Deadly Blind Spots: How Murder-Suicide Risks Get Missed

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In May 2022, Dwayne Lockhart* met with his therapist in Dallas, expressing suicidal thoughts after his wife announced plans to leave. The therapist's notes, reviewed in subsequent investigations, show a thorough suicide assessment focused on Lockhart's personal risk—previous attempts, current plan, and access to means. What wasn't documented was any structured assessment for homicidal thoughts toward his wife, despite his statements about "not being able to go on without her." The following week, he killed her and himself.

In a separate case in 2021, Jennifer Torres* sought help from a domestic violence program in Oregon, describing her husband's controlling behaviors—monitoring her phone, managing her finances, and isolating her from her family. The advocate's assessment noted these tactics but classified the risk as moderate due to a lack of physical violence or criminal history. The assessment didn't probe for signs that Torres's husband was suicidal, even after she mentioned his comments about "ending it all" if she left. Three months later, he killed them both.

These are composite cases*. However, similar ones play out across the United States every day. When it comes to murder-suicide, one person may see the tusk of the elephant while another sees the leg. But no one recognizes it's an elephant until it's too late.

What Mental Health Professionals Miss

We mental health professionals are good at assessing suicide risk. We know how to ask about suicidal thoughts, specific plans, and access to means. We know how to galvanize protective factors and monitor situational risks.

Sure, we're taught to include "harm yourself or others" in our standard inquiry, but when someone is depressed or anxious, we rarely go beyond that. What often goes unexplored is any structured assessment for homicidal thoughts toward the partner, even when the client's distress is about a relationship breakup or a custody battle.

Clinicians frequently "anchor" on psychiatric diagnoses (e.g., depression, psychosis) and use assessment scales that match the presenting symptoms. However, an over-reliance on suicide risk scales is likely to lead to false negatives when it comes to murder-suicide risk, as these tools may ignore contextual factors like possessive behaviors or weapon access. These mental health assessments may overlook coercive behaviors unless explicitly disclosed, as clinicians may lack training in recognizing relational abuse dynamics.

Research backs up this hypothesis; a study of 300 domestic homicide reviews found that 50 percent of cases involved coercive control, yet only 12 percent of mental health professionals routinely assessed for it during suicide risk evaluations. In another study, 85 percent of murder-suicide perpetrators with depression were given antidepressants, but less than 15 percent were screened for partner violence histories.

This tunnel vision means that critical opportunities are lost. Almost two-thirds of murder-suicide perpetrators have had contact with mental health services in the year before they killed, typically for depression and anxiety. Nearly half had previously thought about or attempted suicide. Even more telling, after killing their partners, about one in five died by suicide or tried to. These aren't just statistics; they're documented warning signs sitting in medical records, potentially out of reach when they matter most.

What General Practitioners Don't Know

While most murder-suicide perpetrators had accessed mental health care at some point over the past year, few had received medical care in recent weeks. Most were no longer connected to mental health services. The 40 percent who did reach out visited their general practitioner. Half of those (21.5 percent) attempted or completed suicide after the homicide.

Think of that brief visit, a patient sitting in their doctor's office, talking about their emotional distress. The doctor is skilled in general medicine but without the specialized tools needed to spot the difference between ordinary emotional distress and warning signs of impending violence. The patient is reaching out one last time for help, but not through the specialists who might best be able to intervene.

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What Risk Assessors Neglect

We domestic violence experts excel at recognizing patterns of power and control. Our screening tools help identify escalating physical violence, stalking, and direct threats. But, used in isolation, these danger assessments may not capture the lethal risk posed by an abuser's suicidal thoughts, particularly when the control tactics appear more "respectable" than physical violence. Law enforcement and victim advocates may focus on assessing physical violence risk and documenting control tactics, failing to probe deeply for signs that the abuser is suicidal, even when victims report their partners have made comments about "ending it all" if they leave.

The "bunker mentality" in threat management—where professionals focus narrowly on their domain—allows high-risk individuals to fall through gaps. For instance, law enforcement might address physical violence without recognizing depressive symptoms or the coercive control that often precedes domestic homicide. This oversight is especially worrisome when it comes to murder-suicide risk, where perpetrators often don't have the arrest records or restraining orders that we see in those who commit domestic homicide.

Research, for instance, tells us that around 22 percent of intimate partner homicide-suicide perpetrators have documented histories of domestic violence, such as prior arrests or restraining orders; compare this to 60 to 70 percent of domestic violence homicide perpetrators. However, these incidents often involve underreported coercive control rather than physical violence.

Similarly, only 7 percent of interpersonal partner murder-suicide perpetrators had an active restraining order at the time of the incident (compared to 25 to 30 percent of domestic violence homicide perpetrators), despite 62 percent of incidents occurring during relationship breakdowns. This finding highlights another gap in systemic risk assessment, as many perpetrators escalate from non-physical abuse (e.g., surveillance, threats) to lethal violence without prior felony charges.

Slipping Through the Cracks

Murder-suicide represents a unique behavioral phenomenon distinct from standalone homicide or suicide, characterized by intersecting risk profiles that combine interpersonal violence with self-directed lethal intent. Murder-suicide perpetrators exhibit higher rates of untreated depression, intimate partner conflict, and access to firearms compared to homicide-only offenders while differing from suicide-only individuals through pronounced histories of coercive control and externalized aggression. Key examples of these intersecting risks include:

• Relationship crisis combined with mental health indicators
• Suicidal statements tied explicitly to a partner leaving
• Depression or anxiety diagnoses during relationship dissolution
• Recent separation or divorce proceedings
• Expressions of "not being able to live without" the partner
• Coercive control patterns that include suicidal threats
• Using threats of self-harm to manipulate partner
• Obsessive monitoring disguised as concern about a partner's mental health
• Statements implying partner is responsible for potential suicide
• History of controlling behavior with recent onset of suicidal ideation

The Bottom Line

The lethal synergy of depression and coercive control demands paradigm shifts in murder-suicide risk assessment. By integrating professional silos between mental health professionals, general practitioners, domestic violence experts, and law enforcement, we can identify at-risk individuals before despair metastasizes into violence. We can see beyond the obvious signs and recognize that while murder-suicide perpetrators exhibit "cleaner" records than domestic violence homicide offenders, they pose unique risks. Systemic failures to connect coercive control patterns with suicidal crises enable preventable escalations.

Medical records, mental health histories, and domestic violence reports all contain pieces of the puzzle. We know the warning signs exist. We know where they're documented. What we haven't figured out yet is how to get this critical information to the right people at the right time to prevent these tragedies.