65 claims on pp. 14–95 (fact 35, statement 6, evidence 16, conjecture 4, definition 4).
An additional two attacks using bladed weapons targeted staff and patients at mental health facilities.
An additional two attacks using bladed weapons targeted staff and patients at mental health facilities
A 39-year-old man stabbed a counselor and other employees at a mental health center after the center had determined that morning he was not appropriate for its treatment program. He was subdued by a client until police arrived.
A 39-year-old man entered a mental health treatment center.
Earlier that morning the center had determined the attacker was not appropriate for its treatment program because of his long history of violence and the severity of his mental health needs.
Earlier that morning, the center had determined that the attacker was not appropriate for their treatment program due to his long history of violence and the severity of his mental health needs.
One bladed-weapon attack at a mental health facility was perpetrated by a patient released one month earlier; another by an individual denied entry into a treatment program hours earlier.
including one attack perpetrated by a patient who had been released one month earlier and another who had been denied entry into a treatment program hours earlier
A 22-year-old U.S. military service member facing health, family, peer, and performance stressors, and seeking mental health care for sleep, coping, and belonging problems, fatally shot two civilian workers and injured a third on base before dying by suicide.
A 22-year-old service member in the U.S. military, armed with his service rifle and handgun, fatally shot two civilian workers and injured a third on base
At multiple points the service member sought medical attention for mental health problems, including difficulty sleeping and concentrating, coping with stress, and feelings of alienation and not belonging among peers.
At multiple points in time, the attacker sought medical attention for mental health problems, including visits for difficulty sleeping and concentrating, issues coping with stress, and feelings of alienation and lacking a sense of belonging among his peers.
The lone employee attacker without a grievance appeared to be motivated solely by psychotic symptoms.
appeared to be motivated solely by psychotic symptoms
Psychotic symptoms were a motive for 5 employee attackers (23%).
Sample (n = 5 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
Psychotic Symptoms | 5 | 23%
The attacker with the most motivations appeared to be motivated by psychotic symptoms, a workplace grievance, a desire to kill, and a desire for fame or notoriety.
appeared to be motivated by psychotic symptoms, a workplace grievance, a desire to kill, and a desire for fame or notoriety
The attacker held delusional beliefs that after death he would become a cartoon female ghost and join violent cartoon characters in an afterlife.
The attacker harbored delusional beliefs that when he died after his attack, he would become a cartoon female ghost character and join other violent cartoon characters in an afterlife.
A gunman previously treated for PTSD at a residential treatment center took five hostages, released two, and fatally shot the remaining three employees after an eight-hour standoff. One victim had expelled him from the program two weeks earlier because he had knives and threatened to kill staff.
locked himself in a room with the remaining three victims for eight hours
Over half of all workplace attackers (n = 30, 59%) were found to have experienced mental health symptoms prior to their attack.
Sample (n = 30 of 51) · attackers, all affiliation types
Over half of all workplace attackers (n = 30, 59%) were found to have experienced mental health symptoms prior to their attack
Psychosis was found in 15 attackers, evidenced by delusions and hallucinations.
Sample (n = 15 of 51) · attackers, all affiliation types
including psychosis (n = 15)
Delusions are false, idiosyncratic beliefs that are maintained despite evidence to the contrary.
which are false, idiosyncratic beliefs that are firmly maintained despite evidence to the contrary
Hallucinations are sensory perceptions that seem real but occur without any external stimulation.
sensory perceptions that seem real but occur without any external stimulation
Hallucinations were experienced by five attackers (n = 5).
Sample (n = 5 of 51) · attackers, all affiliation types
hallucinations (n = 5)
Paranoid delusions were the most common type of delusional belief experienced by attackers.
Paranoid delusions were the most common type of delusional beliefs experienced by attackers
Auditory hallucinations, such as hearing voices, were the most common form of hallucination.
auditory hallucinations (e.g., hearing voices) were the most common form of hallucinations
Other symptoms included depression (n = 15).
Sample (n = 15 of 51) · attackers, all affiliation types
depression (n = 15)
Other symptoms included paranoia (n = 11).
Sample (n = 11 of 51) · attackers, all affiliation types
paranoia (n = 11)
Nearly two-fifths of attackers (n = 20, 39%) received a prior diagnosis or treatment for a mental health issue before the attack.
Sample (n = 20 of 51) · attackers, all affiliation types
Nearly two-fifths of attackers (n = 20, 39%) received a prior diagnosis or treatment for a mental health issue before the attack.
A warehouse employee used a forklift to block an exit before shooting coworkers with a revolver. On a call to police he described hearing voices since his teens, past treatment for psychosis, and a belief that a manager was attacking his mind.
used a forklift to block an exit before shooting coworkers with a revolver
The attacker claimed a manager was a powerful psychic attacking his mind and cited this as a contributing factor to his motive.
which he cited as a contributing factor to his motive
Attackers who targeted a current or former workplace had a higher proportion of mental health struggles (n = 14, 64%) than other attackers.
Sample (n = 14 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
attackers who targeted a current or former place of employment experienced a higher proportion (n = 14, 64%) of mental health struggles than other attackers
Employee attackers experienced the most paranoia (n = 9, 41%) compared to other attacker categories.
Sample (n = 9 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
Employee attackers experienced the most paranoia (n = 9, 41%) and psychosis (n = 9, 41%)
Employee attackers also had psychosis (n = 9, 41%), compared to other attacker categories.
Sample (n = 9 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
and psychosis (n = 9, 41%)
Employee attackers had delusional beliefs (n = 5, 23%).
Sample (n = 5 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
including delusional beliefs (n = 5, 23%)
Employee attackers had hallucinations (n = 4, 18%).
Sample (n = 4 of 22) · current or former employee attackers (22 attacks, each by a lone attacker)
hallucinations (n = 4, 18%)
Attackers who targeted romantic partners or family members had higher rates of depression (n = 4, 44%) than others.
Sample (n = 4 of 9) · attacks by current or former romantic partners or relatives (9 attacks, each by a lone attacker)
this group had higher rates of depression (n = 4, 44%) and suicidal ideation (n = 3, 33%) than others
The same group had higher rates of suicidal ideation (n = 3, 33%) than others.
Sample (n = 3 of 9) · attacks by current or former romantic partners or relatives (9 attacks, each by a lone attacker)
and suicidal ideation (n = 3, 33%) than others
Evidence of suicidal ideation existed for only three employee attackers.
Although there was evidence of suicidal ideation for only three employee attackers
Figure 3 charts any mental health symptom, paranoia, psychosis, depression, and suicidal ideation for current or former employees, customers and visitors, and romantic partners or relatives.
FIGURE 3 Mental Health Symptoms
On the call, the attacker said he had heard voices since he was a teenager and had been treated for psychosis and schizophrenia.
On this call, the attacker told dispatchers that he had been hearing voices in his head since he was a teenager and that he had been previously treated for psychosis and schizophrenia.
Figure 3 shows any mental health symptom in 64% of current or former employee attackers, 55% of customer, client, patient, and visitor attackers, and 56% of romantic partner and relative attackers.
Sample (N = 22 | 20 | 9 by column) · Figure 3 columns: employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
| Any | 64% | 55% | 56% |
Figure 3 shows paranoia in 41% of current or former employee attackers, 5% of customer, client, patient, and visitor attackers, and 11% of romantic partner and relative attackers.
Sample (N = 22 | 20 | 9 by column) · Figure 3 columns: employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
| Paranoia | 41% | 5% | 11% |
Figure 3 shows psychosis in 41% of current or former employee attackers, 20% of customer, client, patient, and visitor attackers, and 22% of romantic partner and relative attackers.
Sample (N = 22 | 20 | 9 by column) · Figure 3 columns: employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
| Psychosis | 41% | 20% | 22% |
Figure 3 shows depression in 32% of current or former employee attackers, 20% of customer, client, patient, and visitor attackers, and 44% of romantic partner and relative attackers.
Sample (N = 22 | 20 | 9 by column) · Figure 3 columns: employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
| Depression | 32% | 20% | 44% |
Figure 3 shows suicidal ideation in 14% of current or former employee attackers, 15% of customer, client, patient, and visitor attackers, and 33% of romantic partner and relative attackers.
Sample (N = 22 | 20 | 9 by column) · Figure 3 columns: employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
| Suicidal Ideation | 14% | 15% | 33% |
Six of the 51 workplace attackers experienced delusions (n = 6), evidencing psychosis.
Sample (n = 6 of 51) · attackers, all affiliation types
delusions (n = 6)
Nine of the 51 workplace attackers experienced suicidal ideations (n = 9).
Sample (n = 9 of 51) · attackers, all affiliation types
suicidal ideations (n = 9)
Other training, such as mental health, de-escalation, mediation, trauma-informed care, and tabletop exercises, can be valuable to team members.
Other training can be valuable to BTAM team members, including training on mental health
Suicidal ideations are among the behaviors that may be concerning.
Concerning behaviors may include escalating interpersonal disputes, grievances, concerning social media content, stalking and harassment, obsessions with violence, idolizing past attackers, fixating on people or locations, suicidal ideations, self-harm, unusual levels of aggression, threats, weapons violations, and physical assaults.
cite page 50 Step 4: Identify and Process Reports of Concerning Behavior
Self-harm is among the behaviors that may be concerning.
Concerning behaviors may include escalating interpersonal disputes, grievances, concerning social media content, stalking and harassment, obsessions with violence, idolizing past attackers, fixating on people or locations, suicidal ideations, self-harm, unusual levels of aggression, threats, weapons violations, and physical assaults.
cite page 50 Step 4: Identify and Process Reports of Concerning Behavior
Figure 8 lists, under Contextually Concerning, challenges with mental health, such as depressed mood, paranoia, or anxiety.
Challenges with mental health, such as depressed mood, paranoia, or anxiety
cite page 51 Step 4: Identify and Process Reports of Concerning Behavior
Figure 8 lists, under Objectively Concerning, expressions of homicidal or suicidal thoughts.
Expressions of homicidal or suicidal thoughts
cite page 51 Step 4: Identify and Process Reports of Concerning Behavior
The therapist calls trauma-informed care the most successful strategy for managing IPV, using a nonjudgmental, recovery-oriented stance.
The most successful strategy is trauma-informed care
cite page 53 Step 4: Identify and Process Reports of Concerning Behavior
A BTAM team leader at a global corporation says common cases include suicidal ideation, individual crises, difficulty managing work, and domestic violence.
A lot of what we tend to see are cases involving suicidal ideation, someone going through an individualized crisis
cite page 54 Step 4: Identify and Process Reports of Concerning Behavior
The scenario's behaviors may illustrate individual or environmental factors that, if unaddressed, could raise the possibility of harm to self or others.
may illustrate individual or environmental factors that, if unaddressed, could contribute to an increased possibility of harm to self or others
Why inferred Hedged with 'may illustrate' and 'could contribute', so typed as conjecture.
cite page 54 Step 4: Identify and Process Reports of Concerning Behavior
Community mental health partners can be valuable assets at nearly any stage of a behavioral threat assessment.
Community mental health partners can be valuable assets at nearly any stage of a behavioral threat assessment
Social media content can also contain indicators that an individual is in crisis (e.g., expressions of hopelessness, desperation, pleas for help), which could warrant further assessment.
Social media content can also contain indicators that an individual is in crisis
Mental health history covers current or previous symptoms that negatively impact the individual, particularly when untreated, such as paranoia, delusions, depression, and suicidality.
Current or previous history of mental health symptoms that negatively impact the individual, particularly when left untreated
Mental health history may or may not include prior formal diagnoses, hospitalizations, and treatment (e.g., prescription medication).
Mental health history may or may not include prior formal diagnoses, hospitalizations, and treatment (e.g., prescription medication).
After his assault, the attacker was known to be paranoid, believing others were searching for him or out to get him.
In the aftermath of his assault, he was known to be paranoid, believing others were searching for him or out to get him.
He was known to act in a paranoid, hostile, and argumentative manner and harassed his coworkers.
He was known to act in a paranoid, hostile, and argumentative manner and harassed his coworkers.
A trauma-informed care approach helps staff recognize and respond to signs of trauma in patients.
Using a trauma-informed care approach to help staff recognize and respond to signs of trauma in patients.
These resources can be effective tools to enhance employees' coping skills, mental wellness, and sense of connection to work and colleagues.
These resources can be effective tools to enhance employees' coping skills, mental wellness, and sense of connection to their work, their colleagues, and their organization.
Why inferred Hedged with 'can be effective'; classified as conjecture.
cite page 88 Step 7: Promote a Safe and Supportive Organizational Climate
Data Table 1 reports psychotic symptoms as a motive in 12% of all attacks (n = 50), 23% of attacks by current or former employees (n = 22), 0% by customers, clients, patients, and visitors (n = 19), and 11% by romantic partners and relatives (n = 9).
Sample (N = 50 | 22 | 19 | 9 by column) · Data Table 1 columns: all attacks 50 | employees 22 | customers, clients, patients, visitors 19 | partners and relatives 9
Psychotic Symptoms | 12% | 23% | 0% | 11%
Data Table 2 reports mental health symptoms for 59% of all attackers (n = 51), 64% of current or former employees (n = 22), 55% of customers, clients, patients, and visitors (n = 20), and 56% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
**Mental Health Symptoms** | 59% | 64% | 55% | 56%
Data Table 2 reports a known mental health treatment/diagnosis for 39% of all attackers (n = 51), 36% of current or former employees (n = 22), 45% of customers, clients, patients, and visitors (n = 20), and 33% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Known Treatment/Diagnosis | 39% | 36% | 45% | 33%
Data Table 2 reports psychosis for 29% of all attackers (n = 51), 41% of current or former employees (n = 22), 20% of customers, clients, patients, and visitors (n = 20), and 22% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Psychosis | 29% | 41% | 20% | 22%
Data Table 2 reports paranoia (a sub-row of psychosis) for 22% of all attackers (n = 51), 41% of current or former employees (n = 22), 5% of customers, clients, patients, and visitors (n = 20), and 11% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Paranoia | 22% | 41% | 5% | 11%
Data Table 2 reports delusions (a sub-row of psychosis) for 12% of all attackers (n = 51), 23% of current or former employees (n = 22), 0% of customers, clients, patients, and visitors (n = 20), and 11% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Delusions | 12% | 23% | 0% | 11%
Data Table 2 reports hallucinations (a sub-row of psychosis) for 10% of all attackers (n = 51), 18% of current or former employees (n = 22), 0% of customers, clients, patients, and visitors (n = 20), and 11% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Hallucinations | 10% | 18% | 0% | 11%
Data Table 2 reports depression for 29% of all attackers (n = 51), 32% of current or former employees (n = 22), 20% of customers, clients, patients, and visitors (n = 20), and 44% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Depression | 29% | 32% | 20% | 44%
Data Table 2 reports suicidal ideations/attempts for 18% of all attackers (n = 51), 14% of current or former employees (n = 22), 15% of customers, clients, patients, and visitors (n = 20), and 33% of romantic partners and relatives (n = 9).
Sample (N = 51 | 22 | 20 | 9 by column) · Data Table 2 columns: all attackers 51 | employees 22 | customers, clients, patients, visitors 20 | partners and relatives 9
Suicidal Ideations/Attempts | 18% | 14% | 15% | 33%
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