A clinical study of those who utter threats to kill

Objective: The current study sought to examine the psychiatric characteristics and rate of subsequent violence among those who uttered explicit threats to kill.

Method: Data were drawn from 144 referrals of adults to a community-based forensic mental health consultation and treatment service. Each had explicitly threatened to kill a person other than themselves.

Results: Assaults were made by over 20%, including one homicide, within 12 months of assessment. Two participants committed suicide in the follow-up period. Factors found to contribute to violence risk were substance abuse, prior violence, limited education and untreated mental disorders. Threateners were often habitual in their threatening behaviour and typically targeted those they interacted with on a daily basis. Clinical characteristics showed a psychiatrically complex group who shared many features of other offender groups.

Conclusions: The type of threat that led to referral for a mental health assessment was not uncommonly followed by violence. Factors enhancing risk resemble findings from other groups of offenders. Those referred for clinical evaluation typically have complex clinical presentations and marked deficits in effectively managing interpersonal conflict.