Duty to warn and duty to protect
Tarasoff, and why what it requires depends entirely on where you practise.
Tarasoff v. Regents of the University of California (1974, revised 1976) established that a therapist may have a duty to protect an identifiable third party from a serious threat of violence by a patient. The 1976 revision replaced a duty to warn with a broader duty to protect, which can be discharged by means other than disclosure.
Enormous jurisdictional variation
| Model | What it requires |
|---|---|
| Mandatory duty | The clinician must act, usually by warning the victim and notifying law enforcement |
| Permissive duty | The clinician may disclose without liability, but is not required to |
| No duty | No statutory duty exists; ordinary confidentiality rules apply |
Discharging the duty
- 1Assess: identifiable victim, serious threat, means, opportunity, history of violence.
- 2Consult — colleague, supervisor, and where available legal counsel. Document it.
- 3Consider options short of disclosure: intensified treatment, voluntary hospitalisation, means restriction, involving family with consent.
- 4If disclosure is required, disclose the minimum necessary to the people who need to know.
- 5Tell the patient what you are doing, unless doing so would increase danger.
- 6Document the reasoning, including the options considered and rejected.
One further point worth holding: mental illness is a weak predictor of violence, and people with severe mental illness are considerably more likely to be victims than perpetrators. The strongest predictors are history of violence, substance use and access to weapons.
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