Homicidal Ideation

I can see how someone would disclose suicidal ideation, maybe even intent and planning. After all, as far as I’ve been able to find, suicide itself isn’t a crime (at least in Texas), although aiding a suicide could be either a class c misdemeanor or state jail felony. A disclosure of suicidal ideation or intent is often a cry for help, and if the attempt fails the result is likely commitment to a behavioral hospital and not criminal charges. But what does one do when a client discloses they’ve been having homicidal ideation?

This is the one disclosure that wasn’t even close to being on my radar. I figure, if someone truly wants to kill another, they’re not likely to foil their own plan by talking to someone who would oppose it and be mandated to report – they’d probably either just do it, or they’d keep the thought to themselves until it passes. But, as mandated reporters, counselors can’t just sit back à-la-Rogerian, listen, and hope such thoughts dissipate from a client’s mind and into the ether.

Only a few months into my counseling career and I’ve already had an experience with homicidal ideation. Here are some helpful steps to take/questions to ask in such a situation (not necessarily in this order):

  • Who/What/Where – Is there a specific target? What would be the setting and who would be the victim(s)?
  • Why – If there is a specific target, what would be the reason for choosing that target? Needless to say, there must be other alternatives to homicide – what are these other alternatives?
  • How – Is there a plan? I guess this is a more general way of ascertaining the who/where/what, but it adds the how and what with.
  • If there is a plan and it involves a weapon, does the person disclosing have access to the weapon at home, or through someone they have regular contact with? If there’s no personal access or access through another, does the client have the financial means to easily procure the weapon?
  • Are the homicidal thoughts deliberate, or are they intrusive? That is, is the client consciously contemplating murder, or are these thoughts that attack the consciousness of the client similar to the way a compulsion might attack someone with a OCD diagnosis? If the thoughts are intrusive, being aware of this may help a client realize that although they may not be able to control random manifestations of a thought, they can control whether and/or how they will act on a thought.
  • If no-one is in immediate threat of harm, is the client willing to sign a Safety Plan?
  • If the client is not willing to sign a safety plan, can I get the client to verbally commit (i.e., promise) to call a crisis line should they feel they might act on their thoughts? Provide a crisis line number.
  • Document meticulously, and if you feel the client is not an immediate threat for any reason(s), specifically state why in the progress note.
  • If the client is seeing another professional (LPC, LCDC, psychologist, psychiatrist, ask him/her to sign releases of information to coordinate care. Sometimes a client will compartmentalize information (e.g., disclose drug use and homicidal thoughts to a LCDC, but not to a psychiatrist or a LPC) in order to avoid undesired consequences like adjustments to medication or forced hospitalization, but in a situation like this transparency on the client’s part is needed as much as the expertise of caregiver involved.
  • If unsure what to do, consult a supervisor for guidance. Make sure to document this.
  • Make sure to have professional liability insurance. Your agency might have malpractice insurance, but this may only cover them as a practice and not necessarily the counselor as an individual.

A key consideration: At the point the counselor starts talking about safety plans, no-harm contracts or releases of information, the client may regret having disclosed anything. They might be afraid of consequences, of how they might be perceived by another professional to whom they feel accountable but haven’t disclosed anything (e.g., “liar” or “crazy”), even of disappointing another practitioner to whom they’ve not disclosed something.

The important thing, for me, no matter what my course of action will be: To help the client understand that I care, that I do not judge them, and that everyone who provides treatment in some way has their well-being as one of their primary concerns. To let them know that it takes courage to be honest and that they are brave, and that they are loved.

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