Research in western nations has found that pathologically fixated individuals pose a risk of serious harm to public figures, and that many of these fixated persons are mentally ill and require treatment. Over the past decade, integrated fixated threat assessment agencies have been established in western Europe and Australia to specifically assess and manage this group. The current study examines 400 consecutive referrals to a fixated threat assessment center in Queensland, Australia, with a particular focus on the mental health and risk profile of those who engage in inappropriate contact with public office holders. It considers the high proportion of delusional disorders in this cohort, and their identification and management by psychiatric services. The authors conclude with a discussion of the mental health response to this group and impediments to mitigating the risks posed by fixated persons. Copyright © 2016 John Wiley & Sons, Ltd.