When there is concern about potential harm to others, violence risk assessment should consider the client's presentation, history, context, and the provider's observations and clinical judgment.
In many outpatient mental health settings, violence risk assessment relies on structured clinical inquiry.
What should I consider when assessing violence risk?
When a concern is identified, assess the nature, severity, specificity, and imminence of the risk. Expand to sections below to read more about the clinical considerations:
Consider:
- Has the client expressed thoughts of harming someone?
- Are the thoughts passive, vague, recurring, or specific?
Consider:
- Does the client intend to act on these thoughts?
- Does the client feel they are in control of their actions?
Consider:
- Has the client identified a specific person or target?
- Have they shared details about their plan?
Consider:
- Does the client have access to weapons or other means?
- Are they able to access the identified individual(s)?
Consider:
- Prior aggression, threats, or violent behavior
- Patterns of escalation
Consider changes from the client's baseline, including:
- Escalating or threatening language
- Impulsive actions or loss of control
- Increased agitation or irritability
Also consider:
- Substance use
- Acute stressors, such as loss or legal or financial issues
- Psychosis or other acute psychiatric symptoms
- Environmental instability or other contextual concerns
Structured violence risk assessment tools
Structured, evidence-supported tools that can support violence risk assessment include the HCR-20-V3 (for use with adults) and the SAVRY (for use with adolescents). These tools are intended for use by providers with the appropriate training and experience:
- The Historical Clinical Risk Management-20 (HCR-20)
- The Structured Assessment of Violence Risk in Youth (SAVRY)
- Palo Alto University - An Introduction to Violence Risk Assessments