1. Dr Rajan Darjee Consultant Forensic Psychiatrist Dr Katharine Russell Consultant Forensic Clinical Psychologist

2. Repeated attempts to impose unwanted communications and/or contacts on another in a manner that could be expected to cause distress and/or fear in any reasonable person Repeated attempts to impose unwanted communications and/or contacts on another in a manner that could be expected to cause distress and/or fear in any reasonable person

3. Telephone calls Telephone calls Letters Letters Emails Emails Fax Fax Mobile phone text messages Mobile phone text messages Graffiti Graffiti Social networking websites Social networking websites

4. Loitering near victim or where they live/work Loitering near victim or where they live/work Spying on victim Spying on victim Following the victim Following the victim Accosting the victim, in public or private Accosting the victim, in public or private Entering the victim’s home or workplace Entering the victim’s home or workplace

5. Sending or leaving unsolicited materials/gifts Sending or leaving unsolicited materials/gifts Ordering or cancelling goods and services Ordering or cancelling goods and services Making vexatious complaints Making vexatious complaints Cyberstalking Cyberstalking Threats Threats Property damage Property damage Violence Violence

6. Single incidents recorded and seen in isolation may hide a course of stalking Single incidents recorded and seen in isolation may hide a course of stalking When put together it becomes clear that a campaign of stalking is underway When put together it becomes clear that a campaign of stalking is underway For the arresting officer this may be difficult to ascertain and will rely on good information systems that allow the linkages to be seen For the arresting officer this may be difficult to ascertain and will rely on good information systems that allow the linkages to be seen

7. About 50% of cases a day or two About 50% of cases a day or two If continues beyond 2 weeks, often extends to months or years If continues beyond 2 weeks, often extends to months or years

8. (1) A PERSON (“A”) COMMITS AN OFFENCE, TO BE KNOWN AS THE OFFENCE OF STALKING, WHERE A STALKS ANOTHER PERSON (“B”). (2) FOR THE PURPOSES OF SUBSECTION (1), A STALKS B WHERE— (A) A ENGAGES IN A COURSE OF CONDUCT, (B) SUBSECTION (3) OR (4) APPLIES, AND (C) A'S COURSE OF CONDUCT CAUSES B TO SUFFER FEAR OR ALARM. (3) THIS SUBSECTION APPLIES WHERE A ENGAGES IN THE COURSE OF CONDUCT WITH THE INTENTION OF CAUSING B TO SUFFER FEAR OR ALARM. (4) THIS SUBSECTION APPLIES WHERE A KNOWS, OR OUGHT IN ALL THE CIRCUMSTANCES TO HAVE KNOWN, THAT ENGAGING IN THE COURSE OF CONDUCT WOULD BE LIKELY TO CAUSE B TO SUFFER FEAR OR ALARM. (5) IT IS A DEFENCE FOR A PERSON CHARGED WITH AN OFFENCE UNDER THIS SECTION TO SHOW THAT THE COURSE OF CONDUCT— (A) WAS AUTHORISED BY VIRTUE OF ANY ENACTMENT OR RULE OF LAW, (B) WAS ENGAGED IN FOR THE PURPOSE OF PREVENTING OR DETECTING CRIME, OR (C) WAS, IN THE PARTICULAR CIRCUMSTANCES, REASONABLE.

9. (6) IN THIS SECTION— “CONDUCT” means— (a) following B or any other person, (b) contacting, or attempting to contact, B or any other person by any means, (c) publishing any statement or other material— (i) relating or purporting to relate to B or to any other person, (ii) purporting to originate from B or from any other person, (d) monitoring the use by B or by any other person of the internet, email or any other form of electronic communication, (e) entering any premises, (f) loitering in any place (whether public or private), (g) interfering with any property in the possession of B or of any other person, (h) giving anything to B or to any other person or leaving anything where it may be found by, given to or brought to the attention of B or any other person, (i) watching or spying on B or any other person, (j) acting in any other way that a reasonable person would expect would cause B to suffer fear or alarm, and “COURSE OF CONDUCT” involves conduct on at least two occasions. (7)A PERSON CONVICTED OF THE OFFENCE OF STALKING IS LIABLE— (A)ON CONVICTION ON INDICTMENT, TO IMPRISONMENT FOR A TERM NOT EXCEEDING 5 YEARS, OR TO A FINE, OR TO BOTH, (B)ON SUMMARY CONVICTION, TO IMPRISONMENT FOR A TERM NOT EXCEEDING 12 MONTHS, OR TO A FINE NOT EXCEEDING THE STATUTORY MAXIMUM, OR TO BOTH.

10. 1. Conduct 2. Intent 3. Effect on victim

11. Has existed for centuries Has existed for centuries Constructed as a social problem in modern western societies Constructed as a social problem in modern western societies Label ‘stalking’ used since late 1980s Label ‘stalking’ used since late 1980s First anti-stalking law in California in 1990 First anti-stalking law in California in 1990 Influence of high-profile ‘celebrity stalkers’ and cases where stalkers have killed Influence of high-profile ‘celebrity stalkers’ and cases where stalkers have killed

12. About 1 in 5 females and 1 in 10 males will be stalked at sometime during their lifetime About 1 in 5 females and 1 in 10 males will be stalked at sometime during their lifetime In the UK 5 million people experience stalking in any one year In the UK 5 million people experience stalking in any one year

13. Morris et al (2002) – n=1029 (age ≥16) Morris et al (2002) – n=1029 (age ≥16) ‘Persistent and unwanted attention’ ‘Persistent and unwanted attention’ Lifetime experience - Males – 7% Females – 17% Lifetime experience - Males – 7% Females – 17% In the last year – Males – 2%Females 5% In the last year – Males – 2%Females 5% ‘Stalking’ ‘Stalking’ Lifetime experience – Males – 4%Females – 10% Lifetime experience – Males – 4%Females – 10% In the last year – Males – 1%Females - 3% In the last year – Males – 1%Females - 3%

14. 80-90% of stalkers male, about 80% of victims female 80-90% of stalkers male, about 80% of victims female Prior relationships: Prior relationships: Acquaintances Acquaintances casual, professional, workplace, neighbourhood casual, professional, workplace, neighbourhood Ex-intimates Ex-intimates former sexual partners, family, friends former sexual partners, family, friends Strangers Strangers public figures, private strangers public figures, private strangers

15. Personality disorder45% Personality disorder45% Psychotic illness 21% Psychotic illness 21% Depression 13% Depression 13% Substance use disorder10% Substance use disorder10% Paraphilia6% Paraphilia6% Bipolar disorder4% Bipolar disorder4% Anxiety disorder3% Anxiety disorder3% Asperger’s Syndrome2% Asperger’s Syndrome2% No diagnosis17% No diagnosis17%

16. Clients who stalk clinicians Multiple studies show that mental health professionals are at increased risk of being stalked (Galeazzi & Di Fazio, 2006) Multiple studies show that mental health professionals are at increased risk of being stalked (Galeazzi & Di Fazio, 2006) 10-20% of surveyed professionals report stalking in context of work 10-20% of surveyed professionals report stalking in context of work Average duration of 5-10 months Average duration of 5-10 months Male and female clinicians at equal risk Male and female clinicians at equal risk Male and female clients equally likely to stalk and same gender stalking is common Male and female clients equally likely to stalk and same gender stalking is common

17. Clients who stalk clinicians Two broad reasons: Two broad reasons: Patient who develops resentment towards clinician due to some perceived slight/mistreatment (might be family member) Patient who develops resentment towards clinician due to some perceived slight/mistreatment (might be family member) Patient who develops romantic or child-like attachment to clinician and stalking is about the hope of a relationship/delusional belief about an existing relationship Patient who develops romantic or child-like attachment to clinician and stalking is about the hope of a relationship/delusional belief about an existing relationship

18. PRIMARY PRIMARY The individual who is the stalker’s prime interest and who the behaviour is primarily intended to affect The individual who is the stalker’s prime interest and who the behaviour is primarily intended to affect SECONDARY SECONDARY Someone who is targeted by the stalker due to their connection with the primary victim; often family, friends, new partner, work colleagues or police. Someone who is targeted by the stalker due to their connection with the primary victim; often family, friends, new partner, work colleagues or police.

19. Effect will depend on nature of stalking, relationship with stalker, characteristics of victim, social circumstances of victim, response of services Effect will depend on nature of stalking, relationship with stalker, characteristics of victim, social circumstances of victim, response of services Violence is not necessarily the primary concern. Persistence and recurrence may cause more concern and distress. Violence is not necessarily the primary concern. Persistence and recurrence may cause more concern and distress. Psychosocial damage due to chronic intrusiveness can have a greater impact than an incident of serious violence Psychosocial damage due to chronic intrusiveness can have a greater impact than an incident of serious violence Stalking (without physical violence) causes serious harm to victims (HMA v Johnstone) Stalking (without physical violence) causes serious harm to victims (HMA v Johnstone)

20. Does the victim see it as stalking? Does the victim see it as stalking? If they have been in a relationship or have children are they prepared to identify it as stalking If they have been in a relationship or have children are they prepared to identify it as stalking Victims may only report most serious incidents Victims may only report most serious incidents Victim factors are crucial in assessing and managing risk Victim factors are crucial in assessing and managing risk

21. Rejected Rejected Resentful Resentful Intimacy seekers Intimacy seekers Incompetent suitor Incompetent suitor Predatory Predatory

22. Previous sexual relationship Previous sexual relationship Want to keep the victim in their lives Want to keep the victim in their lives Reconciliation, show their love, scare them back, revenge, you’ll never be free of me, retain the link Reconciliation, show their love, scare them back, revenge, you’ll never be free of me, retain the link

23. Rejected

24. Grudge about perceived wrong Grudge about perceived wrong Wants to get redress/revenge Wants to get redress/revenge Not following a sexual relationship Not following a sexual relationship

25. Stalker infatuated with victim Stalker infatuated with victim Believes victim is infatuated with them too Believes victim is infatuated with them too No previous sexual relationship No previous sexual relationship

26. Want a date Want a date Don’t understand or don’t care about whether victim interested or not Don’t understand or don’t care about whether victim interested or not

27. Thrill (usually sexual) of pursuit and monitoring Thrill (usually sexual) of pursuit and monitoring Prelude to an attack (or making victim feel they’ll be attacked) Prelude to an attack (or making victim feel they’ll be attacked) Targeted stranger or sometimes acquaintance Targeted stranger or sometimes acquaintance

28. FIVE GROUPS LIKE OTHER STALKERS Rejected Rejected Resentful Resentful Intimacy seekers Intimacy seekers Incompetent suitor Incompetent suitor Predatory Predatory THREE ADDITIONAL GROUPS UNIQUE TO PUBLIC FIGURE STALKERS Help seekers Help seekers Attention seekers Attention seekers Chaotic Chaotic

29. Violence (very serious violence) Violence (very serious violence) Persistence Persistence Recurrence Recurrence Psychosocial damage to perpetrator Psychosocial damage to perpetrator Escalation Escalation Disruption Disruption

30. About 50% of stalkers return to stalking within twelve months (Rosenfeld 2003). About 50% of stalkers return to stalking within twelve months (Rosenfeld 2003). Between 30-40% of stalking victims are explicitly threatened with physical harm (Mullen et al 2006) Between 30-40% of stalking victims are explicitly threatened with physical harm (Mullen et al 2006) Between 10-33% of stalking victims are physically assaulted (Mullen et al 2006). Between 10-33% of stalking victims are physically assaulted (Mullen et al 2006). The nature of this physical violence is usually relatively minor, with serious violence (such as homicide, attempted homicide or rape) being relatively infrequent. The nature of this physical violence is usually relatively minor, with serious violence (such as homicide, attempted homicide or rape) being relatively infrequent.

31. Being an intimacy seeker or ex-partner Being an intimacy seeker or ex-partner Stalking in work place situations or where professionals are pursued by ex-patients or clients Stalking in work place situations or where professionals are pursued by ex-patients or clients Having a personality disorder, particularly if combined with a substance misuse problem Having a personality disorder, particularly if combined with a substance misuse problem Sending the victim unsolicited materials Sending the victim unsolicited materials Perpetrator aged over 30 years Perpetrator aged over 30 years Chronic psychosis (especially mono-delusional erotomania) Chronic psychosis (especially mono-delusional erotomania)

32. FACTORS IDENTIFIED IN MORE THAN ONE STUDY: Being an ex-intimate partner of the victim Being an ex-intimate partner of the victim Substance abuse Substance abuse Making threats of physical violence Making threats of physical violence Absence of psychosis Absence of psychosis History of offending, particularly violent or sexual offending History of offending, particularly violent or sexual offending FACTORS IDENTIFIED IN ONE STUDY ONLY: Suicidal ideation Suicidal ideation Having a personality disorder Having a personality disorder Social isolation Social isolation Poor education Poor education Revenge motive Revenge motive Youth Youth Escalation of stalking behaviour Escalation of stalking behaviour

33. EX-INTIMATES EX-INTIMATES 1 in 2 who threaten violence are violent 1 in 2 who threaten violence are violent OTHERS OTHERS 1 in 10 who threaten violence are violent 1 in 10 who threaten violence are violent

34. NATURE OF STALKING  Ex-intimate partner  Appearing at the victim’s home  Threats (verbal or written) to stalking victim  Violence towards stalking victim  Threatening messages left on the victim’s car  Threat to harm children  Shorter duration of stalking OTHER FACTORS  Not having previous convictions or violent convictions  Employed  Major depression  Suicidal or homicidal ideation  Last resort thinking

35. 75% of female victims of homicide are stalked prior to being killed …… but only a very small percentage of stalkers kill their victims

36. Acute conflict Severe disinhibition Capacity for serious violence

37. Specific times or dates may act as triggers for escalation or recurrence of stalking, e.g. Specific times or dates may act as triggers for escalation or recurrence of stalking, e.g. Anniversaries Anniversaries Birthdays Birthdays Victim gets new partner/marries Victim gets new partner/marries Victim has a child with new partner/perpetrator Victim has a child with new partner/perpetrator Perpetrator loses job/suffers loss or bereavement Perpetrator loses job/suffers loss or bereavement Perpetrator sees victim or is reminded of victim (e.g. at court) Perpetrator sees victim or is reminded of victim (e.g. at court) Perpetrator released from custody – has the risk changed? Perpetrator released from custody – has the risk changed?

38. Experience ongoing failure/frustration Experience ongoing failure/frustration Legal ramifications Legal ramifications Loss of family/friends employment Loss of family/friends employment Mental disorder Mental disorder Suicidal ideation Suicidal ideation Suicide (36x rate in general population) Suicide (36x rate in general population)

39. Only a few studies. No long-term prospective studies yet. Only a few studies. No long-term prospective studies yet. But we have to assess and manage these cases as best we can But we have to assess and manage these cases as best we can Base assessment and management on: Base assessment and management on: Emerging research on stalking Emerging research on stalking Wider research and practice relating to risk assessment Wider research and practice relating to risk assessment Clinical/practice experience Clinical/practice experience

40. Screens Screens Stalking Risk Profile Screening Checklist (SRP: SC) Stalking Risk Profile Screening Checklist (SRP: SC) Stalking Assessment Screen (SAS) Stalking Assessment Screen (SAS) Domestic Abuse, Stalking and Honour Based Violence (DASH) Domestic Abuse, Stalking and Honour Based Violence (DASH) Comprehensive assessment tools (structured professional judgment) Comprehensive assessment tools (structured professional judgment) Stalking Assessment and Management (SAM) Stalking Assessment and Management (SAM) Stalking Risk Profile (SRP) Stalking Risk Profile (SRP)

41. Screening checklist for risk of violence/harm Screening checklist for risk of violence/harm Any stalking/harassment case Any stalking/harassment case Two or more incidents and/or victim extremely frightened Two or more incidents and/or victim extremely frightened

43. Gather relevant background information Gather relevant background information Determine presence and relevance of risk factors Determine presence and relevance of risk factors Construct risk formulation Construct risk formulation Set out plausible future risk scenarios Set out plausible future risk scenarios Make risk management plan Make risk management plan Make judgements about prioritisation, imminence, serious harm and review Make judgements about prioritisation, imminence, serious harm and review

44. NATURE OF STALKING N1. Communicates about victim N1. Communicates about victim N2. Communicates with victim N2. Communicates with victim N3. Approaches victim N3. Approaches victim N4. Direct contact with victim N4. Direct contact with victim N5. Intimidates victim N5. Intimidates victim N6. Threatens victim N6. Threatens victim N7. Violent toward victim N7. Violent toward victim N8. Stalking is persistent N8. Stalking is persistent N9. Stalking involves supervision violations N9. Stalking involves supervision violations N10. Stalking is escalating N10. Stalking is escalating Other Considerations Related to the Nature of the Stalking Other Considerations Related to the Nature of the Stalking PERPETRATOR RISK FACTORS P1. Angry P1. Angry P2. Obsessed P2. Obsessed P3. Irrational P3. Irrational P4. Unrepentant P4. Unrepentant P5. Intimate relationship problems P5. Intimate relationship problems P6. Non-intimate relationship problems P7. Distressed P7. Distressed P8. Substance use problems P8. Substance use problems P9. Employment and financial problems P9. Employment and financial problems P10. Criminality P10. Criminality Other Considerations Related to the Perpetrator Other Considerations Related to the Perpetrator VICTIM VULNERABILITY FACTORS V1. Inconsistent behaviour toward perpetrator V1. Inconsistent behaviour toward perpetrator V2. Inconsistent attitude toward perpetrator V2. Inconsistent attitude toward perpetrator V3. Non-intimate relationship problems V3. Non-intimate relationship problems V4. Inadequate access to resources V4. Inadequate access to resources V5. Intimate relationship problems V5. Intimate relationship problems V6. Employment and financial problems V6. Employment and financial problems V7. Distressed V7. Distressed V8. Substance use problems V8. Substance use problems V9. Unsafe living situation V9. Unsafe living situation V10. Concerns related to dependents V10. Concerns related to dependents Other Considerations Related to Victim

45. 1. Gather information 2. Apply motivational typology 3. Rate risk factors for each domain of risk: violence, persistence, recurrence, psychosocial damage to stalker violence, persistence, recurrence, psychosocial damage to stalker 4. Risk judgement (low, medium or high) for each domain of risk 5. Formulation 6. Management recommendations Addendum for Public Figure Victims

46. RISK FACTORS: Red Flag risk factors (5) Red Flag risk factors (5) suicidal ideation suicidal ideation homicidal ideation homicidal ideation last resort thinking last resort thinking high risk psychotic phenomena high risk psychotic phenomena psychopathy psychopathy General risk factors for each risk domain General risk factors for each risk domain Type specific risk factors for each risk domain Type specific risk factors for each risk domain

47. Stalking is different from other types of violence Stalking is different from other types of violence Risks include persistence, recurrence, violence, escalation, disruption, psychosocial damage to victims & psychosocial damage to perpetrators Risks include persistence, recurrence, violence, escalation, disruption, psychosocial damage to victims & psychosocial damage to perpetrators Understanding the motivation/relationship context (using typology) is crucial Understanding the motivation/relationship context (using typology) is crucial Some risk factors overlap with those for other types of violence but some do not Some risk factors overlap with those for other types of violence but some do not There are different risk factors for different types of risks and different types of stalkers (SRP) There are different risk factors for different types of risks and different types of stalkers (SRP) Screens (eg S-DASH) can help identify high risk of harm cases Screens (eg S-DASH) can help identify high risk of harm cases Structured professional judgement approaches (SAM or SRP) should be used for a comprehensive assessment Structured professional judgement approaches (SAM or SRP) should be used for a comprehensive assessment SAM works well for ex-intimate stalkers but may not be as good for other types SAM works well for ex-intimate stalkers but may not be as good for other types SRP is more comprehensive, but more complicated SRP is more comprehensive, but more complicated

48. Motivation Motivation Relationship Relationship Risk of … Risk of … Violence Violence Persistence / Recurrence Persistence / Recurrence Psychosocial damage to stalker Psychosocial damage to stalker Role of mental disorder Role of mental disorder Underlying problems, predisposing and perpetuating factors Underlying problems, predisposing and perpetuating factors Current context Current context Responsivity issues Responsivity issues Strengths and protective factors Strengths and protective factors

49. Predisposing Precipitating / offence analysis PerpetuatingProtective Formulation

50. Predisposing Stable dynamic factors Personality Role of mental disorders Precipitating / offence analysis Motivation Destabilisers/disinhibitors/triggers Victim selection Method of offending Perpetuating Ongoing stable dynamic factors Response to interventions Response to offences Reasons for chronic or escalating offending Protective Intrinsic strengths Extrinsic supports/controls Consider desistance and ‘good lives’ Consider periods of non-offending Formulation

51. “ Speculate” systematically about “possible futures” “ Speculate” systematically about “possible futures” Based on formulation and risk factors Based on formulation and risk factors Types of risk scenarios: Types of risk scenarios: Repeat, escalation (inc. worst case), twist, improvement Repeat, escalation (inc. worst case), twist, improvement What? When? Where? Whom? Why? How? What? When? Where? Whom? Why? How? Plausible? Likely? Imminent? Plausible? Likely? Imminent? Plausible scenarios should inform risk management Plausible scenarios should inform risk management

52.  Monitoring  Supervision/restrictions  Treatment  Victim safety planning  Contingency planning  Communication  Review

53. Arrest and prosecution Arrest and prosecution Conviction for specific stalking offences Conviction for specific stalking offences Community and custodial sentences Community and custodial sentences Interdicts, restraining orders, intervention orders, non-harassment orders Interdicts, restraining orders, intervention orders, non-harassment orders Mental health legislation Mental health legislation

54. Aims to decrease likelihood and impact of further stalking Aims to decrease likelihood and impact of further stalking Don’t have same staff working with perpetrators and victims Don’t have same staff working with perpetrators and victims Security Security  ? Re-location in some extreme situations Open channels of communication to professionals Open channels of communication to professionals What to do if intrusions continue and what the professional response will be What to do if intrusions continue and what the professional response will be Whether and how to respond to further contact Whether and how to respond to further contact  ? Tell stalker behaviour unwanted and should stop Take threats and victim’s fear seriously, particularly if victim is ex-partner Take threats and victim’s fear seriously, particularly if victim is ex-partner Support and treatment Support and treatment Remember potential secondary victims Remember potential secondary victims

55. Are there indicators of imminent risk of serious harm to the victim? If so recommend remand in custody or put in place robust victim safety plan Are there indicators of imminent risk of serious harm to the victim? If so recommend remand in custody or put in place robust victim safety plan Victim support and safety planning Victim support and safety planning Arrest, conviction and/or sentence may not deter the perpetrator. They may even increase risk Arrest, conviction and/or sentence may not deter the perpetrator. They may even increase risk Be particularly vigilant for signs of escalating risk – especially last resort thinking Be particularly vigilant for signs of escalating risk – especially last resort thinking Do not inadvertently perpetuate risk, for example: Do not inadvertently perpetuate risk, for example: Keeping direct or indirect link with victim going Keeping direct or indirect link with victim going Being confrontational or shaming towards perpetrator Being confrontational or shaming towards perpetrator

56. Mentally ill stalkers should be referred to mental health services Mentally ill stalkers should be referred to mental health services Very high likelihood of mental illness in ‘intimacy seekers’ Very high likelihood of mental illness in ‘intimacy seekers’ Some mental health services have specialist expertise in assessing and managing stalking cases Some mental health services have specialist expertise in assessing and managing stalking cases

57. Available in Edinburgh, Lothian and Borders Available in Edinburgh, Lothian and Borders Direct referrals from police or criminal justice social work Direct referrals from police or criminal justice social work Provides psychological and psychiatric input to help agencies manage difficult cases Provides psychological and psychiatric input to help agencies manage difficult cases Stalking, threats, domestic violence, sexual offending, fire raising, other serious violence Stalking, threats, domestic violence, sexual offending, fire raising, other serious violence Provide advice, consultation, assessment, training, link to mental health services Provide advice, consultation, assessment, training, link to mental health services Take stalking referrals at any stage from investigation to management post-sentence Take stalking referrals at any stage from investigation to management post-sentence Use evidence based assessments (SAM & SRP) Use evidence based assessments (SAM & SRP)

58. TO CONTACT US: rajan.darjee@nhs.netkatharine.russell@nhs.net 0131 537 5866