Introduction
Developments in threat assessment, particularly in the area of concerning communications and approaches to public figures, have led to the setting-up in a number of countries of a new style of service for assessing and managing risk to the prominent from the actions of lone individuals. Known as Fixated Threat Assessment Centers (FTACs), their central characteristic is that they are jointly staffed by police officers and by psychiatric staff from health services. They are based on the realization that the interests of the prominent in terms of protection overlap with those of the people harassing them in terms of medical care. Research over the last decade has re-established that the majority of those threatening, harassing or attacking public figures have unmet mental health needs, and that attention to these is often the most effective way of reducing risk, while at the same time improving their lot and focusing on treatment, rather than criminalization. The approach has recently been expanded to encompass assessment and intervention in individuals suspected of being radicalized into extreme ideologies and at risk of proceeding to commit terrorist acts.
The presence of psychiatry in FTACs allows the understanding of motive and mental state which is essential to accurate risk assessment. It also allows health-based interventions to lower or manage risk. The psychiatric involvement here has little to do with the application in courts of the Victorian psychiatric defense of insanity, a legal rather than a medical concept. Nor is it to do with issues of responsibility for an individual’s actions which are prominent in some jurisdictions and completely absent in others. Rather, it deals with the reality that mental illness affects people’s judgment and behavior, not simply through prominent symptomatology, but through the disinhibition associated with illness, the loss of judgment which comes with social isolation and the absence of a restraining peer group, and the disconnection with social values that often accompanies social decline. Effective interventions will involve compulsory psychiatric treatment in some cases, but in others, simple interventions such as connecting the individual with treating services. Networking with statutory agencies such as social work or housing may be highly effective, as may family contact. It is important to note at the outset that the focus of these interventions is prevention of harm. The exercise is not solely concerned with violence, but also with other forms of risk. Concerning communications and approaches may give rise to psychological distress, to fear as to what might happen next, to public embarrassment, to disruption of the ability to perform a public role, and to the use of expensive police resources, some of which prove unnecessary when comprehensive risk assessment is applied.
A key concept in this field is that of fixation. Fixation has been described by Mullen et al as “an intense preoccupation with an individual, activity, or idea,” “an obsessive preoccupation … pursued to an abnormally intense degree.”Reference Mullen, James and Meloy 1 In the public figure context, fixation may be the result of grievances, real or otherwise, of idiosyncratic quests for “justice,” of perceived rejection, bizarre amorous attachments or misguided quests for help. Fixation may arise out of mental illness, although this is not always the case. People who engage in stalking behavior and those who become vexatious litigants or querulants commonly are fixated. A striking feature of pathological fixation is the level of psychosocial harm done to the fixated individual as well as the potential for harm both to those closest to the individual and to those who are the object of their fixation. The work of FTACs and similar units in consequence limits harm, not only to prominent people, but to the families and communities from which the fixated individuals come.
The development of FTACs
In 2003, the British government funded a research project designed to increase the efficiency and effectiveness of the royal and parliamentary protection services. 2 The aim was to improve their ability to evaluate and manage the threat presented by stalkers, threateners, and those who attempted to force their way into the presence of royalty or members of parliament, whether it be with ill or benign intent. For efficiency, read decrease the escalating costs, both of monitoring increasing numbers of potentially problematic people and of providing close protection to an ever-wider circle of royalty and parliamentarians. For effectiveness, read improve methods of recognizing and managing those at high risk of acting to disrupt, or even endanger, the lives of protectees. To give some idea of the magnitude of the problem, the Queen alone, at that time, was the target of the activities of over 2000 active, problematic individuals.
The commissioning of the research reflected the realization that, in terms of threat toward public figures, although the motivation and modus operandi of terrorist and criminal groups were understood and well-established systems were in place to assess and manage them, there was little understanding of risks posed by disturbed members of the general public who exhibited a pattern of harassment and stalking towards public figures and made repeated attempts to communicate with them or enter their presence. Such individuals did not fit into standard policing methods for assessing and managing threat. While it was recognized that terrorist organizations tended to engage in random attacks on mass population targets rather than prominent individuals, isolated loners remained an unknown quantity.
At the outset of the research phase, those of us involved in what was termed the Fixated Research Group believed we would face the classic problem of identifying and prioritizing multiple factors correlated with moving from stalking and threatening to acting in a manner which placed the principals at risk. In the end, we hoped to generate some kind of predictive algorithm. The researchers were given extraordinary access to the records of the police, protection services, and mental health services. In addition, vast quantities of material generated by the stalkers and threateners were made available. Our initial assumptions about multiple factors and the need for complex algorithms proved mistaken.
As the data accumulated, it became increasingly clear that one factor above all determined both the continuing persistence and intensity of the problem behaviors themselves and the probability of progression to actions which were even more disruptive and on occasion violent. That factor was the presence of untreated mental illness. Most of the persistent stalkers and threateners had serious mental disorders, and virtually all of those attempting to break through the barriers protecting the principals, or making attempted or actual attacks, were psychotic at the time.Reference James, Meloy and Mullen 3 Severe mental illness was the key both to understanding an individual’s motivation and to assessing different forms of risk—the probability of persistence, intensity, and progression to violence. Of course, this is not the same as saying that one has to be mad to target a public figure or that psychotic illness, which is relatively common, could be used as a marker for potential attack. Rather, it affords an avenue for better understanding and assessment of public figure threat cases, as well as opening possibilities for prevention. The treatment of mental illness was revealed as the management method most likely to reduce risk. A predominately criminal justice and security problem became a predominately mental health problem.
The findings of the Fixated Research Group, published in a series of thirteen papers in peer-reviewed journals, led to the establishment of the FTAC in the United Kingdom in 2006—a model subsequently adopted elsewhere. The unit located within the Specialist Operations section of the Metropolitan Police, based in London but with a national remit. Its key feature is that it is staffed both by medical personnel from the National Health Service and by police officers, being jointly funded by the Office of Security and Counter-terrorism at the Home Office and by the Department of Health.
The aims of the approach are two-fold: to improve the outcomes for the individuals referred and at the same time to reduce the risk they may pose to the individual they are focused on, or indeed others close to them. The service does not attempt the futile task of attempting to predict who might go on to act in dangerous ways. Rather, it has adopted a population model. It is possible, through looking at the associations of progressing to commit destructive behaviors, to tell which individuals lie in the minority of cases from which problems are likely to come. By intervening in all such cases, it is possible to prevent individuals going on to engage in dangerous actions without knowing which particular individuals would, without intervention, have gone on to do so. An analogy is attention to risk factors in cardiac disease: by identifying those with high cholesterol, obesity, smoking, and so on, it is possible to intervene in a population to reduce the risk of adverse outcomes without knowing exactly which cases, without intervention, would have gone on to suffer them.
A pilot scheme established for 18 months demonstrated the effectiveness of the approach,Reference James, Kerrigan, Forfar, Farnham and Preston 4 and led to the unit becoming permanent. The presence of psychiatrists allowed the diagnosis of mental illness and an analysis of its influence on motivation, risk, and potential management options. U.K. FTAC considered referrals of those who made inappropriate approaches or communications to the royal family, senior politicians, and “iconic sites.” These referrals led to a process of information gathering by police and mental health professionals and an assessment of the problems each individual might produce. A level of concern was used in describing these,Reference Scalora, Baumgartner and Zimmerman 5 not a level of risk, given that concern levels involve decisions made on limited information in real-time operational situations, as opposed to risk assessment which involves considering large amounts of information at relative leisure. Ways of mitigating or removing concerns were then considered, and a management plan established.Reference James, Farnham, Wilson, Meloy and Hoffmann 6 This generally involved catalyzing action from statutory services around the country, including police, health services, social services, and even housing. Where mental illness was evident, there was usually liaison with the psychiatric services responsible for the individual’s domicile. The role of FTAC was not direct involvement in treatment: rather the emphasis was on the appropriate sharing of information and the communication of this information in a targeted way to relevant agencies in the part of the country in which the individual lived, with the aim of initiating interventions from other services locally, sometimes on a multi-agency basis. In many cases, FTAC arranges a networked community response, which will involve both the monitoring of cases and practical interventions, with the provision of a support worker. Such practical interventions can be remarkably effective. This reflects the fact that the importance of mental illness to assessing and managing risk concerns not only psychotic symptomatology, but also difficulties in the correct interpretation of events, poor judgment, disinhibition, and social isolation which removes the moderating influence of personal relationships and peer groups.
The range of possible interventions also means that the model can be used in jurisdictions with very different health care arrangements and mental health laws. The United Kingdom has advantages in terms of ease of compulsory hospitalization, given the low legal threshold and the existence of the National Health Service. The United Kingdom also differs in that responsibility in the mentally ill is only relevant in homicide cases, and hospitalization is routinely used as a final disposal in sentencing at court, with the criteria being the person’s health, rather than meeting any insanity criteria. Yet, the model has proved equally useful in countries with quite different systems and in jurisdictions such as Australian states which have a system not dissimilar to the competency/insanity limitations in the United States.
The efficacy of U.K. FTAC’s operations was demonstrated in part by the proportion of referrals in which mental illness was identified. In a study of 100 individuals assessed as being of high or moderate concern by FTAC, 86% were found to be suffering from psychotic illness. Compulsory admission was the outcome in 53% of cases and voluntary admission in 4%, while 26.5% were taken on for management by community mental health teams or assertive outreach services.Reference James, Kerrigan, Forfar, Farnham and Preston 4 With intervention, 80% of cases had been managed down to a low level of concern by the end of the study period. A more sophisticated assessment of FTAC outcomes used a mirrored design in which individuals were in effect their own controls.Reference James and Farnham 7 The study looked at 1- and 2-year periods before and after FTAC intervention. It identified highly significant reductions both in the number of individuals engaging in communications and problematic approaches and also in the total numbers of incidents of concern.Reference James and Farnham 7 It also saw a reduction in police call-outs, raising the possibility that the exercise might prove cost-neutral.
Re-inventing the wheel
The establishment of the U.K. FTAC, and the research upon which it was based, can be considered something of a watershed moment in that it brought a focus on mental illness back into threat assessment practice, and it illustrated the overlap between public figure threat assessment and the field of stalking, so enabling insights in terms of motivation, classification and formalized means of assessing threat to be brought across from stalking research.Reference Mullen, Pathé and Purcell 8 Threat assessment and management as a construct and a paradigm had seen a resurgence in interest from the 1980s onwards after a century of neglect.Reference Farnham and Busch 9 This included the development of a threat assessment service in 1986 for Congress in the United StatesReference Scalora, Zimmerman, Wells, Meloy, Sheridan and Hoffman 10 (which over time increasingly came to resemble the approach taken in the U.K. FTAC) and the establishment of the Los Angeles Police Department (LAPD) threat management unit in 1990 following the killing of Rebecca Schaeffer by an obsessive fan Robert Bardo in 1990Reference Pathé and WSG 11 , Reference Zona, Palarea, Lane and Meloy 12 and the subsequent introduction of anti-stalking legislation in California. However, research in the United States into harassment, threats, and violence toward public figures had either failed to report findings about mental illness or had failed to interpret them. Dietz and Martell considered threatening and otherwise inappropriate communications to Congress in a lengthy report to the Department of Justice in 1989,Reference Dietz and Martell 13 , Reference Dietz, Matthews, Martell, Stewart, Hrouda and Warren 14 but did not include their mental illness findings in their subsequent published account.Reference Pathé and WSG 11 The Exceptional Case Study Project in 1997 conducted for the United States Secret Service further expanded the knowledge base in the United States in this area,Reference Fein and Vossekuil 15 but there was a delay in recognizing the significance of mental illness in this population.Reference James 16 Its authors looked at 83 cases, of which 45% were assassinations and 54% “near lethal approaches.” They found that 61% of the individuals concerned had a history of psychiatric problems, 43% of delusional ideas and 10% of violent command hallucinations. Nevertheless, the conclusion of the authors was that mental illness was not of particular importance. This is despite the fact that, if one takes the figure for delusional ideas as representing the prevalence of psychosis in the sample and compares it with the point prevalence of psychosis in the general population of around 0.4%,Reference Kirkbride, Errazuriz and Croudace 17 the study cases were 110 times more likely to have a psychotic disorder. Suggestions as to why the mental illness factor was played down are variousReference James 18: It may be that mental illness was thought to be a politically unacceptable form of exculpation, that there was confusion between the (medically meaningless) concept of legal insanity and the presence of psychotic illness, or simply that the constellation of psychiatric services in the United States was not such that psychiatric care seemed a relevant management option. As regards the legal test of insanity in many Anglo-Saxon jurisdictions, it is relevant to note that its roots lie in criteria set out by the United Kingdom’s Law Lords in 1843, in the wake of the case of Daniel McNaughton, their specific aim being to de-medicalize and recriminalize attacks on public figures by psychotic individuals.Reference James, Kerrigan, Forfar, Farnham and Preston 4 , Reference James 18
Dietz and Martell,Reference Dietz and Martell 19 in reconsidering their 1989 findings 21 years later, contended that their omission of their mental illness findings in their published paper was for national security reasons. They then put forward the contention that: “Every instance of an attack on a public figure in the United States for which adequate information has been made publicly available has been the work of a mentally disorder person who issued one or more preattack signals in the form of inappropriate letters, visits or statements.” (p. 344). This is along the lines of the conclusions of the Fixated Research Group’s study of attacks on European politicians,Reference James, Mullen and Meloy 20 which found that death and serious injury were significantly associated with psychosis, the presence of delusions, loner status, and the absence of a political motive. Similar results were obtained in a subsequent and partially-overlapping study of violence toward German politiciansReference Hoffmann, Meloy, Guldimann and Ermer 21 and also in the Fixated Research Group’s study of historical attacks upon the British royal family.Reference James, Mullen and Pathe 22 However, such conclusions are not new, and it appears characteristic of research in this field that insufficient attention is paid to publications from previous centuries or to those not in the English language. None of the recent U.S. researchers had gone back to the ground-breaking work of LaschiReference Laschi 23or the 1890 “exceptional case series” by Régis,Reference Regis 24 which had described and classified public figure attacks and identified the central role of mental illness.Reference James 18 The problem of fixated individuals, it is evident, is common across recent centuries and across different countries within the western world.
Establishment of FTACs in other countries
Interest in the FTAC model led to the formation of the European Network of Public Figure Threat Assessment Agencies, which brought together police and security services from countries within the European Union, as well as further afield, and which functioned as a forum for discussing new developments. An FTAC was then set up in the Netherlands where a study of inappropriate communications and approaches to the Dutch royal family found that 75% were psychotic and a further 11% suffering from mood disorders.Reference van der Meer, Bootsma and Meloy 25 Surveys were also conducted of the extent of the problem of harassment and stalking for politicians. In Sweden, a study of members of parliament from the years 1998 to 2005 found that 74% had been subject to harassment, threats, or violence and 68% of perpetrators were thought probably to be mentally ill. 26 A survey of regional politicians in Canada found that 30% had suffered harassment with 87% believing their harassers to be mentally ill.Reference Adams, Hazelwood, Pitre, Bedard and Landry 27
Next, a survey in the United Kingdom of members the Westminster Parliament found that 81% of respondents were subject to at least one of the intrusive/aggressive behaviors studied.Reference James, Farnham, Sukhwal, Jones, Carlisle and Henley 28 This survey was repeated for the Queensland (Australia) state Parliament in 2011.Reference Pathé, Phillips, Perdacher and Heffernan 29 A similarly high rate (93%) of harassment was identified. The survey was also conducted in NorwayReference Bergland 30 , Reference Bjelland and Bjørgo 31 and New Zealand.Reference Every-Palmer, Barry-Walsh and Pathe 32 The New Zealand survey benefited from an unusually high response rate (84%) and consistent with the other surveys found that one form of harassment or another was the norm (87% of respondents reporting such behavior) with a distinct increase in the contribution from electronic media compared with the United Kingdom (60% reported inappropriate social media contact), likely due to the later date at which the survey was conducted. The effects of such behavior are not trivial, as have been illustrated by James et alReference James, Sukhwal and Farnham 33 with significant proportions of Members of Parliament (MPs) suffering psychological ill effects.
These surveys and the experience of established FTACs also highlighted that it is not the MPs alone who bear the brunt of this behavior, but also their staff, including those in often isolated and vulnerable constituency-based offices.
The Queensland survey led to the establishment of an FTAC in Queensland in 2013 operating under a similar model to the United Kingdom—one with an emphasis on joint work between police and mental health, and a high rate of mental health interventions in those referred.Reference Pathé, Lowry and Haworth 34 Similarly, in New Zealand, a small pilot service was established in September 2017 with a permanent service following in July 2019. In both these services, referrals are drawn from those who communicate to or intrude upon members of parliament, with a finding of high rate of mental illness among the communicators and threateners, again providing an opportunity for intervention and treatment in these individuals.
Within Australia, interest in this approach was accelerated by several high-profile incidents. The inquest into the Lindt café siege in New South Wales recommended the establishment of a fixated threat service in that state. 35 The individual at the center of this siege had made abnormal communications to the Queen on several occasions, and the U.K. FTAC had notified Australian Federal Police of their concerns. In Victoria, the tragic events of January 2017 on Bourke street in Melbourne where a car was used to attack pedestrians, resulting in the death of 6 and over 30 wounded, provided further impetus for the establishment of a service in that state. In Australia, FTACs have now been established in New South Wales (2017), Victoria (2018), and Western Australia (2018). In 2016, the Australian Federal Police (AFP) established an FTAC in the Australian capital, Canberra.Reference Riddle, Ferriman, Farmer and Baillie 36 FTAC capabilities are also evolving in smaller jurisdictions (South Australia, the Australian Capital Territory, Tasmania, and the Northern Territory).
An important finding from the new FTACs is that the cases that they deal with are virtually indistinguishable, regardless of country. This is presumably a reflection of the fact that mental disorders occur with similar frequency across different populations. A consistent finding has been the significant proportion of cases with delusional disorder, a form of psychosis which rarely presents to general mental health services, given that the personality is preserved and it does not lead to disturbance of day-to-day functions in the manner typical of the schizophrenias. Given the association of delusional disorder with querulousness and persistent litigation as well as paranoid and grandiose presentations, this finding is perhaps not surprising. The other group which appears to be consistently over-represented in FTAC samples is autistic spectrum disorder.
Lone actors and grievance-fuelled violence
The FTAC approach has obvious parallels with psychiatric diversion schemes at courts and police stations and, like those services, the aim is the prevention of further problem behavior, rather than its criminalization. Court diversion schemes are not new, with services having been set up in Chicago in 1914Reference Kegel 37 and Baltimore in 1917,Reference Oliver 38 the workings of which are remarkably similar to more recent initiatives developed in the United Kindom in the 1980s and 1990s.Reference James 39 Whereas this is a further lesson on the folly of failing to research the lessons of the past, it emphasizes the enduring power of the model adopted by FTAC, which has recently been expanded from the field of public figures threat to that of lone-actor and grievance-fueled violence, to which this chapter will now turn.
Régis, in his 1890 monograph, divided attackers of the prominent into three types which, restated in the modern idiom, are as follows: first, psychotic cases where the involvement of a prominent person is almost incidental: second, querulants, often suffering from a delusional disorder, pursuing a highly personal and idiosyncratic quest for justice; and a third group which shared a variety of characteristics—underlying mental disorder, a burning grievance fired by perceived maltreatment by society, a world-weariness leading to a suicidal trajectory, a seeking of notoriety in death, sometimes wrapped in religious or political flags. Recent research has found that many of the characteristics of this third group overlap with those of lone actors who engage in acts of violence toward other targets: school/university shooters, workplace killings, rampage killers, and lone-actor terrorism. 40-46 Indeed, the overlap between these various groups is such that they can be considered to form a constellation of behaviors which can be grouped together under the category of “grievance-fuelled violence.”Reference James 18 Lone terrorists have more in common with fixated individuals and other forms of lone killers than they do with group terrorists. Corner and GillReference Corner and Gill 47 found that lone actor terrorists are nearly fourteen times more likely to have mental health problems than those in terrorist groups, with 40% having a history of diagnosed mental health problems. There is increasing evidence that a proportion of those that engage in this kind of violence may be mentally illReference Gill and Corner 48 , Reference Gill, Horgan and Deckert 49 and therefore there is a role for mental health professionals.Reference James and Hurlow 50 The possible mechanisms through which mental illness may be linked to lone actor terrorism are various.Reference Pathé, Haworth and Goodwin 51 Some mentally disordered people may be susceptible to ideological influences as a result of chronic stress, disenfranchisement, and social isolation.Reference Gill 52 Radical political or religious ideologies may resonate with this group, or tap into their delusional beliefs, so rendering them at risk of indoctrination or radicalization, and more sensitive to the contagion effects of well-publicized lone-actor violence. There may also be fixated persons pursuing some idiosyncratic quest whose wrap their cases in the flag of a wider cause in the search for greater legitimacy. Mental illness may be just one element in the mix that leads to extremist thinking or terrorist activity, rather than the driving force. However, addressing it may be a way of avoiding harmful outcomes in those at risk of progressing to various forms of grievance-fueled violence. Intervention through the fixated threat model is also supported by research from the threat assessment area that highlights that a number of people that go on to commit these kind of offences are in retrospect found to have engaged in behaviors that flagged their potential (so-called leakageReference Meloy 53 , Reference Meloy, Hoffman and James 54).
In the circumstances, it is unsurprising that the FTAC model should expand into these areas in which threat assessment programs incorporating information sharing and multidisciplinary working had become more common. 55-58 The violence represents the end product of a process involving social and psychological forces and effects, with a potentially identifiable and recognizable pathway. In the Netherlands, the National Police Threat Management Team created a multi-agency unit for assessing those in danger of radicalization, building on their FTAC model.Reference Voerman 59 In London, collaboration between psychiatric staff from FTAC and anti-terrorism police was set up in 2017 to evaluate cases of potential terrorist radicalization. This was under the umbrella of the prevent program,Reference Government 60 part of the contest counter-terrorism strategy. Prevent requires statutory agencies to refer to a central point all cases where the radicalization of individuals is suspected. The new development enabled the referral of cases for consideration in terms of mental ill-health and risk as part of the overall response. In Australia, the Queensland FTAC expanded its role to incorporate the assessment of cases potentially mentally ill and thought to be at risk of lone actor violence or grievance-fueled violence and the Victorian service from inception has incorporated this group.Reference Pathé, Haworth and Goodwin 51 All the Australian FTACs except the Canberra unit have now extended their scope beyond fixation to grievance-fueled violence in general. With FTAC involvement, counter-terrorism investigations are generally not suspended. But given that mentally ill individuals who have adopted extremist beliefs have fewer inhibitions to violent action, the detailed analysis of their networks and background should not delay critical, risk-mitigating psychiatric intervention. Referral to FTAC may change priorities in the counter-terrorism input. And where mental illness is the predominant factor, there may be no further need for involvement of counter-terrorist measures, with the FTAC services becoming the lead agency in the case. As to research findings from FTACs involved in wider lone-actor cases, only one small series is available in the public domain.Reference Pathé, Haworth and Goodwin 51 Security concerns take time to overcome in the publishing of results in this area.
Further activities
The U.K. FTAC has now been running for 13 years. Over time its role has expanded. With the development of expertise, it has become involved in forward security planning for major events, education, training and research.Reference James, Farnham, Wilson, Meloy and Hoffmann 6 It co-ordinated the fixated strand in the security arrangements for the 2012 London Olympics, both in terms of forward-planning and operations on the ground. It fulfilled similar functions for royal weddings and for other major events. Similarly, the Queensland FTAC was involved in security planning and operations for the G20 summit in BrisbaneReference Pathé, Haworth and Lowry 61 and for the 2018 Commonwealth Games.
A further benefit of research in this area has been the refinement of risk assessment instruments. Such tools involve the use of risk factors, in other words characteristics or behaviors which are significantly associated statistically with the undesired outcome. It proved possible at U.K. FTAC to combine findings from the literatures on violence, stalking, harassment, and the making of threats with clinical insights and best practice from security agencies and threat assessment centers in the United States and Europe. The work at FTAC over 10 years resulted in the publication of the Communications Threat Assessment Protocol-25 (CTAP).Reference James, MacKenzie and Farnham 62 This includes a simple one-sided screen for referrers to decide which cases of concerning correspondence should be sent to threat assessment agencies for further action: if any of the list of items on the sheet is scored positive, the case must be referred. Such a screen is of practical importance for, without it, large numbers of inappropriate cases would be referred, so impairing the function of the threat assessment unit, and some cases which should be referred won’t have been. A second structured tool within the CTAP allows an initial assessment of concerning communications by a threat assessment unit, allowing triage into different levels of urgency and action. For more detailed threat assessment with more information available, many of the FTACs use an adapted version of the Stalking Risk Profile, which incorporates a section on public figure harassment cases.Reference MacKenzie, McEwan, Pathé, James, Ogloff and Mullen 63
Conclusion
The FTAC model emerged as a logical response to rigorous research which demonstrated the importance of mental illness in those who approach and threaten public figures. It involves an innovative approach with police and mental health professionals working together. The primary benefit of the model is the improvement in outcomes for often unrecognized mental illness in individuals whose lives have been blighted and whose condition imperils those around them as well as public figures. It is this that brings such work within the ethical remit of medicine. By focusing on threat assessment and management rather than attempts at prediction, FTACs reduce the potential for further adverse consequences. Since the establishment of the first unit in the United Kingdom, the model has been adopted in a number of jurisdictions and countries, sometimes in modified form. Recent research continues to confirm the value of this approach. An overlap with lone-actor and grievance-fueled violence has been recognized and this is also an area of growth and development. The emphasis continues to be primarily a public-health one seeking to intervene and improve outcomes for affected individuals at the same time as preventing harm.
Disclosures
The authors do not have anything to disclose.
