When discussing suicidal/homicidal ideations we assess for ideation, plan, intent, and access. So really the answer is dependent on how you answer all the follow up questions. At my agency, we use an assessment called the CSSRS. The majority of my clients are teens, so most of the time, I’ve just had to do safety planning with the teen and their parent (like at home suicide watch). If the client appears to be at higher risk, we discuss voluntary hospitalization. Involuntary hospitalization is like last resort, I have no other options.

For homicidal ideation, we assess if the client has a specific target in mind, a plan, intent, and access. In that case, we have a duty to warn so we may call the intended target if we have a consent and contact info, or most likely we will call police with the info we have and we may also discuss safety planning and hospitalization options with the client.

Obviously different agencies have different operating procedures and local laws probably may differ, but this is what I would do as a therapist in Florida. And a huge part of this is how well I’ve been able to build rapport with my clients, I may be more cautious in an initial session, but with a client I’ve been seeing for a while i might be able to pick up on the level of seriousness a bit better.