Leading psychiatrists have urged the government to boost public resources for youth mental health to tackle an association between depression or anxiety and sympathies with violent protest and terrorism. Edgar Jones and Kamaldeep Bhui, professors of psychiatry at King’s College London and the University of Oxford, warned that the underfunding of mental health services has left young people with PTSD, anxiety and depression susceptible to a range of poor outcomes, including radicalisation, which can culminate in violent extremism. Their call for greater focus on psychological and psychiatric services comes after last Saturday’s killing of James Furlong, Joe Ritchie-Bennett and David Wails in a Reading park. The arrested suspect, Khairi Saadallah, 25, had been diagnosed with post-traumatic stress disorder, depression and an emotionally unstable personality disorder. Bhui and Jones’s research into white British, Pakistani and Bangladeshi populations in England identified an association between depression and anxiety and holding extremist attitudes. By contrast, adherence to a religion, mosque attendance and levels of social capital did not show any association with extremism. “We need to stem the flow of potential recruits in the future, and you can only do that by properly understanding people’s lives and beliefs and what can help them flourish in a different way,” said Bhui, who is also editor-in-chief of the British Journal of Psychiatry. “Mental health is absolutely fundamental.” “This is as important as spending money on counter-terrorism services,” said Jones. “In the long term, we need to prevent these things from happening.” Saadallah, a refugee from Libya, was assessed by the government’s counter-terrorism Prevent programme and was found to have no clear ideology, but was deemed to need additional mental health support. Police determined that the attack should be treated as a terrorist incident, but with investigators keeping an open mind as to the motivation. Labour has meanwhile also called for a judge-led review into the official strategy for tackling attacks by lone terrorists, examining probation, the prison system, mental health services, local authorities and housing providers. Drawing links between poor mental health and susceptibility to extremism is contentious, as mental health advocates argue that it risks stigmatising the majority of sufferers who would never become extremists and are more likely to become victims of violence than perpetrators. Jones said: “We don’t say that mental illness causes terrorism. We say that if you suffer from mental illness, it may increase your risk of being radicalised.” Sophie Corlett, head of external relations at the mental health charity Mind, said: “On the rare occasions when someone with a mental health problem has committed an act of violence, there are invariably many reasons behind it … Simplistic links between mental health problems and violence fuels outdated misconceptions that people with mental health problems are to be feared.” The Royal College of Psychiatrists’ position on counter-terrorism and psychiatry is that while “there is no link between mental disorder and group-based terrorism, terrorists who act alone … are statistically more likely to have a background that includes mental illness, in particular psychosis and autism spectrum disorders”. It adds: “Some lone actors, though not all, are adolescents and young adults, who will either have or be at risk of mental health disorders, such as early-onset psychosis, depression or autism spectrum disorders. Others may be loosely described as ‘alienated’ or ‘troubled’. All these young people might benefit from access to existing services, in particular child and adolescent mental health services.” Research in 2019 by Jones, Bhui, and Elizabeth-Rose Ahearn involving Muslim men and women in Bradford and east London found “a significant association between anxiety and terrorism sympathy”. Individuals with anxiety were almost three times more likely to sympathise with terrorism. The links between depression and anxiety and sympathy with terrorism are likely to be “driven by the underlying biological and cognitive causes of these common mental disorders”, they found. By contrast, discrimination, social capital, belonging to the local area and a sense of belonging to Britain all did not present as significant risk factors. Neither was there a link with religion or mosque attendance. “We think that if you suffer from depression, PTSD or anxiety, it increases your risk of wanting bonding capital,” said Jones. “That is, identifying people like yourself because it will give you a sense of protection, social identity and belonging. Of course, the radical groups fall into that category. Instead of feeling you belong to, say, Manchester, you belong to a very defined group who have radical views. Because it gives you a sense of wellbeing, it gives you a short-term antidote to this feeling of depression and worthlessness and being threatened.” He said to boost their effectiveness, mental health services needed to overcome stigma about mental health, which is actively fostered by extremist groups. Islamic State has been explicit in its propaganda describing mental illness as decadence, he said. “I was shown a recruitment video where they accurately reported PTSD rates among American troops and said it was a sign of their weakness,” Jones said. Mind agrees, however, on the need for more resources for early intervention in mental health problems. “We know that mental health services are really struggling at the moment and that before the pandemic, only one in three people who needed mental health services were getting the support,” said Corlett. “While excellent crisis care exists, in some parts of the country there are problems with access to these services, meaning that sometimes people are denied the urgent help they need … We must not allow people to slip through the net.”