Basic Homicide Risk Assessment

Introduction to Homicide Risk Assessment

All mental health professionals in the US and Canada have an ethical duty to warn, the requirement to warn someone who is at risk of harm of that harm. This leads clinicians to conduct homicide risk assessments to determine the level of danger to others.

In therapy or crisis intervention, the clinician is required to breach a client’s confidentiality in order to make notifications for both homicide risk and suicide. The homicide notification was codified in Tarasoff v. Regents of the University of California (1976), a famous case where a psychologist was held liable after failure to take adequate steps to protect a woman that a client had confessed the desire to kill, when he did.

Borum & Reddy (2001) enumerated a variety of steps to performing a homicide risk assessment in a Tarasoff-style risk assessment, which is differentiated from a more long-term risk assessment by a focus on on clinical judgement than on an examination of actuarial risk factors. The ACTION steps below are used to perform the assessment.

To start, it’s important to clarify the difference between making a threat, and posing a threat. Someone who says they wish to hurt someone may not pose intent or take action that demonstrates an actual risk. Preparatory behaviours help guide the risk assessment, and include selecting a target, choosing the method, time and place of violence, acquiring means, and so on.

The goals of the Tarasoff homicide risk assessment will be:

1. Is the client headed towards a violent act?
2. How fast is the client moving towards that act, and do opportunities exist for intervention?

ACTION Steps for Tarasoff Homicide Risk Assessment

Attitudes in support of violence

Is the client demonstrating any antisocial attitudes or beliefs? If the client is at risk of harming their partner, do they hold misogynistic or patriarchal beliefs? The goal here is to determine whether the client believes that violence is a justified or normal response to this situation. The more justified the client believes he or she is, the higher the risk of violence.

Borum & Reddy also identify other factors to explore under attitudes:

• Hostile attribution bias
• Violent fantasies
• Expectations about success of violence
• Whether the client feels it will accomplish their goal

Capacity to carry out threat

Does the client have access to the means, and the intellectual capacity to carry out a criminal, violent act? They also need access to the target and opportunity. Stalking often precedes violent acts (Meloy, 2002) and this can lead to an individual learning about the target’s schedule and whereabouts.

Thresholds crossed in progression of behaviour

Any presence of lawbreaking indicates a “willingness and ability to engage in antisocial behavior to accomplish one’s objective.” Additionally, any kind of plan and preparatory behaviours to achieve this plan should be explored.

Intent to act vs. threats alone

It’s important to clarify the difference between an actual intent to act versus simple threats. On the distress line, we clarify with callers who make violent comments whether they actually intend to harm the person they’re speaking about, or whether their comments are a result of frustration.

Questioning the client helps suss out their intent, in addition to any preparatory behaviours, alternative plans to accomplish their aim (that may or may not involve violence.) A client who believes there is no other way to meet their goals are more likely to turn to violence.

Other’s knowledge of the client

Knowing how others respond to the client’s planned actions will help assess their potential for action. If many people around them respond negatively to their plan they may be less likely to follow through. On the opposite side, if their supports provide little resistance this can increase risk. The client’s self-report can also help inform their attitudes.

Non-compliance with strategies to reduce risk

Is the client willing and interested in reducing their chance of committing a violent act? If they have previously breached legal requirements like parole or court orders, or demonstrate a willingness to do so in the future, this raises their risk.

Appreciating the gravity of their mental health status and desire for treatment may also be important.

Further Reading

See the original article by Borum & Reddy for a more detailed review of the risk factors and additional items, or a book like Clinician’s Guide to Violence Risk Assessment by Mills, Kroner & Morgan.

Bibliography

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Meloy, J. (2002). “Stalking and violence.” In J. Boon and L. Sheridan (eds.) Stalking and psychosexual obsession: Psychological perspectives for prevention, polcing, and treatment. West Sussex, UK: John Wiley & Sons, Ltd

Tarasoff v. Regents of the University of California, 131 Cal. Rptr. 14 (Cal. 1976)