A model for managing the mentally ill fixated person at major events.

Objective: The main risk of serious harm at major public figure gatherings comes not from terrorists or criminal activity but from fixated persons, many of whom have a serious mental illness. This paper reviews a collaborative mental health-police diversionary model for assessing and managing mentally ill individuals who attend major events because of their fixation on a dignitary or some idiosyncratic cause.

Method: We examine the role of a multidisciplinary fixated threat assessment service during the pre-operational, operational and post-operational phases of major events in Queensland in 2014, including the G20 World Leaders' Summit. The benefits and challenges of this unique approach are reviewed.

Results: The royal visit and G20 Finance Ministers' Meeting presented opportunities for the Queensland Fixated Threat Assessment Centre to develop and refine its approach to assessing and managing the threat posed by fixated persons at such events. Based on this experience, we also developed a typology to assist in the assessment of mentally ill people who present at public figure gatherings. In the week prior to the G20 Summit, six fixated people required hospitalisation for acute psychosis. A further 18 cases were identified during the event, one of whom was an involuntary patient whose leave from hospital was revoked as a consequence of his concerning behaviour at one of the G20 venues. There were no other admissions to hospital during the event, but in the remaining cases, where indicated, follow-up was arranged through the treating mental health service or general practitioner. There were no disruptive incidents involving fixated individuals during the G20.

Conclusion: This novel diversionary model for assessing and intervening with concerning, fixated persons at major events proved effective in mitigating the risk posed by these individuals. It also highlighted the need for police, security and mental health services to consider the fixated in major event planning, for the safety of the event, the public and vulnerable mentally ill, fixated persons.