Violence risk assessment after named threats in first-episode psychosis (MEQ)

(i) Structured assessment. Ensure interview safety (staff, exit, search bag/weapon). Map current threats, intent now vs earlier, plan, target (flatmate), access, ability to resist. Detail violence history (wall punch, any other). Explore persecutory/TCO content, command hallucinations, insight. Substance timeline (meth). Mood, impulsivity, sleep, agitation. Collateral from flatmate/police. Capacity and legal options under local law (principles only). Parallel suicide/vulnerability enquiry. MSE with quoted content.^[2][4]

(ii) Formulation factors. Static: male, young adult, early violence signal (wall punch), no prior service contact (limits known history). Dynamic: untreated first-episode psychosis with named victim, recent threats, knife access, meth use, agitation/guardedness, minimisation now. Protective: brought to care, some engagement possible, potential supports if engaged. Formulation: elevated near-term risk of harm to flatmate driven by untreated psychosis + substances + means + access; not reassured by denial alone.^[1][2][3]

(iii) Illness–violence nuance. Association between psychosis and violence is real but modest at population level; most people with psychosis are never violent. Risk concentrates with substances, prior violence, and untreated first-episode periods (disproportionate share of psychosis-related homicide before treatment). Avoid stigma while acting on dynamic risk.^[1][3]

(iv) Immediate plan. Secure knife; separate from flatmate; medical/psych work-up; consider admission (voluntary if capacity and agrees, otherwise least-restrictive compulsory pathway per jurisdiction). Treat psychosis urgently; address meth intoxication/withdrawal; de-escalate agitation. Lawful victim warning/police liaison if indicated. No discharge to shared housing with accessible weapons. Substance treatment as risk management.^[1][4]

(v) Tools and documentation. Use imminent tools (e.g. DASA) once inpatient for shift-level aggression risk; longer SPJ-style formulation for ongoing plan — not a score alone. Document scenarios (who/what/when), drivers, actions (weapon, who informed), legal status, observation level, review time.^[4][5]