While risk assessment tools for extremist violence have shown initial validation in community settings, little guidance exists for forensic psychiatric settings due to limited empirical evidence on mental health’s role in radicalisation and overlaps between extremist and general individual violence. This research comprises three linked studies to explore factors relevant to radicalisation in forensic mental health patients. This is summarised in a conceptual model to aid the formulation of risk assessments where clinical guidance is currently lacking. The paper aims to develop clinical guidance to aid the understanding of risk assessment findings for forensic psychiatric populations regarding extremist violence.
Firstly, a Delphi study with 19 experts established consensus on factors applicable to forensic mental health settings. Secondly, interviews with five radicalised adult male forensic patients in a UK high-security hospital provided lived experiences. Thirdly, clinical notes on 32 patients with radicalisation indicators, extreme views or organised crime involvement were compared with 42 individually violent offenders.
The first study established most consensus related to environmental and contextual factors linked to radicalisation. In Study 2, discourse analysis revealed key themes in interviews, including membership as survival, natural determination, innocence and support for these ideologies’ importance. Although no significant differences emerged between influences on extremist versus general violence in Study 3, smallest space analysis identified distinct factor compositions for violence types. For extremist violence, three clusters emerged: injustice collector, social offender and dominance seeker. Notably, ideology was absent across cases.
This study introduces a preliminary eco-system of extremist violence model to assist risk management and clinical formulations. It also reintroduces the term “group-based violence” to destigmatise and better reflect risk factor overlaps across violence types linked to group membership.
To the best of the authors’ knowledge, this is the first study to offer clinical guidance for assessing extremist violence risk in forensic psychiatric populations.
