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Unmet needs: analysing the Fixated Threat Assessment Centre’s fulfilment of the public health approach, and its value for violence prevention
Open accessAbstract
The Fixated Threat Assessment Centre (FTAC) operates with a public health approach, through catalysing mental health treatment for those with mental health needs unidentified, untreated, or sub-optimally managed by mainstream services. While much literature examines mental illness’s role in fixated threats, unmet mental health needs garner less attention. This paper evaluates the value and fulfilment of safeguarding within FTAC, through analysing whether (1) FTAC identifies and successfully refers into treatment those with unmet needs, and (2) unmet needs are related to concerning behaviours. Two measures of unmet needs are analysed: disengagement from mental health services, and unidentified mental illness. Data comprise FTAC referrals from 2012 to 2016, and methods include chi-squared tests and logistic regressions. Results indicate FTAC does safeguard individuals referred. Over a quarter of referrals (where previous mental healthcare information is available) have unmet needs, predominantly psychotic illnesses. These are directed to (mental) health-based interventions, reducing concern levels. Safeguarding is useful for violence prevention, as unmet needs isolate a subgroup exhibiting disproportionately concerning behaviours (approach, problematic approach, breaching security barriers). Findings imply unmet mental health needs should be given more attention in research as a variable, and in threat assessment as a risk indicator for assessments of levels of concern.
Overview
CoChat Summary
TL;DR
This study analyses 1,914 FTAC referrals from 2012–2016 and finds that over a quarter had unmet mental health needs, predominantly psychotic illnesses, and that FTAC disproportionately directed them to mental-health interventions and reduced judged concern. Unmet needs also identified a subgroup with more concerning approach and security-breach behaviours, supporting their value as a risk indicator in fixated threat assessment.
Key findings
- In the analysed sample, 26.70% had one of two unmet-needs forms: 21.42% were recorded as disengaged from mental health services and 5.28% had an unidentified mental illness; 84.06% had previous contact with services but only 52.25% were in contact at referral.
- Unmet needs disproportionately involved psychotic illness: disengaged cases were more likely to have schizophrenia (OR = 1.57), while unidentified mental illness was less likely to be schizophrenia (OR = 0.49) and disproportionately involved delusional disorder (OR = 3.12).
- FTAC disproportionately provided (mental) health-based interventions to disengaged individuals and was unlikely to take no action or police/criminal-justice action alone; both unmet-needs forms were related to a decrease in judged level of concern.
- Disengaged individuals were more likely to approach (OR = 1.80), to both communicate and approach (OR = 1.75), and, among communicators, to approach (OR = 2.10); among approachers, unidentified mental illness was associated with successful security breaches (odds over 27 times higher than no breach and 11 times higher than a failed attempt).
Methods
- Data were 1,914 FTAC referrals from 2012–2016, drawn from an original 2,866 referrals after removing cases with missing key mental-health information, international cases, and missing concerning-behaviour data.
- Two unmet-needs variables were created: unidentified mental illness (no confirmed prior or current mental health service contact but FTAC clinicians judged a disorder/overt illness) and disengaged from mental health services (known to services but recorded as noncompliant).
- Analysis used bivariate chi-squared tests and multivariate logistic regressions for approach and breach behaviours, with control variables drawn from prior fixated-threat literature where available.
Limitations
- The paper states limitations including outdated data, missing data, unavailable interrater reliability, less information on low-concern cases, and selection effects from analysing only non-international referrals with mental-healthcare information.
- It states there is no counterfactual, so it cannot determine what would have happened without FTAC; concern measures are professional judgements rather than objective outcomes and may be biased.
- The paper states the causal link between unmet needs and concerning behaviours is unclear, and the findings are limited to fixated threats and FTAC; the observational design also cannot establish causality.
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Claims the paper makes
0 Valid · 2 Not valid · 32 Not checked · 140 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“5.28% have either a disorder or overt illness identified by FTAC which, before FTAC involvement, had never been identified by professionals as they had never been in contact with mental health services ('Unidentified mental illness').”
§ Unmet needs: analysing the Fixated Threat Assessment Centre's fulfilment of the public health approach, and its value for violence prevention > Does FTAC identify individuals with unmet mental health needs?
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Over a quarter of referrals (where previous mental healthcare information is available) have unmet needs, predominantly psychotic illnesses.”
- Also stated in: § Does FTAC identify individuals with unmet mental health needs? · boosted
“This shows that around half of this study's cohort experience delusions, with the most prevalent disorder overwhelmingly being schizophrenia.”
§ Unmet needs: analysing the Fixated Threat Assessment Centre's fulfilment of the public health approach, and its value for violence prevention > Abstract
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Does FTAC identify individuals with unmet mental health needs? · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Unidentified mental illnesses are disproportionately delusional disorders (OR = 3.12).”
§ Unmet needs: analysing the Fixated Threat Assessment Centre's fulfilment of the public health approach, and its value for violence prevention > Does FTAC identify individuals with unmet mental health needs?
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is a clear mental health need, as 84.06% had previous contact with a mental health service.”
§ Unmet needs: analysing the Fixated Threat Assessment Centre's fulfilment of the public health approach, and its value for violence prevention > Does FTAC identify individuals with unmet mental health needs?
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Altogether, a total of 26.70% of the sample have one of these two forms of unmet needs.”
§ Unmet needs: analysing the Fixated Threat Assessment Centre's fulfilment of the public health approach, and its value for violence prevention > Does FTAC identify individuals with unmet mental health needs?
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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- Consistentχ²(8) = 24.491reported p = .002 · recomputed p = .002
“χ 2 (8, N = 1132) = 24.491,p = .002”
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Citations
Cites
Witt, K., van Dorn, R., & Fazel, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055942 · Cited by 468
Psychosis as a risk factor for violence to others: A meta-analysis.
Douglas, K. S., Guy, L. S., & Hart, S. D. (2009) · Psychological Bulletin · doi:10.1037/a0016311 · Cited by 415
Violence in first-episode psychosis: A systematic review and meta-analysis
Large, M. M., & Nielssen, O. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2010.11.026 · Cited by 278
Fein, R., & Vossekuil, B. (1999) · Journal of Forensic Sciences · doi:10.1520/jfs14457j · Cited by 223
Antipsychotics, mood stabilisers, and risk of violent crime
Fazel, S., Zetterqvist, J., Larsson, H., Långström, N., & Lichtenstein, P. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60379-2 · Cited by 207
Threatening and Otherwise Inappropriate Letters to Members of the United States Congress
Dietz, P. E., Matthews, D., Martell, D. A., Stewart, T., Hrouda, D. R., & Warren, J. I. (1991) · Journal of Forensic Sciences · doi:10.1520/jfs13165j · Cited by 182
Cornell, D. G., Sheras, P. L., Gregory, A., & Fan, X. (2009) · School Psychology Quarterly · doi:10.1037/a0016182 · Cited by 170
Guidelines for Student Threat Assessment: Field-Test Findings
Cornell, D. G., Sheras, P. L., Kaplan, S. G., McConville, D., Douglass, J., Elkon, A., McKnight, L., Branson, C., & Cole, J. C. M. (2004) · School Psychology Review · doi:10.1080/02796015.2004.12086266 · Cited by 125
Harassment, stalking, threats and attacks targeting New Zealand politicians: A mental health issue
Every‐Palmer, S., Barry-Walsh, J., & Pathé, M. T. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415583700 · Cited by 115
Cornell, D. G., Gregory, A., & Fan, X. (2011) · NASSP Bulletin · doi:10.1177/0192636511415255 · Cited by 113
Research works printed but not linked: 7
- Cornell, D., Sheras, P., Kaplan, S., Levy-Elkon, A., McConville, D., McKnight, L., & Posey, J. (2004). Guidelines for responding to student threats of violence: Field test of a threat assessment approach. In M. J. Furlong, P. M. Bates, D. C. Smith, P. M. Kingery, & P. M (Eds.), Appraisal and prediction of school violence: Methods, issues and contents (pp. 11–36). Nova Science Publishers.
- James, D. V., Farnham, F. R., & Wilson, S. P. (2013). The fixated threat assessment centre: Implementing a joint policing and psychiatric approach to risk assessment and management in public figure threat cases. In J. R. Meloy, & J. Hoffman (Eds.), International handbook of threat assessment (1st ed., pp. 299–320). Oxford University Press.
- James, D. V., Meloy, J. R., Mullen, P. E., Pathé, M. T., Farnham, F. R., Preston, L. F., & Darnley, B. J. (2010). Abnormal attentions toward the British royal family: Factors associated with approach and escalation. The Journal of the American Academy of Psychiatry and the Law, 38(3), 329–340. https://repository.tavistockandportman.ac.uk/471/1/Darnley_Abnml_attn.pdf.
- James, D. V., Mullen, P. E., Pathé, M. T., Meloy, J. R., Farnham, F. R., Preston, L., & Darnley, B. (2008). Attacks on the British royal family: The role of psychotic illness. The Journal of the American Academy of Psychiatry and the Law, 36(1), 59–67. https://fixatedthreat.com/perch/resources/attacks-on-the-british-royal-family.pdf.
- McEwan, T. E., & Darjee, R. (2021). The problem behaviour program: Threat assessment and management in a community forensic mental health context. In J. R. Meloy, & J. Hoffman (Eds.), International handbook of threat assessment (2nd ed., pp. 536–553). Oxford University Press.
- McEwan, T. E., MacKenzie, R. D., & McCarthy, J. (2013). The problem behavior program: Threat assessment and management in community forensic mental health. In J. R. Meloy, & J. Hoffman (Eds.), International handbook of threat assessment (1st ed., pp. 360–374). Oxford University Press.
- Wilson, S. P., Pathé, M. T., Farnham, F. R., & James, D. V. (2021). The fixated threat assessment centers: The joint policing and psychiatric approach to risk assessment and management in cases of public figure threat and lone actor grievance-fueled violence. In J. R. Meloy, & J. Hoffmann (Eds.), International handbook of threat assessment (2nd ed., pp. 471–487). Oxford University Press.
Cited by
The aetiology of fixation in lone offenders with overvalued beliefs: A systematic scoping review
Kristinsdottir, K., Underwood, A., Atkinson, J., Jones, H., & Freestone, M. C. (2026) · Aggression and Violent Behavior · doi:10.1016/j.avb.2026.102193
Metadata
- Authors
- Seaward, A., Marchment, Z., Wilson, S., Elfituri, S., Farnham, F., Plumb, T., Rose, K., Taylor, A., Corner, E., & Gill, P.
- Affiliations
- University College London (GB)
- North London NHS Foundation Trust (GB)
- Metropolitan Police Service (GB)
- Australian National University (AU)
- Corresponding author
- Seaward, Amber
- Venue
- Psychology, Crime & Law
- Publisher
- Informa UK Limited
- Published
- 2025-11-03
- Pages
- 1-24
- ISSN
- 1068-316X (ISSN-L)
- 1477-2744
- OpenAlex
- W4415841687
- Cited by
- 1
- References
- 48
- Citations by year
- 2026: 1
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychology Crime and Law (publishedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- European Research Council
- Horizon 2020 (758834)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Sociology and Political Science › Stalking, Cyberstalking, and Harassment
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Keywords
- unmet mental health needs, public health approach, violence prevention, safeguarding, threat assessment, psychosis, risk indicators
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- Seaward, A., Marchment, Z., Wilson, S., Elfituri, S., Farnham, F., Plumb, T., Rose, K., Taylor, A., Corner, E., & Gill, P. (2025). Unmet needs: analysing the Fixated Threat Assessment Centre’s fulfilment of the public health approach, and its value for violence prevention. Psychology, Crime & Law. https://doi.org/10.1080/1068316x.2025.2581795
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