hospitalisation for acute psychosis. A further 18 cases were identified during the event, one of whom was an involuntary patient whose leave from hospital was revoked as a consequence of his concerning behaviour at one of the G20 venues. There were no other admissions to hospital during the event, but in the remaining cases, where indicated, follow-up was arranged through the treating mental health service or general practitioner. There were no disruptive incidents involving fixated individuals during the G20. CONCLUSION: This novel diversionary model for assessing and intervening with concerning, fixated persons at major events proved effective in mitigating the risk posed by these individuals. It also highlighted the need for police, security and mental health services to consider the fixated in major event planning, for the safety of the event, the public and vulnerable mentally ill, fixated persons.

Commentary: Stalking by patients--psychiatrists' tales of anger, lust and ignorance.

Stalking is a thriving social and criminal concern and a risk inherent in our personal and professional lives. Health care professionals, particularly psychiatrists and other mental health practitioners, are vulnerable to being stalked by their patients and, far from providing helpful insights that discourage the behavior, their training can be a hindrance. Neither a psychiatrist's gender nor seniority confers protection from the protracted vengeance or infatuation of a patient-turned-stalker, any more than does working through the transference and soldiering on. The ensuing social, psychological, and vocational damage can, however, be minimized through early recognition, informed advice, and the support, not censure, of our colleagues.

Advances in stalking risk assessment.

Over the past 15 years, forensic mental health has become more concerned with the concepts of violence prevention, management, and treatment. The development of specialist tools to aid in the assessment of a range of risks reflects this concern. This article explores contemporary thinking on violence risk assessment and how this knowledge can be applied to the relatively newer field of stalking risk assessment. The role of risk state and risk status are discussed, in addition to the way that standard structured professional judgment procedures need to be adapted to reflect the variety of risks present in stalking situations. The authors go on to describe the development and format of the Stalking Risk Profile, a set of structured professional judgment guidelines for assessing risk in stalkers. Suggestions are made for future research to enhance knowledge and improve practice in the field of stalking risk assessment.

Stalkers and harassers of British royalty: an exploration of proxy behaviours for violence.

Study of risk factors for violence to prominent people is difficult because of low base rates. This study of harassers of the royal family examined factors suggested in the literature as proxies for violence--breaching security barriers, achieving proximity, approach with a weapon, and approach with homicidal ideation. A stratified sample of different types of approach behaviour was randomly extracted from 2,332 Royalty Protection Police files, which had been divided into behavioural types. The final sample size was 275. Significant differences in illness symptomatology and motivation were found for each proxy group. Querulants were significantly over-represented in three of the four groups. There was generally little overlap between the proxy groups. There is no evidence of the proxy items examined being part of a "pathway to violence". Different motivations may be associated with different patterns of risk. Risk assessment must incorporate knowledge of the interactions between motivation, mental state, and behaviour.

Factors associated with escalation and problematic approaches toward public figures.

Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research.

Abnormal attentions toward the British Royal Family: factors associated with approach and escalation.

Abnormal approach and escalation from communication to physical intrusion are central concerns in managing risk to prominent people. This study was a retrospective analysis of police files of those who have shown abnormal attentions toward the British Royal Family. Approach (n = 222), compared with communication only (n = 53), was significantly associated with specific factors, most notably serious mental illness and grandiosity. In a sample of those who engaged in abnormal communication (n = 132), those who approached (n = 79) were significantly more likely to evidence mental illness and grandiosity, to use multiple communications, to employ multiple means of communication, and to be driven by motivations that concerned a personal entitlement to the prominent individual. Logistic regression produced a model comprising grandiosity, multiple communications, and multiple means of communication, for which receiver operating characteristic (ROC) analysis gave an area under the curve (AUC) of 0.82. The implications of these findings are discussed in relation to those for other target groups.

Harm associated with stalking victimization.

OBJECTIVE: The purpose of the present study was to determine the frequency at which assault and attempted assault occur as outcomes among stalking victims, and to explore the common characteristics of those cases in which the victims report these harmful outcomes as a result of the stalking behaviour. METHOD: A sample of 3700 men and women randomly selected from the electoral roll were sent a postal questionnaire to determine the prevalence and nature of their experiences of stalking behaviours. Those who self-reported that they had been stalked were divided according to whether their pursuer had, or had not, attacked them. RESULTS: Of the 432 who reported having been stalked, 75 (17.4%) had been attacked. A number of victim and perpetrator factors differentiated those who reported attacks. A combination of the victim being threatened, being an ex-intimate, and being younger at the time of the stalking incident were predictive of attack. A multivariate model containing these factors correctly classified 82% of the sample and achieved an AUC of 0.87. CONCLUSIONS: Stalking is an all too common problem behaviour that can result in a range of harmful outcomes for victims. Threats made by ex-intimates are a particular cause for concern. The generalizability of these findings should be tested using robust prospective methodologies in diverse populations.

Attacks on the British Royal family: the role of psychotic illness.

The role of psychotic disorders in attacks on British Royalty is examined. In the 23 attacks, there was evidence of psychotic illness at the time in 11 (48%) cases, with evidence of mental disorder in 4 additional ones. These data almost certainly underestimate the contribution of major mental disorder, as psychiatric evaluations were not available on several attackers. Psychotic states do not, however, preclude a rational element to the attackers' grievances. The objective of most attackers was to commit an outrageous act to bring attention to grievances. Nine attackers had stalked their victims. Greater attention to psychiatric disorder among those who harass royalty or other public figures would allow early intervention. Ensuring that the obviously mentally ill stalkers of prominent persons are referred to psychiatric services would meet the needs of most of them for treatment and care, while reducing the chances that a tiny minority will progress to attack.

Assessing and managing the risks in the stalking situation.

Stalking is a common social problem, often driven by psychiatric disorder in its perpetrators and productive of psychological and social damage in its victims. Assessing and managing the risks in the stalking situation is a task that frequently falls on the mental health professional. The concerns of risks in the stalking situation are not confined to violence but include psychosocial damage, chronicity, and recurrence, and, for the stalker, arrest and incarceration. This article outlines a structured approach to assessment and management involving domains based on the relationship between stalker and victim, the type of motivation driving the stalking, the stalker's risk profile, the victim's risk profile, and finally, the legal and mental health context. The assessment is closely linked to management strategies to counter specific ascertained risks and future hazards. These strategies will be limited, or facilitated, according to the current legal and mental health contexts that have a critical impact on the stalking situation.

Association between stalking victimisation and psychiatric morbidity in a random community sample.

BACKGROUND: No studies have assessed psychopathology among victims of stalking who have not sought specialist help. AIMS: To examine the associations between stalking victimisation and psychiatric morbidity in a representative community sample. METHOD: A random community sample (n=1844) completed surveys examining the experience of harassment and current mental health. The 28-item General Health Questionnaire (GHQ-28) and the Impact of Event Scale were used to assess symptomatology in those reporting brief harassment (n=196) or protracted stalking (n=236) and a matched control group reporting no harassment (n=432). RESULTS: Rates of caseness on the GHQ-28 were higher among stalking victims (36.4%) than among controls (19.3%) and victims of brief harassment (21.9%). Psychiatric morbidity did not differ according to the recency of victimisation, with 34.1% of victims meeting caseness criteria 1 year after stalking had ended. CONCLUSIONS: In a significant minority of victims, stalking victimisation is associated with psychiatric morbidity that may persist long after it has ceased. Recognition of the immediate and long-term impacts of stalking is necessary to assist victims and help alleviate distress and long-term disability.

Legislation in Victoria on sexual offenders: issues for health professionals.

New legislation passed in Victoria (the Serious Sex Offenders Monitoring Act 2005) extends the role of doctors in managing and treating sex offenders. This legislation is not based on a solid understanding of the research evidence on treatment of sex offenders or on their risk of reoffending. The legislation creates ethical and professional dilemmas for health professionals through the conflation of legal control of offenders with the medical management of disorders of sexual preference. There is a critical need for research and funding in this area, rather than ever more oppressive laws, if governments are to be serious about treating sex offenders, rather than simply incarcerating them.

A research review of public figure threats, approaches, attacks, and assassinations in the United States.

The authors review extant research on threats, approaches, attacks, and assassinations of public figures in the United States. Despite the limited number of studies, data exist concerning: 1) threatening letters and approaches to celebrities; 2) attacks and assassinations of public figures, usually the President of the United States; 3) threats and approaches to legislative members of state and federal governments; and 4) threats, approaches, and attacks against federal judicial officials. Similarities and differences across the various studies are discussed. Consistent findings across the studies indicate that direct threats toward the target are unusual and are often correlated negatively with an approach or attack; a significant proportion of subjects are mentally ill and have criminal histories; many subjects evidenced a downward spiral in their lives in the months or year before their approach or attack; and if an attack occurred, it was predatory (instrumental, premeditated) rather than affective (emotional, reactive), and the weapon of choice was a firearm, usually a handgun. Operational guidance and further research recommendations are made.

Stalking by law: damaging victims and rewarding offenders.

The introduction of anti-stalking statutes throughout Australia and much of the Western world has brought greater protection for the victims of various forms of harassment and intrusions. However, despite these new provisions, the legal system is failing some victims of stalking. This article examines those areas of the justice system that are particularly susceptible to manipulation by stalkers and the impact of these abuses on stalking victims. It also presents ways in which the problems encountered by stalking victims may be frustrated rather than alleviated by specific aspects of the enforcement of anti-stalking laws and of the functioning of certain courts and tribunals. Approaches that prevent or discourage the perpetuation of harassment and damage to victims of stalking within the legal system are discussed.

Understanding sexual offending in schizophrenia.

BACKGROUND: Studies have found an elevated incidence of violent sexual offences in males with schizophrenia. The relationship between sexual offending and psychiatric illness is, however, complex and poorly defined. AIMS: The aim of the present article is to delineate possible mechanisms that underlie offensive sexual behaviour in schizophrenia that can be used as a framework for assessing and treating these behaviours. A review of research pertaining to the aetiology of sexual deviance in schizophrenia was conducted, focusing in particular on the role of early childhood experiences, deviant sexual preferences, antisocial personality traits, psychiatric symptomatology and associated treatment effects, the impact of mental illness on sexual and social functioning, and other potential contributory factors. TOWARDS A TYPOLOGY: It is proposed that schizophrenic patients who engage in sexually offensive activities fall into four broad groups: (1) those with a pre-existing paraphilia; (2) those whose deviant sexuality arises in the context of illness and/or its treatment; (3) those whose deviant sexuality is one manifestation of more generalized antisocial behaviour, and (4) factors other than the above. This classification provides a useful framework for evaluating and treating sexually offensive behaviours in schizophrenic patients.

Patients who stalk doctors: their motives and management.

The prevalence of stalking is increasing and healthcare professionals are overrepresented among stalking victims. The most common motivations for stalking are patients' developing a romantic attachment, due to delusional beliefs (as in erotomania) or misplaced expectations (often by socially inept patients), and patients' developing a resentment for some supposed injury. Strategies to prevent victimisation and minimise the impact of stalking include: taking care to preserve privacy and security, making clear to patients that the relationship will always be professional and what the boundaries are, informing colleagues and other relevant parties, transferring the patient's care to another doctor, and considering legal action.