What is a GP’s role when they suspect a patient is at risk of radicalisation to violence?

Doug Hendrie

27/05/2019 2:46:16 PM

GPs can be vital in determining whether patients are a risk to themselves or the community.

Angry patient
Radicalisation has a number of early warning signs.

The Federal Government has provided a new guide for doctors who are worried a patient is being radicalised to the point of committing violence.
The Department of Home Affairs guide suggests the best way to divert people from radicalisation involves ‘early action by concerned families, friends and communities, with further assistance from specialised services where needed’.
Many signs of radicalisation – such as social withdrawal – overlap with mental illness, according to Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC).
However, he said that radicalisation would often present with a different context, such as a patient severing connections with family and friends and increasingly extreme language and behaviours, including statements of superiority or expressions of hatred.
‘Similar to a medical condition, there are people who are at risk. There can be a destabilising or triggering event, and then there are signs and symptoms,’ Associate Professor Morgan told newsGP. ‘Once identified, there is a management process, a referral process and, rarely, an emergency response.
‘People are at risk of radicalisation if they are living with a grievance, exposed to violence, socially marginalised or have unmet health and welfare needs.
‘Radicalisation can be preceded by a triggering event or series of events. Examples might include personal contact or online contact with an extremist group that might provide the missing social connectedness and narrative about a grievance. Other triggers might include significant life events such as losing a job or experiencing discrimination.’
Associate Professor Morgan said GPs should take histories of such a patient, with a view to trying to understand the sequence of events.
‘What are the triggers and motivations? Are there grievances? What ideology or beliefs underpin the observed behaviours? What is the state of self-worth? Any substance use disorder, medical needs, financial or forensic troubles?’ he said.
‘Beyond the individual, explore what current relationships might be part of the radicalisation process, including online activity; identify personal supports who might be tapped to help the process of disengagement from radicalisation.
‘Open and honest communication that is accepting of the person will help maintain a therapeutic alliance. This can be done without condoning unacceptable behaviours.’
Associate Professor Morgan said the goal of managing radicalisation is to enable disengagement from radicalising influences and finding more positive influences, while maintaining the patient’s safety.
‘If the history suggests that a loss of social connectedness was part of the underlying radicalisation, try to identify a family member or close friend to be a role model with whom the patient can connect,’ he said.
‘Reconnecting with employment, education and social activities might help. To manage ideology, a respected leader might provide more mainstream guidance and fulfil the need for meaning.
‘For patients engaging in illegal or unhelpful behaviours, there may be a need to identify offending behaviour programs.’  
For early concerns, GPs can contact their state’s intervention coordinator for advice or a referral. Intervention coordinators can provide tailored support and case management.
If GPs are concerned a patient has already become radicalised to the point of violence, the guide suggests calling the National Security Hotline – 1800 123 400 – which is confidential and can be anonymous.
The Home Affairs guide states that ‘maintaining patient confidentiality must be balanced against the need to disclose information to preserve the safety of the patient and others in the community’.

extremism Home Affairs radicalisation violence

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