Clinical Services Addressing Violent Extremism: The Quebec Model

Abstract The association of ideologically motivated violence with mental health disorders raises specific challenges for security agencies and clinical services. The aim of this paper is to describe the clientele of a specialized intervention program based in Montreal, Quebec, in terms of type of violent ideology and clinical presentation. We conducted a retrospective chart review of 156 individuals referred for violent extremism who received clinical services between 2016 and 2021. Univariate statistics were used to present a description of client sociodemographic and clinical characteristics. Roughly a third of clients referred for violent extremism presented non-ideologically based violence (32.6%), followed by 31.4% affiliated with far-right extremist ideology and over a quarter (25.6%) holding extremist views on gender. Over a third of these individuals had a stress-related (35.7%) and/or mood and anxiety disorder (36.9%), followed by 28% with an autism spectrum disorder diagnosis. The majority had some previous contact with mental health services. A significant number of clients displaying extremist discourses and/or actions needed psychiatric services but often failed to receive them because of the reluctance of clinicians to work with individuals perceived as high risk; in addition, individuals may be reluctant to engage in services perceived to be part of a socio-political system they reject. Specialized services are important as a means to provide mental health care to this group and also to develop knowledge and best practices for working with this clientele and provide consultation to mainstream mental health service providers.