Mental health professionals have a lot to contribute to the prevention and countering of violent extremism (P/CVE), by assessing the risks and needs of those most vulnerable to radicalisation or those already radicalised, and by defining the role that mental health problems may have as precursors, modulators or consequences of extremist ideologies and/or extremist violence.
But although the function of mental health professionals – including psychiatrists and psychologists – working in P/CVE is both known and discussed, little has been discussed about the emotional consequences of this work. Most research studies investigating terrorism provide little in the way of evidence-based prevention and intervention strategies to address the psychological needs of radicalised and highly violent individuals, or victims of terrorism. However, this should not stop actions to improve the working conditions of mental health professionals. Supporting these professionals to guard against these consequences is crucial if they are to achieve positive results in their work.
Building resilience in mental health practitioners is therefore essential for different reasons, including: the responsibility that they have, both towards their patients and towards the general public; the problems (personal, social, community) they must face when dealing with extremely violent individuals; the challenges surrounding confidentiality and sharing information externally; the dangers of exposure to radical beliefs; and the psychological harm or emotional issues that mental health experts can develop over time.
All of these issues can have a negative effect upon the mental health, well-being, and work effectiveness of mental health professionals working in P/CVE, as they are often at the forefront of any response to adverse events. Many mental health professionals suffer from burnout, trauma or ethical issues (related to decision making surrounding the well-being of vulnerable and radicalised patients).
In addition to these challenges, personal issues such as feelings of failure (in the face of unfavourable prognoses) or the lack of support (from institutional structures), contributes to an aggravation of the difficulties experienced by mental health professionals. There is much more work that could be done by institutions to provide adequate formal training, care, or support for mental health professionals. Many professionals currently have to develop their own "do-it-yourself" responses to the risks they face. We need to take steps to change this.
Building resilience in mental health professionals therefore can protect them against burnout, anxiety and/or depression.
Firstly, training is essential. The more information and tools mental health professionals have about the subject matter, the better the care they will be able to provide and the better they will be able to deal with a crisis when it arises. Training might focus on radicalisation processes, crisis management, stress management and vicarious trauma.
Secondly, there should be a real focus on supporting the well-being of mental health professionals. Currently there is little in the way of psychological support provided to mental health professionals. Therefore measures to support the well-being of mental health professionals should include increasing awareness of the importance of practitioners’ well-being and promoting the support that is available to them.
Given the stresses and pressures that mental health professionals face, they would find it valuable to be able to count on the psychological support and training from experts in how to face crisis and burnout situations, and how to design and establish coping strategies – such as expert forums and group defusing and debriefing sessions.
Given these two needs, and based upon experiences from the training of, and support to mental health professionals in other highly demanding contexts, we could define a model of care for mental health caregivers.
Design and Implement Training in Psychological First Aid with Extremist Populations
We should learn from the psychological care given to caregivers and health professionals in cases of disasters, crises, emergencies. Providing "psychological first aid training" can limit distress among mental health professionals and prevent them feeling "overwhelmed" or "burned out".
Each professional community has its own ways of coping with stressful events and managing reactions to difficult times. In the last decade, there has been a growing movement in the world to provide mental health support to cope with stressful and traumatic life events. This strategy has gone by several names, but is most commonly known as psychological first aid (PFA). The success of PFA lies in its development as a potential preventive measure of more serious psychological consequences.
If we focus on P/CVE strategies, PFA will essentially provide people with skills they can use to respond to the psychological consequences of terrorism in their own lives, as well as in the lives of their family, friends and neighbours. As a community approach, it can provide well-organised community work to increase skills, knowledge and effectiveness to maximise health and resilience. Therefore, this model could also be used (through training and assistance programmes) to help those mental health professionals who deal with radicalised, highly violent or terrorist populations.
Design and Implement Psycho-educational Support and Interventions
Although some carers are able to cope, many others need psychosocial support. The effects that psycho-educational, supportive, respite-based, psychotherapy, care recipient-centred, and multicomponent interventions have on caregivers are well known.
Psycho-educational interventions designed for mental health professionals who are responsible for the care of highly vulnerable people (from a more clinical point of view) involve a structured programme aimed at providing information about the support process and about resources and services that are available. Intervention formats typically include workshops and conferences, group discussions, and written materials and are always led by a trained leader (mental health professionals with extensive experience working with these vulnerable groups and with detailed knowledge of how to address the problems these groups could generate).
This type of intervention involves a therapeutic relationship between the caregiver and a trained professional, and should follow a cognitive–behavioural approach, where therapists may teach self-monitoring, challenge negative thoughts and assumptions that maintain the caregiver's problematic behaviour; help caregivers develop problem-solving abilities by focusing on emotional reactivity management; and help the caregiver reengage in positive experiences related to their professional role.
If we have learned anything from the various crises experienced in recent years, it is that the ability of P/CVE practitioners to effectively do their work would be improved if we take care of our caregivers. If we increase their levels of resilience, we will be building better coping strategies against the mental health problems that societies, communities and vulnerable actors face.
Dr. Eva María Jiménez González is a co-lead of the RAN Mental Health Working Group.