5 resources to help clients with homicidal ideation

How to assess homicidal ideation & thoughts

It is not also a simple process to assess whether or not a client has homicidal ideation. Rarely does an individual casually disclose that they think about harming themselves, let alone others for that matter. As mental health professionals, it is important to know how to assess an individual for the potential for harm and determine if they are at risk or might put others at risk. Doing so might just save their lives or keep others out of harm’s way.

For clients that you have determined could have homicidal ideation, you need to know what steps to take to get them back on the right track. This article will discuss how to assess a client for the potential for harm and what to do if you believe they have homicidal ideation.

How to assess homicidal ideation & thoughts

In order to assess a client for their potential to harm or homicidal ideation, you first need to understand just what harm is. It essentially breaks down to whether or not that client is at risk for suicide (purposely ending one’s own life), homicide (purposely ending the life of another person(s)), or any form of violence against themselves or others. The assessment for this homicidal ideation/risk is the process of evaluating the possibility that an individual might be on the track toward either of these possibilities.

There is no singular time that is more appropriate to complete a risk assessment for homicidal ideation. Most therapists complete them at the start of any therapy-client relationship. During intake is a great time to assess a client for risk, but it is often necessary down the line as well. Even if you have been seeing a client for years, there may be a day where an assessment for homicidal ideation is necessary if you believe the client might be at risk for harming themselves or others.

Information that might be gathered during an assessment could include:

Risk factors
Suicidal intent
Plan
Lethality
Access to Means
Time frame
Hope
Previous attempts

Harm assessment questions:

There are several different types of questions you might ask to assess someone’s risk for homicidal ideation (harm assessment). This list is not a complete list of all possible questions you could ask your client, only short examples of what might work.

Identifying stressors associated with harm:

How are things going for you (at home, school, etc.)?
Describe your current relationship with your family, friends, and other important relationships.
What are some things in your life that might be stressful?
Has anything in your life changed recently (and when)?

Identifying thoughts of revenge:

Is there a specific person that has upset you lately?
What is it like for you to feel angry? What do you think about it?
How do you respond when you’re angry?
Describe what you might do when you believe someone has been unfair to you.
If you could respond the way you wanted to, what would that look like?
Have you ever had thoughts of hurting someone?

View on weapons:

Have you seen or used a weapon before?
Describe the time that you used a weapon and why.
When is a weapon useful or when might you use one?
Do you have access to weapons (family members, hunting equipment, etc.)?

Attitude toward violence:

Do you play video games that have violence?
How do those games make you feel?
What is the most violent thing you have ever witnessed?
Have you ever been in a physical fight?
How did that fight make you feel?

Assess for depression:

What has your general mood been, recently?
How are you feeling right now?
Do you ever feel hopeless or helpless?
Have you lost interest in things that bring you joy?
When you think about the future, what do you imagine?

Identify homicidal ideation:

Have you ever had thoughts of hurting someone?
If yes, what did you think about doing it?
Have you ever thought about killing someone?
How often do you think about it?
Do you have a plan?

Levels of risk for harm:

Once you have assessed the risk for homicidal ideation, there are different levels of risk that the client might fall into. If a client is low on the list, then they might not be at high risk for hurting themselves or others. If they are high on the list, then it might be time to connect them to resources.

No thoughts of harming self or others
Fleeting thoughts of harm, but has never made an action plan
Thoughts of harm and history of homicidal ideation and behavior
Thoughts of harm and has thought of an action plan, but not sure if they will carry it out.
Thoughts of harm and detailed action plan for how and where it will happen.

Resources to help clients with homicidal ideation:

If your client falls in the first or second category of homicidal ideation, then continued work with you might be all they need. If they are on level 3 or higher for homicidal ideation, then they might need to be referred to other specialists and organizations that can better help them.

Higher level of care/experts

Therapists that have specialties or experience with homicidal ideation are best equipped to help your client navigate their risk factors toward violence. Referring them to someone with more experience might be the best option for getting them the help they need.

ATAP The Association of Threat Assessment Professionals (ATAP) is an organization that specializes in homicidal ideation. If you do not know any other providers that have experience with this kind of care, this is a great place to start. This is an educational resource for therapists looking to learn more about risk assessments for potential harm.

NABITA The National Association for Behavioral Intervention and Threat Assessment (NABITA) is an organization that helps providers connect and network with one another. Members have access to resources that can help a therapist better understand homicidal ideation and how to effectively help their client.

Homicidal ideation is a rare, but real risk factor that exists in some of the most unexpected of clients. If you believe your client might be experiencing homicidal ideation, then it may be time to connect to some of these resources.