Homicidal Ideation: Definition, Assessment & Management

Instructor: Patricia Jankowski

Patricia has a BSChE. She's an experienced registered nurse who has worked in various acute care areas as well as in legal nurse consulting.

Homicidal ideation is a thought pattern that may lead to actual homicide or the killing of one person by another. In this lesson, we will discuss the assessment of a person's risk for committing homicide, and related causes and management.

Lockdown! Active Shooter!

911 OPERATOR: ''Hello, this is 911, what is your emergency?''

STUDENT: ''Operator, there's a guy in the hall here at our high school and he has a gun that looks like a big rifle! He's shooting at the students! I'm hiding in a room with a teacher and a few other students. Please, send someone, fast!''

911OPERATOR: ''Try to stay calm. Tell me your location. A car will be on the way.''

STUDENT: ''We're at the Marjory Stoneman Douglas High School in Parkland, Florida. I think the guy shooting is someone who used to go to school here but got expelled! Please help us!''

The above 911 call illustrates a situation that has become all too common in the U.S. It is based on a real shooting that recently occurred in Parkland, Florida, in which 17 people were killed by one shooter at a high school. Although school shootings are not the only type of homicides that occur, they often have the same characteristics as other types of homicides. Let's take a look at this tragic phenomenon, the risks of it happening, and what can be done to prevent it.


Homicidal ideation can be a dangerous thing
Man with gun


What is Homicidal Ideation?

Homicidal ideation is a thought pattern characterized by the desire to kill another person or persons, along with a mental plan for a method of doing it. This ideation can be a result of many possible contributing factors, including severe mental illness such as schizophrenia.

Assessing Risk of Homicide

When a patient presents to the ER with a psychiatric emergency, a thorough assessment of the risk or likelihood of him or her committing a homicide is the beginning of prevention. The law also requires that mental health providers must act to protect anyone who is at risk of being harmed by someone with homicidal intent, as stipulated in Tarasoff v Regents of the University of California, 1976. This duty to protect also necessitates a thorough risk assessment.

To assess the risk, the clinician must ask relevant questions in a firm but compassionate way to determine how serious the patient is about their desire to kill someone. Some of the areas of questioning include:

  • Patient beliefs - If the patient has strong beliefs that women are inferior or has hateful beliefs about members of another race or religion, they may feel it is okay to murder someone of that gender, race or religion. A person with no moral compass and with this type of ideology is at greater risk of committing a homicide.
  • Available means and opportunity - If the patient actually has access to a weapon, especially a gun, has expressed homicidal intent and is able to reach the victim without much difficulty, there is a serious risk.
  • Past experiences with violence - If the patient has acted upon violent feelings in the past and has a record of attempting to kill or hurt others, the risk is great that they will do it again, especially if their past experience did not result in a negative outcome. Violations of court orders or parole that have gone unpunished are examples of this.

Homicide risk in a patient can be rated as low, moderate, or high, but all homicidal ideation should be taken seriously by mental health personnel.

Causes and Risk Factors for Homicidal Ideation

The are many causes and contributing factors that lead to homicidal ideation. In the introductory example, the accused killer had been expelled from the school where the homicides occurred. He obtained access to an AR-15 rifle, a semiautomatic weapon. One study from the FBI showed that firearms of some kind were used in about 67% of all homicides in the U.S., and it is known from research that the greater the availability of firearms, the higher the homicide rates.

But there are other risk factors, too. State and federal funding cuts mean less mental health services are available for those who need them. This can also mean cuts in the available police force and its ability to serve the community with crime prevention programs. It has also been shown from FBI crime studies that homicide rates increase with decreased employment.

Gang activity, drug trafficking, and drug and alcohol use are also factors that can contribute to the likelihood of someone committing a homicide. Gang activity creates isolation and alienation from society, and drugs and alcohol impair judgment and understanding of the consequences of violent illegal actions.

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