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Wellspring Risk Assessment for Homicidality (2019)

Risk Assessment and Protocol for Duty to Warn under Volk

1.      Any case that presents with reckless or dangerous behavior that may involve danger to self or others should be brought for consultation.  Even if no specific threat is made to another person, consult as soon as possible with a knowledgeable colleague.

2.      There must be a “serious and imminent threat to harm” to trigger a duty to warn.  In other words, a client would need to say “I’m going out right now and shoot at people” in order to call the police or a Designated Mental Health Professional (DMHP).  Unless there is a serious and imminent threat, HIPAA privacy standards still prevail.

3.      We would be liable for “foreseeable” victims, e.g. family members, friends, co-workers who the individual might harm.  If the client was having homicidal thoughts and expressed them in session, but didn’t name a specific victim, we should consider contacting anyone who might be known to him (e.g. co-workers, family, as well as police or DMHPs).

4.      We have a duty to conduct a risk assessment and thoroughly document what we considered in making that assessment. 

5.      Homicide risk assessment has fewer literature references than suicide risk assessment.  Below is a summary of what is considered to be components of a violence/homicide risk assessment:               

·         History of violence
·         Substance abuse
·         Mental incapacity
·         Organized plan
·         Unavailability of support group
·         Violent environment

6.      In addition, we should also consider and assess for suicide risk, as many of the factors for suicide are also risk factors for homicide.  Risk factors include:

  • Mental illness
  • Physical illness
  • Previous attempts
  • Family conflict
  • Unemployment
  • Social isolation

7.      Warning signs for suicide include:

  • I:  Suicidal Ideation
  • S: Substance use
  • P: Purposelessness
  • A: Anxiety
  • T: Feeling Trapped
  • H: Hopelessness
  • W: Withdrawal
  • A:  Anger
  • R:  Recklessness
  • M:  Mood changes

8.      Once the assessment is complete, document your decision making process, something like:  “Based on the presence/absence of these risk factors and warning signs, I believe there is/isn’t a serious and imminent threat to harm, and that there are/aren’t any foreseeable victims.  I will continue to assess the situation, and if it appears that a serious and imminent threat to foreseeable victims is evident, I will contact those potential victims, the DMHP, and/or the police.

9.      We would also list the names and dates of anyone we consulted with (in these cases we would always use multiple layers of consultation, Branch Director, VP CTS, attorneys, other relevant treatment providers such as psychiatry) as part of our process.

10.  If we do have to make call a call to foreseeable victims and/or police, the HIPAA concept of “minimum necessary” is to be adhered to.  We would release only the minimum amount of information to victims or police that would allow them to protect themselves or foreseeable victim.  This might be a description of the person, name, workplace, history of violence, what they said that makes us believe there is danger.  We would not include any extensive personal history.

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