Violent fantasy, dangerousness, and the duty to warn and protect

An evaluation of homicidal ideation is a routine component of a mental status examination and may be evaluated in more depth in forensic evaluations as a dangerousness risk assessment. The evaluation of dangerousness often includes asking about violent fantasies that may have physical or sexual content. The authors examine the circumstances in which the revelation of violent fantasies to a mental health professional may trigger a duty to warn or protect third parties. Legal cases in which violent fantasies were considered in the context of assessing potential dangerousness are reviewed. The research literature on homicidal and sexually violent fantasies in both non-incarcerated and offender populations is examined. No consistent predictive relationship between violent fantasies and criminally dangerous behavior is reported in the available scientific literature. The authors suggest factors that mental health professionals may consider when assessing whether a particular violent fantasy indicates that a patient's thoughts could give rise to a duty.