Mental health evaluations key to stopping terrorist attacks

Op-ed: Mental health evaluations could prevent terrorist attacks.

The father of Ahmad Khan Rahami, the suspect of recent bombings in New York and New Jersey, told reporters that in 2014 he was worried about his son and took his concerns to the FBI. They investigated, the father said, and told him his son was fine.

"He's OK," they said. "He's clean, he's not a terrorist.'"

No one ever linked the young man to a mental health professional trained in threat assessment who could better determine whether he was on a dangerous path — one that could result in mass violence — and whether treatment could be offered to get him off that path.

Emotional and family instability often play a role in terrorist attacks, along with misguided ideology. That suggests we can't rely only on traditional law enforcement approaches to prevent them but must also incorporate the skills of mental health professionals. Law enforcement officials widely acknowledge this, yet we still have no national or local programs to make the necessary links regarding ideological terrorism. The closest we come is in some school districts where experts are trained to spot the potential for school violence and prevent it.

Using this model, I helped design and lead a tabletop exercise this summer in partnership with the U.S. Department of Homeland Security's Office for Community Partnerships and the Los Angeles County Department of Mental Health.

At the center of the conference room sat an actor and mental health professionals from the Los Angeles County Department of Mental Health's school violence prevention program. In the audience were local mental health professionals, community-based service providers, local activists, law enforcement and federal officials.

We devised two mock cases of persons possibly on their way to an attack. One character was a college student motivated by white supremacists and another was a disgruntled employee inspired by ISIL, also known as ISIS. In each case, there was an opportunity to change the course of events; words had been spoken in a classroom or a workplace that triggered concern.

We invited the mental health professionals to assess whether they were a threat or not and then to talk with a team of other community-based providers to decide what to do next. The professionals had to do what they do every day with threatened violence in schools. But in this instance, they were faced with new challenges related to ideologically-motivated violence.

The characters were very convincing, and the situations they dramatized were intentionally ambiguous. The mental health professionals did many things well. They listened compassionately and asked probing questions. The teams came to reasonable conclusions about the potential for violence, and they knew when and how to cooperate with law enforcement.

Those who attended the tabletop saw first hand how mental health professionals could play a role in violence prevention. They saw a trained mental health professional conducting an interview in a way that was non-threatening and non-stigmatizing, but effective in understanding the person's intentions and capabilities for violence. The tabletop convinced all present that getting mental health professionals involved after concerns are expressed, by building on the best practices of school violence prevention, may be an effective way to seize opportunities now being missed and to prevent the next terrorist attacks.

We also found there was room for improvement in the mental health professionals' approach. They didn't know enough about ideologically-motivated violence to recognize how committed the actors were to taking violent action. They also had no established relations with service providers to refer these clients back to their home communities. They weren't sure how to best inform or involve community leaders, either, especially those who may have deep suspicions about both mental health professionals and law enforcement.

The tabletop made it clear what kinds of further training and capacity building need to be arranged for successful violence prevention programs with mental health professionals. But to be sure a lot more than a tabletop needs to be done.

With $10 million of new grants from the U.S. Department of Homeland Security soon to be awarded, some communities should be able to bring mental health professionals into their public safety efforts, giving those in need from underserved communities greater access to services. But more resources will be needed given the scale of the problem — and the stakes.

While the attacks Mr. Rahami is accused of committing were not fatal, the next one may be.

Dr. Stevan Weine is a researcher with the University of Maryland's National Consortium for the Study of Terrorism and a professor of psychiatry at the University of Illinois at Chicago. His email is smweine@uic.edu.

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