21/01/2013 09:28 GMT | Updated 23/03/2013 05:12 GMT

Do Armed Guards Prevent You From Being Shot?

Greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention and encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives.

"Are the President's kids more important than yours?" begins the current National Rifle Association (NRA) television advert. It suggests Mr. Obama has different standards for the safety of his own children than he does for other people's. While his kids are protected at school by armed security personnel, Obama has come out firmly against the NRA's suggestion that all schools should have armed guards to protect them against malevolent shooters.

While it's obvious that the president's children are more at risk than yours or mine, do armed guards necessarily protect you from being shot?

First, there's the risk of being assassinated by your own security guards, which was the fate of Indira Ghandi and, in 2011, of the powerful half-brother of Afghan President Karzai. The presence of armed bodyguards did not prevent the shooting of the Kennedys, Ronald Reagan nor the attempted shooting of Gerald Ford. In Europe it didn't prevent the shooting of Wolfgang Schäuble, who now performs his role as German finance minister from a wheelchair.

All these attacks took place in the presence of close protection officers.

On 4 November 1995, Itzhak Rabin, prime minister of Israel, similarly protected, was shot twice in the back at close range, dying minutes later. The inquiry into the assassination, commissioned a confidential report examining all available sources on 213 successful or attempted assassinations of dignitaries of different nationalities between 1835 and 1999.

Some 38% of attacks were perpetrated by those whose presence and proximity to the VIP was justified by the role they play, or the service they provided, including members of the VIP's entourage, security staff, catering and service staff, members of the media.

All non-terrorist attacks on elected politicians in Western Europe between 1990 and 2004 were recently analysed in a study published in the academic journal Acta Psychiatrica Scandinavica. Of twenty-four attacks identified, including five fatalities, and eight serious injuries, ten attackers were psychotic and four were drunk. Eleven attackers evidenced warning behaviours. Entitled 'The role of mental disorder in attacks on European politicians 1990-2004' the investigation found the mentally disordered, most of whom gave warnings, were responsible for most fatal and seriously injurious attacks.

Warnings from the mentally disordered often went on for years and included posters, newspaper advertisements, attempted law suits against the government, chaotic deluded threatening letters to politicians and police, leafleting the public, telling others of their intention to attack, and even attempted setting fire to themselves in front of the victim's place of work.

Greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention and encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives. This should be the emphasis, rather than just more firepower to protect targets such as politicians or schools.

The psychotic are not going to be put off by the possibility of armed resistance, such as guards at schools, which is one argument of the gun lobby. The deluded and hallucinated are immune to the rational development of such fear, and have usually already decided to die as part of the whole exercise - going out in a blaze of 'glory.'

The importance of mental illness in such attacks has been increasingly recognised in recent years leading to the setting up of the UK Fixated Threat Assessment Centre, a joint police and psychiatric unit to assess and manage the threat from mentally ill loners. The same approach has been adopted in the USA, and the Capitol Police who have responsibility for the safety of Members of Congress has a threat assessment unit incorporating forensic psychologists.

Just this past week-end 25-year-old Oktai Enimehmedov, climbed onstage and held a gun to the head of the leader of Bulgaria's Movement for Rights and Freedoms party, Ahmed Dogan, but the gun apparently stuck and didn't shoot. It has been reported that the assailant has prior convictions, including causing bodily harm and drug possession, and that he expected to die in the attack.

Park Dietz and Daniel Martell, Psychiatrists at the David Geffen School of Medicine, UCLA, and world authorities on stalking and threat, in a paper entitled 'Approaching and Stalking Public Figures - A Prerequisite to Attack' commented: "Every instance of an attack on a public figure by a lone stranger in the United States for which adequate information has been made publicly available has been the work of a mentally disordered person who issued one or more pre-attack signals in the form of inappropriate letters, visits or statements."

It has just been reported that a 15-year-old has shot dead five in New Mexico, the latest shooting incident in the US since the Sandy Hook massacre, which sparked the current gun control debate. Many school shooters have also proved to be suffering from untreated mental illness so prevention programmes for school (and university) shootings are now being adopted across the USA, with staff trained to look for signs of potential trouble and psychology-led teams available to assess risk in worrying cases.

However, just last week it emerged that the widow of a victim of the Colorado cinema massacre is suing the alleged gunman's psychiatrist, claiming the doctor could have had him detained for "fantasising about killing a lot of people."

Chantel Blunk's husband Jonathan was among the 12 people who died when James Holmes opened fire in the Aurora movie theatre on July 20 last year. She alleges that Dr Lynne Fenton was negligent in her advice to campus police after Holmes confided to her about the fantasy the month before the shooting.

In 1969 the psychologist treating a student named Poddar who had developed schizophrenia, failed to inform his potential victim of his plan to kill her, which he subsequently did. The resultant Californian landmark court case established the principle that the confidential character of patient-psychotherapist communications must yield when disclosure is essential to avert danger to others.

That principle is now central to psychiatric practice, but errors still allegedly occur. Holmes' psychiatrist appears to have recognised the importance of his fantasies about killing a lot of people - to the extent of apparently informing the campus police. However, media reports suggest she seems to have advised police not to have him hospitalised - which might have averted the massacre - and so failed to protect the public.

Whatever the eventual outcome of the legal action by the victim's widow, it cannot but reinforce the need for better training of personnel in clinics, schools and universities, about the recognition and response to students showing danger signs - and, if the information in this case proves to be correct, the training of police on when to act on their own initiative. We don't know how many lives have been saved when someone has been correctly diagnosed and treated.

No-one appears to have suggested that the way to have prevented the Aurora massacre would have been to put armed guards in cinemas, particularly when many in the audience thought the shooting was some part of the film action.

But the contention that Mr. Holmes' hospitalisation and improved prior assessment, plus better and more available treatment facilities, might have prevented the fatal outcomes, appears plausible.