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We Asked a Psychiatrist About the Questionable Link Between Mental Health and Terrorism

Are we too quick to assume that people behind horrific attacks are "crazy"?

by Yasmin Jeffery
04 August 2016, 2:04pm

Floral tributes near the scene of a fatal stabbing in Russell Square, London, after a 19-year-old man was arrested on suspicion of murder after a woman was killed and five people injured in a knife rampage in central London. (Picture by: Jonathan Brady / PA Wire)

Since the police confirmed last night's stabbing spree at Russell Square was not an act of terror, the 19-year-old man currently held on suspicion of murder has already been described as a "crazed knifeman lunging for anyone he could see".

This is nothing new: there have been plenty of examples of media making the jump from "terrorist" to "someone with mental health issues" when talking about the perpetrator in the aftermath of horrific things happening to innocent people. But the general practice of conflating terrorists and people with mental health issues before a diagnosis has been given is dangerous; inaccurate beliefs about mental illness and violence have the ability to encourage widespread stigma and discrimination.

To find out why certain papers and sections of society leap to ascribe attackers' motivations to mental health issues, I got in touch with psychiatrist Dr Simon Wessely. We spoke about the media's reporting of recent attacks across the world, and what should be done to lower the likelihood of future incidents.

VICE: Is mental health being used as a scapegoat for terrorism?
Dr Simon Wessely: Partly, yes. When someone does something that at first sight seems utterly awful and unbelievable and impossible to understand, the reaction is, "He must be mentally ill." And then when you ask, "Why did he do it?" the answer is, "Because he's mentally ill." So it's a completely circular argument and not a helpful reaction, because although it may or may not be true, it doesn't explain anything, and often it's wrong.

What would a better reaction be?
A better reaction, first of all, would be to decide if they are mentally ill or not. We define mental illness by certain sets of criteria and a diagnosis. When given a case, we set out to determine whether the subject is schizophrenic, suffering from depression or whatever it could be, and then we look at whether this can actually be related to what they've done, which we call a formulation. So, first of all, you should assess the person and come to the right view, and that's what we do, but we don't do this overnight or straight after hearing a news bulletin. The person in Russell Square will see a psychiatrist for certain, and they will write a report and decide on his mental health, and then a court will decide how relevant that is and what should be done about it. We have procedures for doing these things that we always follow.

What have you made of the reporting of recent attacks and the intersection with mental health?
I know no more about the Russell Square attack than you do, and it's wrong to speculate, but what I can say is that what keeps me awake at night is the threat of organised terrorism in this city and this country. It's a genuine risk, and I know it won't be carried out with people with mental disorders. We know that terrorist groups actively un-recruit people with mental health issues, and this has been the case for a very, very long time, because of stigma. They're seen as unreliable, difficult to train and regarded as a security threat, which is why your honest-to-god terrorist that poses a threat to our society is not going to be mentally ill. All the studies show that terrorists' rates of mental disorder are very low, and where they do have mental disorder it's often a consequence of what they've done rather than the cause of what they've done. This is much, much more likely. So the people coming back from Syria may well have mental health problems, but this is likely to be a consequence of everything they've done.

What we may be talking about now are people called lone actors. These are people who are not part of organised groups, and there is evidence they do have a higher rate of mental health problems. The evidence is sketchy because – thank god – they don't have very many of these people [to study], but we do know that in those instances there's a higher rate of mental health problems. It isn't any specific health problem, so some will have schizophrenia, some may have some form of autism, and others are just alienated, disturbed people with fractured social backgrounds.

So do you see terrorism and mental health being in any way related?
Organised terrorism, no, but lone actor terrorism, yes. The evidence is clear that there are links in some, and more than you would expect by chance alone. So there is a relationship, just as there is with homicide and mental illness, but remember that it's still very rare. As a proportion of those with mental illness, it's tiny. We have systems for dealing with this, we have the courts, we have forensic psychiatrists who do deal with some dangerous and psychotic people who also talk in radical terms, but are clearly mentally ill, and there's people already being treated in our leading secure forensic settings. We have systems for people at the severe end of the spectrum. Where we have big gaps is the more moderate forms which are not severe enough to warrant attention, but cause concern, and that's where the government needs to make good on promises to make substantial investments in mental health services. £1.4 billion is what was promised in the budget before the last election, and we've yet to see that – but that kind of money will make a difference, and it's the best way of dealing with the growth in the number of alienated people, or whatever you want to call them.

How should society deal with this link?
In each case, you need to find out what their background was, what was behind this, and from there, there may be a role for mental health issues. Terrorism and radicalisation is not a mental illness, so what we do about terrorism is for the police to deal with. What we do about these more lone people who may have mental health problems is make good our promises to improve our child and adolescent mental health services, make them accessible to these people, which is difficult, and use all the tricks we can – through community outreach, community leaders, working with schools and parents – to identify with troubled teenagers and try and help as best we can. If that reduces these events, fair enough, but it's going to be very difficult to know that because they're so fortunately rare.

What worries us is that if we focus all our efforts with adolescents and young people on the prevention of terrorism, you could actually further alienate and then radicalise people already feeling marginalised, alienated, unhappy, disturbed or obsessive – you might add one more to their list of grievances.

We have a prevent and channel programme to which you can refer teenagers suspected of quote-unquote "radicalisation". We don't really have any data about how this is working or what the outcomes are, and I think it's very important that we don't shroud all this in secrecy; we should be open about what the programmes, results and practices are, because a lot of people are already very, very suspicious about these kinds of programmes, partly because they don't know what they are.

How do badly reported stories on people who may or may not have mental health issues influence people actually living with mental health issues?
Well, not great, is the answer. It's a pity, because the media have been making considerable strides in the way they report mental health problems in the last few years, and there's no question about that. Most of the time the media are far more responsible, and I hope we don't go back to the ways of the past. I think, just as we have responsible reporting with suicide now, we should seriously think about how we report these issues. I'm not saying we shouldn't report them, because obviously that's going to happen, but we should change the way we do it.

What does generally worry me is what this could actually cause, because we know suicide can be contagious; we know school shootings in America can be contagious. We have to report this in a responsible way, because there is a genuine risk of contagion. [Some of] the French [media] no longer carry the pictures of perpetrators, and I think that's something we should consider. These issues are a massive public interest, but they need to be reported in a specific way; we can't make people seem heroic. And also, let's be clear; 20 percent of the population has a mental illness. Three percent has schizophrenia. That's a lot of people. Maybe three or four of them are going to go and do this kind of event or horror, and all of us will have members of our family, our friends, even our children, who have mental health problems, and they're not going to take very kindly to such bad representation.

Thanks, Dr Wessely.

@YasminAJeffery

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