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December 22, 2015

Case Management: Handling Client Threats



The news and media reports have a significant impact on human behavior. The human services community is no different and clients who already have mental health challenges may actually be even more impacted by what they see on television. In recent months, the reports of gun violence have sadly become common place in our society. Often times our clients are influenced by this behavior and think it’s acceptable to make homicidal threats. It’s times like these when we as human service professionals need to reevaluate how we deal with client threats.


I recently had an encounter with a client who threatened to get a gun and shoot everyone that did him wrong. I didn’t feel threatened due to the working relationship with the client for several years (And after I confirmed he didn’t have a gun). In hindsight I should have explained the seriousness of these threats a little more than I did at the moment.  Here are some general rules to follow when working with a client who is presenting threatening behaviors:

Take every threat seriously: It’s critical to take every threat seriously no matter how minor it may seem.  We should take it seriously even if we are 99% sure that the client has no means or capability to carry out the threat.  The one percent chance of something happening is too much to risk.

Call emergency services:  Emergency services should be contacted immediately upon receiving any kind of threat. In situations when you’re in a client’s home, be sure to get out of the home and get to a safe place to make the call. Emergency services can send out a trained clinician to assess the situation. Many cities also offer the assistance of  CIT police officers  who are trained to work with the mentally disabled.  These offers often accompany the clinician to perform the evaluation if there is any threat of a violent confrontation.  If it is determined that the client is a legitimate danger to self or others, the clinician may request a petition from a magistrate  to have the client temporarily detained in a psychiatric hospital. This process is often referred to as a TDO or Temporary Detention Order.  In cases that do not rise to the TDO level, a  safety plan is often put in place to prevent further escalation of the situation.

Contact CPS and APS as needed: Adult Protective Services (APS) and/or Child Protective Services (CPS) may also be contacted to determine if more services need to be implemented to prevent unsafe behaviors. CPS would also be involved if there are children in the home that could be put in harm’s way. Of course, case managers, emergency services clinicians as well as police officers are considered mandated reporters  and have are obligated to report these events.   

Document incident according to agency policy:  Of course last but not least, document all events according to agency policy as well as any local and state regulations. This will likely include internal incident reports and progress notes in the client’s record.  It is critical that all parties document the behavior. This creates a “paper trail” of events that can hopefully make it easier to prevent more catastrophic events in the future. It also provides history that can be used for treatment and recognizing triggers that may lead to the behaviors.  Documentation provides proof that all regulations and policies were followed, as this information could potentially be used in court.

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