Challenges in Providing Services

Providing mental health and psychosocial support to persons involved with targeted violence comes with many challenges that are important to acknowledge.

Lack of Evidence-Based Interventions

Mental health specialists are on the most solid ground when they are implementing evidence-based or evidence-informed interventions with persons who are likely to benefit from them. In the space of preventing targeted violence, there are little to no evidence-based interventions, or even agreed upon best practices. In some instances, there may be a relevant evidence-based intervention in a proximate field that can be borrowed. In other cases, it is necessary to rely upon emerging practices or good practices. Unfortunately, there is a tendency in the field to keep applying interventions for which there is no clear evidence of efficacy. Mental health specialists should be thoughtful about what interventions they use, track progress using standard measures, and stay up to date by participating in practitioner networks and continuing education. One practitioner network is the Prevention Practitioners Network organized by the McCain Institute. 

Stress of Working with High-Risk Persons  

Persons involved in violence and extremism can be hard to manage because of the risks they pose to harm others or, on rare occasions, to therapists themselves. Stated simply, these clients are the ones who can keep you up at night. This also means they pose a risk of adversely impacting their clinicians. Additionally, because they bring out anger or fear in others, those negative attitudes can also be transferred to their practitioners, imposing yet additional emotional burdens. For these and other reasons, there is a risk for burnout or vicarious traumatization in the mental health specialist. This calls for careful monitoring and reliance upon best practices for promoting wellness and avoiding burnout and vicarious traumatization. It also calls for practitioners and their agencies to have safety plans in place.

Lack of a Supportive Environment

The work of preventing targeted violence and violent extremism is controversial for some persons and can engender mistrust or negative attitudes. Mental health specialists who get involved in this space may face criticism or rebuke from those opposing this kind of work. They can be named in media stories or social media posts, and their work can become politicized such that governmental support can depend upon who is in power. In extreme cases, mental health specialists may face harassment or threats from associates or supporters of extremist organizations or others. Mental health specialists should not hesitate to contact law enforcement if concerned about their personal safety.

Concerns About Liability

Mental health specialists may be concerned about whether their malpractice insurance covers working with persons involved in violence and extremism, or whether this kind of practice may make them more at risk for lawsuits claiming improper treatment, incompetence, working outside the scope of one’s practice or training, or other general malpractice claims. It is important for mental health specialists to be fully aware of the coverage provided by their malpractice insurance, the licensing laws applicable to their profession and state, and what access they may have to legal consultation if needed. Mental health professionals may want to contact their professional association, malpractice insurance provider, or attorney if they have questions.

Dilemmas regarding information sharing

Many mental health specialists are used to working one on one with clients and keeping all the information protected. In working with persons in the violence prevention space, it is very likely that they will be working collaboratively with a team of persons, including perhaps law enforcement. Mental health specialists need to be familiar with the guidelines and best practices which inform their responsibilities, including information sharing. They should be reminded that HIPPA includes a clause which permits sharing information in the case of imminent risk. In many settings which work with persons involved in violent extremism, organizations have signed MOU which allow for information sharing with law enforcement agencies.  

Conclusions

In the face of all these challenges, mental health specialists working in targeted violence prevention should seek support from peers and supervisors. One place to turn for resources and peer support is the Practitioner’s Prevention Network at Arizona State University’s McCain Institute for International Leadership.