Homicidal threats, ideation and behaviour in adolescents: A clinician's view

Abstract

Background: Homicidal ideation or threats to harm other people are not uncommon presentations in adolescents, and these phenomena cause significant concern to clinicians, services and the wider community. Dr Scott Harden in both public and private practices has been involved in the provision of advice regarding the assessment, treatment and disposition of numerous adolescents presenting with homicidal ideation, threats and actions for more than 10 years. Objectives and methods: The objective was to identify the current best practice with regard to responding to adolescent ideation or threats that have elements of homicidality. The recent literature with regard to assessment of this clinical issue was reviewed. Cases in recent years seen within the forensic adolescent mental health service for the southern two-thirds of Queensland were identified and reviewed. Discussion with other practitioners in the field in peer-review settings was held. General principles in the approach to the clinical problem were identified. Illustrative de-identified or public domain cases will be discussed in detail to illustrate clinical approaches. Findings: There are three stages of response chronologically: the first is rapid assessment of threat and imminent danger, the second is more comprehensive violence risk assessment and formulation and the third is management planning and implementation. The first stage of rapid assessment of threat often does not require specialised expertise but does require rapid gathering of collateral data from multiple sources to make a timely decision regarding the presence or absence of a high level of imminent danger and any requirement for appropriate action. The second stage requires specialised clinicians (in a team or individual context) who have an understanding of the current scientific data predictive of violence risk and the ability to develop individual psychological risk formulations of the young people involved. The third stage often requires a comprehensive management plan involving multiple individuals or agencies with clear communication and liaison. Conclusions: Adolescents who make threats against others or disclose homicidal ideation require rapid assessment of the level of threat they may pose to others as well as specific interventions related to the aetiology of the threat or homicidal ideation. Clinical practice is often complex, frequently has three or more stages and may require multi-agency consultation and coordination.L6116368062016-08-16 <br />