Following the tragic shootings at the movie theater in Aurora, CO, and at Sandy Hook Elementary, we have all been asking: How can we prevent acts of violence in malls, churches, schools and on university campuses? Once again, public officials and law enforcement officers are turning to mental health professionals for the answer to this question.
If you make a statement in an airport that you have a bomb in your possession, you are going to jail. If you try to tell the police on the way to jail that you were only joking, you will quickly learn that such statements are not a joke. In the home, if a man threatens to kill his partner, he will be arrested and taken to jail. Ever since Columbine if a student makes a threat of violence, it will be taken seriously. In the workplace, threats of violence are not tolerated.
In our society, we have developed a zero tolerance policy for threats in airports, threats of domestic violence, threats to national security, and threats of violence on campuses. All mental health professionals know the standard for hospitalizing a client. A person meets the criteria for hospitalization when the individual has a mental disorder and is an imminent danger to self or others; or presents a clear and present danger to self or others. When a client says, “I am going to kill myself” or a student says, “I am going to kill people,” a zero tolerance policy must exist, because these words evidence an imminent risk of harm, and demonstrate that an imminent danger is present. So, if a client is being evaluated for making threats of homicide or suicide, the client cannot avoid consequences by saying, “Oh, I was only joking.”
Difficult situations are still presented, however, when therapists must evaluate suicidal or homicidal ideation in the case of a client who says, “I am thinking about killing myself.” In such a situation a thorough evaluation is needed to determine whether or not there is an imminent risk of harm. If any question exists concerning whether the individual needs to be hospitalized, an immediate consultation must be obtained to resolve the question.
Since the bombing of the Federal Building in Oklahoma City in which children were killed at a daycare center, children have either been killed or endangered by each act of terror that has occurred in schools, malls, churches, and public places. Therefore, when we consider whether to report a threat made by a client concerning an act of violence, would it not be appropriate to report the potential threat if we suspect that child abuse or child endangerment may result? Child abuse includes not only injury to a child, but also situations which pose a risk of harm to children. When a client threatens an act of terror or violence, ask yourself if you suspect that a risk of harm to children will be present or that children will be endangered? That is certainly a different question than whether the suspected perpetrator meets the criteria for hospitalization. If the criteria for hospitalization are present then initiate a hospital hold; and if you suspect that children may be endangered if the threat is acted upon, also report the suspected child abuse.
Mental health professionals should keep in mind that when you hospitalize a client, you are potentially saving lives. The conventional wisdom that we frequently hear these days is to err on the side of safety. Yours and your clients’.
Denis Lane is the author of “The Legal Guide for Practicing Psychotherapy in Colorado 2013”