By Sören Henrich
This blog is based on a recent publication which you can find here.
Last October, MI5 Director General Ken McCallum expressed concern about a growing trend among radicalised individuals that was challenging preventive and policing bodies. A considerable number of reviewed cases presented mixed ideologies or lacked a clear ideological conviction. Furthermore, services struggle to understand pathways toward extremist violence that seem linked to mental health issues.
These issues are even more pronounced in secure forensic settings such as prisons or forensic psychiatric hospitals. Individuals in these environments often represent cases of fully developed violent radicalisation and display more complex mental health needs than radicalised individuals in the general population. Although many risk assessment tools exist in these settings, there is limited guidance on how to synthesise their findings effectively. Furthermore, the empirical evidence base is severely lacking—our 2023 systematic literature review identified only five relevant studies worldwide offering insight into secure forensic services, and some of these did not draw on primary data.
This leads to two main concerns, namely how to resolve the overlap of influences in both cases of extremist violence and violence of non-radicalised individuals and the role of mental health issues in the radicalisation process.
Overlapping Risk Factors:
A persistent challenge in the risk assessment of radicalised individuals is the fact that we cannot distinguish radicalised from non-radicalised individuals solely on the risk factors. Overlap includes, for example, a history of violent behaviour or the presence of delinquent peers.
Only a few seem unique, such as ideological conviction. But as outlined before, the number of those not exhibiting a clear ideology grows, leaving us often in the dark. In addition, practitioners seem to overfocus on ideology as a seemingly catch-all explanation. However, our research is part of a growing number of studies questioning the psychological role of ideology. We are not arguing that a clearly describable worldview has no operational value. For example, it indicates potential modus operandi or victim type. However, it does not psychologically explain why an individual moves towards a violent offence, thus, not helping us to identify points of intervention.
In other words, no matter the ideology, the consensus in the current literature is that there is a universal pathway underlying all different forms of extremist violence, independently of the presence of a particular ideological conviction.
Mental Health Issues and Their Role in the Radicalisation Pathway:
Mental health issues are frequently cited as factors that can facilitate radicalisation, particularly in media narratives. However, research presents conflicting evidence, and in forensic psychiatric hospitals, where all patients have mental health issues, such explanations are overly simplistic. This assumption likely arises from early 2000s research, influenced by the shock of 9/11. At that time, studies concentrated on psychopathology, searching for extreme traits behind terrorist acts, but the results were inconclusive. Subsequently, research shifted in the opposite direction, emphasising the offenders’ normalcy, again with inconclusive outcomes. Today, perspectives are more nuanced. Some mental health conditions may increase the risk of extremist violence, while others might reduce it. Clinicians play a vital role in navigating these complexities, especially where research still struggles to provide clear answers.
Synthesising Clinical Practice through Multi-Methodological Research:
Clinicians must indeed make judgements about individuals’ risk for extremist violence based on whatever empirical evidence is available. In forensic services, we typically utilise a combination of structured risk assessment tools that have been thoroughly validated and psychological formulation. The latter refers to the current best practice in forensic psychology, where assessment findings are broken down into behavioural components. These components are then assigned functions related to the risk of violence, drawing on both clinical and empirical knowledge. A common way of structuring existing knowledge for each specific offence is via the 5P model, in which each P stands for a factor category:
- Present problem: Description of the extremist violence.
- Perpetuating factors: Influences maintaining the problematic behaviour
- Precipitating factors: Triggers of extremist violence
- Predisposing factors: Sometimes framed as vulnerability factors in the individual’s earlier biography
- Protective factors: Encapsulates all influences that mitigate the likelihood of extremist violence
At the time of writing, there was no clinical guidance that was based on primary data, meaning based on the first-hand exploration of radicalised individuals. To address this gap, we conducted multiple studies over five years. We first identified relevant factors from existing research and refined them through three rounds of expert surveys, creating a shared catalogue of influences linked to extremist violence in forensic psychiatric settings. We then interviewed radicalised patients in a high-secure forensic hospital—an exceptionally rare opportunity—to check for missing factors and explore how these influences emerged in real assessments. Finally, we compared detailed clinical records of high-risk patients, both radicalised and non-radicalised, to examine overlaps in risk factors.
Surprising Findings Lead to New Guidance:
Our three studies produced extensive findings, detailed in our article. For this blog post, we highlight two key takeaways. First, while radicalised and non-radicalised forensic patients share many risk factors, statistical profiling revealed that the way these factors interact is distinct. The risk factors are the same, but their composition is unique. This supports viewing extremist violence as part of a broader category, namely ‘group-based violence’, linked by intent toward real or perceived groups, aligning it with hate crimes, lone-actor attacks, and some gang violence. Second, we confirmed that mental health diagnoses alone remain inconclusive. However, focusing on specific symptoms, like heightened threat perception or identity inconsistency, provided clearer insights into risk. We recommend assessors look beyond diagnoses to the functional role of symptoms in the radicalisation process.
Both findings support using a formulation approach to understand risk, as it helps assessors make sense of individual influencing factors. We summarised our insights in a new guidance model: the Eco-System of Extremist Violence (ES-EV). At its core is the social ecosystem, which centres on self- and group identity, exploring how their interplay shapes worldviews and can justify extremist violence. Our insights into group-based violence and symptom impact are included but remain preliminary. The ES-EV is a flexible framework, expected to evolve as research and clinical understanding grow. It does not replace validated risk assessments but extends them by helping to summarise and interpret findings. Training in both assessment tools and psychological formulation is essential.
We hope that this unique insight into the most extreme end of the spectrum relating to both violence and mental health complexities offers new perspectives that can aid professionals and policymakers in understanding and ultimately preventing extremist violence better.
Dr Sören Henrich (he/him/his) is a lecturer and published scholar in Forensic Psychology at the Manchester Metropolitan University, UK. He has more than a decade of clinical experience working with extremely violent individuals with complex mental health issues, both in Germany and the UK. Dr Henrich delivers international training on risk and threat assessment and remains a clinical advisor for secure forensic settings in England.
IMAGE CREDIT: PEXELS
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