The Duty to Protect: Four Decades After Tarasoff

Abstract

(1976), the California Supreme Court held that mental health providers have an obligation to protect persons who could be harmed by a patient.

The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: A critical review and recommendations for research.

“…Another complication is the lack of consistency across states or jurisdictions. As Adi and Mathbout (2018) describe:…”

The pathway to violence and public mass shooters in mental health treatment before attacks

“…Mental health practitioners should also understand the duty to warn and protect laws within their individual states (Adi and Mathbout, 2018;Borum and Reddy, 2001). One challenge related to the duty to warn and protect is that these laws require an identifiable victim (Kivisto, 2016), which is not always appreciated when individuals make ambiguous threats or display red flags for risk of violence but have not verbalized a plan.…”

“…One challenge related to the duty to warn and protect is that these laws require an identifiable victim (Kivisto, 2016), which is not always appreciated when individuals make ambiguous threats or display red flags for risk of violence but have not verbalized a plan. Additionally, there are no clear guidelines for breaching confidentiality (Adi and Mathbout, 2018). Due to this ambiguity, developing relationships with law enforcement and risk management professionals is beneficial so that practitioners can consult when they are unsure about how to move forward when an individual presents with a risk of violence.…”

“…An essential aspect of a mental health provider's role is engaging in risk assessment and mitigation when a patient presents with suicidal or homicidal ideation (Cowan and Cole, 2020;Lankford and Cowan, 2020;Borum and Reddy, 2001;Borum et al, 1999;Hagga ˚rd-Grann, 2007;Kivisto, 2016;Lankford, 2018;Parke et al, 2018). In most states, due to the Tarasoff v. Regents of the University of California, 17 Cal.3d 425 (1976) ruling, mental health professionals have a duty to warn and protect potential victims when a patient threatens violence (Adi and Mathbout, 2018;Borum and Reddy, 2001;Hagga ˚rd-Grann, 2007;Kivisto, 2016;National Conference of State Legislatures, 2018;Parke et al, 2018). However, despite these laws and mandates at the core of the mental health profession, practitioners often lack the training, expertise and confidence needed to adequately assess for risk of violence (US Department of Justice, 2017) and frequently struggle with risk assessment due to its multifaceted and complicated nature (Fox and DeLateur, 2013;Kivisto, 2016).…”

“…Actuarial assessments are rigidly structured and include numerical rating systems based on statistical formulas and certain static risk factors that attempt to predict the overall likelihood of violence in the future (Borum et al, 1999). However, most are normed on the criminal offender population, do not generalize well to other populations (Adi and Mathbout, 2018;Borum et al, 1999), and should be used with caution in clinical practice. For instance, these assessments, such as the Violence Risk Appraisal Guide (Quinsey et al, 1998), are often conducted in forensic settings when determining recidivism and the safety of releasing an inmate into the community (Hagga ˚rd-Grann, 2007;Litwack, 2001).…”