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.

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.

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.

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.

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.

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.

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.