Dr Michele Pathé Senior Forensic Psychiatrist Qld Forensic Mental Health Service

Transcription

1 Dr Michele Pathé Senior Forensic Psychiatrist Qld Forensic Mental Health Service

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3 Clinical definition of stalking A constellation of behaviours involving repeated ( 2 intrusions) and persistent (> 2wks) attempts to impose on another person unwanted communications and/or contacts which induce fear Pathé & Mullen, 1997

4 Domestic violence vs. stalking Behaviours akin to stalking can emerge among co-habiting partners The aim of stalking is to make one s presence felt where it would not otherwise exist Such behaviours in an ongoing relationship are not stalking Managing stalkers will be ineffective in situations where stalker & victim continue to co-habitate

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6 Lifetime incidence of stalking 10-15% 15% in Western nations Stalkers mostly male (80-85%) 85%) Victims mostly female (70-80%) Same-gender stalking 20-25% 25% The incidence of stalking is increasing

7 Greater instability in intimate relationships Greater social complexity & social isolation Culture of blame increasing numbers of frustrated claimants & complainants Technological advances (e.g. Internet, scanners, video surveillance, camera phones)

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9 Communication/contact Phone Calls/SMS Letters, notes Cyberstalking Facebook Twitter Intrusive approaches Following Loitering Surveillance Other behaviours Order/cancel goods Threats & assaults Homicide Malicious rumours Spurious legal action Property damage, arson Stalking by proxy Killing/maiming pets Unsolicited gifts

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11 Context Delusional beliefs STALKERS Vulnerable personality

12 Forensicare Problem Behaviour Clinic, n = 211 (McEwan et al, 2009) Diagnosis Prevalence Personality disorder 20% Psychotic disorder 21% Depression 13% Substance use disorder 10% Paraphilia 6% Bipolar disorder 4% Anxiety disorder 3% Asperger s syndrome 2% Suicidal ideation 10% Other 3% No diagnosis 17%

13 10-25% of stalkers report current suicidal thoughts Stalkers are 6 x more likely than psychiatric patients or communitybased offenders to commit suicide McEwan, Mullen & MacKenzie, 2010

14 Clinical classification of stalkers 1. The Rejected Stalker 2. The Resentful Stalker 3. The Intimacy Seeker 4. The Incompetent Suitor 5. The Predatory Stalker Mullen, Pathé & Purcell, 2009

15 1. The Rejected Context: Breakdown of an intimate relationship Relationship: Victim is usually the former sexual intimate Initial motivation: Pursuit of reconciliation or revenge Sustaining motivation: Stalking compensates for lost intimacy Diagnostically: Personality disorders predominate

16 2. The Intimacy Seeker Context: Loneliness, or lack of intimacy Relationship: Victim is a stranger or acquaintance Initial motivation: To establish an intimate relationship Sustaining motivation: Fantasised relationship becomes a substitute for a real relationship Diagnostically: Erotomania

17 EROTOMANIA The delusional belief of being loved despite the supposed lover having done nothing to encourage that belief

18 3. The Resentful Context: Stalker feels they have been exposed to injustice or humiliation Relationship: Victim is someone who has attracted the stalker s s hostility Initial motivation: Desire for revenge Sustaining motivation: Satisfying sense of power and control that comes from harassing the victim Diagnostically: Paranoid disorders predominate A proportion of these are querulous

19 4. The Incompetent Suitor Context: Loneliness or lust Initial motivation: To establish contact leading to friendship or a sexual relationship. Approaches are often crude and insistent Sustaining motivation: Pursue their victim for a relatively brief period Diagnostically: Often intellectually limited or socially disabled individuals

20 5. The Predatory Context: Arises as a result of deviant sexual interests Relationship: Stranger, acquaintance Motivation: Aimed at gathering information and preparing for an attack, usually sexual Diagnostically: Sexual deviations

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22 1. Usually stalk Ex-intimates (Rejected) Professional contacts (Intimacy seekers) 2. Just as likely to threaten and attack as men 3. Higher rates of psychosis than men Purcell et al 2001; Meloy & Boyd 2003

23 What are the risks associated with stalking?

24 Domains of risk in stalking Violence Persistence Recurrence

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26 VIOLENCE: Red Flag risk factors Suicidal thinking Homicidal thinking High risk psychotic phenomena Delusional jealousy Command hallucinations Delusional impostor syndromes Last resort thinking

27 Risk of violence by stalker type Rejected: Violence occurs in ~40%; 70% make threats to harm or kill the victim or third parties Intimacy Seeker: Low risk of violence to primary target Resentful: 75% make threats; few proceed to actual violence Incompetent Suitor: Low risk of violence Predatory: Sexual violence occurs in 50%

28 Risk of stalking persistence HIGH Intimacy Seekers Resentful Rejected LOW Incompetent Suitors Predatory

29 Impacts of stalking

30 Impact on victims: Impairment in psychological, social, occupational & physical functioning Increased levels of anxiety, depression, posttraumatic stress, guilt, suicide Impact on stalkers: Loss of work, financial security, social ties, psychological deterioration, suicide

31 Main predictor of stalking damage? DURATION

32 Stalking Interventions

33 Principles of management - Stalking requires both legal sanctions and mental health interventions - Importance of comprehensive risk assessment The victim is an important consideration in stalker management

34 Opportunities for stalking intervention in Qld MH system Court Liaison Service Prison Mental Health Service Community Forensic Outreach Service (CFOS) District Mental Health Service Private mental health practitioners

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36 The stalker in the MH system Mentally ill stalkers may be referred to the Mental Health Court District MHS encouraged to refer stalkers to CFOS for forensic opinion, risk assessment and intervention advice CFOS have developed specialist stalking interventions Victim referral to QH Victim Support Service (if stalker on a Forensic Order) or private counselling services CFOS has resources for stalking victims

37 Victim management

38 Approach 1. Assess risk in all relevant domains 2. Combat stalking 3. Treat psychological problems 4. Restore social and occupational functioning

39 1. Assess risk in all relevant domains 2. Combat stalking 3. Treat psychological problems 4. Restore social and occupational functioning

40 Personal safety Home and work security Protect personal information Phone number Post office box Electoral roll Social networking websites Vary routine Car safety Emergency plan

41 Informing others Police Family, friends Flatmates Work colleagues Neighbours School or day care provider

42 Avoiding contact and confrontation Convey clear message that contact is unwanted Thereafter do not negotiate Don t return gifts and letters Don t answer calls - change message Don t respond to Don t retaliate

43 Documentation Document all incidents Retain all evidence Keep separate copies Photographic evidence Witness statements Carry court documents

44 Clients who threaten & stalk

45 It s just part of the job Public figures and public officials Healthcare practitioners (especially mental health) Legal practitioners Teaching profession Police

46 Any profession that comes into contact with lonely and disordered people is more vulnerable to being stalked

47 Health professionals Lifetime risk for mental health professionals: 20% No clear correlation with clinician s s experience or duration of client care High rates of distress and disruption, especially if stalking involves false complaints

48 Motivations for stalking professionals 1. Intense infatuation (Intimacy Seekers) 2. Resentment due to some supposed injury/dereliction (Resentful stalkers) 3. Socially inept client seeking friendship/date (Incompetent Suitors) 4. Pursuit of reconciliation or revenge following termination of therapeutic relationship (Rejected stalkers)

49 Prevention Prediction is difficult Remove personal information from the public domain Phone number Electoral roll Post office box Social networking sites

50 Prevention Don t t leave personal information where it can be accessed by clients Don t t disclose personal details to clients Don t t give home contact details to professional organisations

51 Early stages of stalking Recognise the problem! Share concerns with colleagues Set clear boundaries for appropriate behaviour with clients State the relationship is - and will only ever be - a professional one Try to preserve client s dignity

52 Established stalking Inform colleagues and other relevant parties e.g. family Document carefully, keep evidence Avoid all contact and confrontation Consider criminal prosecution

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54 Established stalking Inform colleagues and other relevant parties e.g. family Document carefully, keep evidence Avoid all contact and confrontation Consider criminal prosecution Use AVOs with caution

55 Restraining order? Most likely to succeed with: Incompetent Suitors & Rejected who have less invested in the relationship and a non-violent, non-criminal background Least likely to succeed with: Psychotic Intimacy Seekers The Rejected with strong investment in relationship (especially if shared children), jealousy, psychopathy

56 Threats should never be ignored!

57 Take home points

58 1. Stalking is prevalent 2. There is a high incidence of mental illness among stalkers 3. Certain occupations are at increased risk of being stalked 4. Clients are usually motivated by infatuation or resentment 5. Prediction is difficult, prevention is better 6. Effective early intervention reduces psychological, social & career damage

59 Final tips This is not your fault Look after yourself Stalking is stressful If you are experiencing threats or stalking, seek advice and, if necessary, treatment

60 Further reading Mullen PE, Pathé M, Purcell R. (2009) Stalkers and Their Victims, 2 nd ed. Cambridge University Press Pathé M. (2002) Surviving Stalking. CUP.

61 STALKING TYPOLOGY M. Pathe_QFMHS_ TYPES OF STALKING Stalking is not a unitary construct. It is merely a grouping term for a series of behaviours. Numerous classifications have evolved over the past two decades, mainly constructed from clinical and law enforcement perspectives. The typology of Mullen et al (2009) ^s based upon the stalker's primary motivation for stalking their victim. It has been adopted by the American Psychiatric Association's Group for the Advancement of Psychiatry Committee on Psychiatry and the Law and is now widely used throughout Australasia, the USA and Europe. Intervention in stalking first requires the determination of stalker type. An understanding of the type of stalker helps to inform us about the likely course of the stalking, clinical management and the associated risks. 1. The Rejected Context: The breakdown of a close relationship. Victim: In most cases, the former sexual intimate. Initial motivation: The pursuit of reconciliation or revenge following the victim's perceived rejection of them, or a fluctuating mix of both reconciliation and revenge. Sustaining motivation: The stalking compensates for lost intimacy by creating the semblance of closeness and a parody of an ongoing relationship. 2. The Intimacy Seeker Context: Loneliness, or the lack of love or confidant. Victim: Stranger (public figure or casual contact) or acquaintance (e.g. professional, casual or workplace contact, or a neighbour). Initial motivation: To establish an intimate relationship. Sustaining motivation: The fantasised or delusional relationship becomes a substitute for a real relationship. The gratification comes from the sense of being in love, or believing oneself to have a friend, rather than the victim's actual behaviour. 3. The Incompetent Suitor Context: The stalking emerges in a context of loneliness or lust. Victim: Stranger or acquaintance Initial motivation: The initial motivation is to establish contact which they hope will lead to a friendship or a sexual relationship. The approaches tend to be crude and insistent. The individual is either indifferent or oblivious to the signs of disinterest or distress their approaches evoke. Sustaining motivation: The lack of positive response from the target of their unwanted attentions, or eventual realisation that the approaches are unwanted, usually removes the 1 Mullen PE, Rathe M, Purcell R. (2009) Stalkers and their Victims, 2nd Ed. UK: Cambridge University Press. 1

62 STALKING TYPOLOGY M. Pathe_Q.FMHS_ motivation for more persistent pursuit. Occasionally, however, the insensitivity is such that they continue to be hopeful and engage in the pursuit for a more protracted period. 4. The Resentful Context: Emerges where the stalker feels they have been exposed to injustice or humiliation. Victim: Someone who has antagonised the stalker by their own actions or by being seen as a representative of an oppressing group. Initial motivation: The desire for revenge. Sustaining motivation: The satisfying sense of power and control that comes from harassing the victim. The stalker's sense of satisfaction is made particularly sweet by the novelty of the experience of for once feeling dominant and in control. The resentful stalker almost invariably feels justified in their actions and presents themself as a victim fighting back against more powerful aggressors. 5. The Predatory Context: Deviant sexual interests and unusual practices. Victim: Stranger, usually a female or child, who has stimulated their sexual interest. Just occasionally, a public figure or a contact that has attracted their murderous rage. Initial motivation: To gain information and prepare for an attack, usually sexual. Sustaining motivation: The pleasure obtained from the voyeurism; the rehearsal in fantasy of the coming attack while watching the victim; the sense of power derived from knowing their fate, and being the agent of that fate. 2