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When Do Therapists Have to Disclose Threats?

When does doctor-patient confidentiality end and public protection begin? Or more specifically, do psychiatrists and therapists have a duty to disclose patient information if a patient poses a threat?

Let's talk a bit about what "privileged communications" are. They're discussions between two individuals that are supposed to be kept confidential. State laws generally recognize a doctor-patient privilege, and some extend it to psychotherapists as well.

There are limits to this privilege, however. One of these limits is when the patient says things that could pose a physical threat to another.

What Types of Threats Must Be Disclosed?

For example, if a patient threatens to kill another person, the psychiatrist is no longer bound by her duty of confidentiality towards the patient.

Similarly, if the patient plans some sort of imminent attack or calamity, the psychiatrist or psychotherapist generally has a duty to disclose the information under most states' laws.

But it's not always clear how this information should be disclosed, or to whom. For example, if a psychiatrist suspects that a patient plans to kill a particular person, should she tell that person? Or should she simply go to the police?

It's a tough call because a psychiatrist is often hearing many thoughts and ramblings. It's not always easy to distinguish which one poses a real threat and which one is simply internal dialogue.

Potential Liability

In some cases, the improper disclosure of these facts, or the failure to report threats to law enforcement, could subject the doctor or therapist to liability.

If a patient ends up killing someone, and the psychiatrist had reason to know about this, then the psychiatrist might be held liable for negligence.

That's the argument behind lawsuit threats against James Holmes' psychiatrist, as discussed earlier on this blog. The psychiatrist is being accused of negligence, as families of victims of the Colorado movie theater massacre say she didn't do enough to prevent it. Although she alerted campus police and a few colleagues about Holmes, it still didn't thwart his crime.

What's the lesson from this discussion? Psychiatrists and therapists must check state laws to be clear about their duty to disclose patient information. By doing so, they can potentially save themselves from lawsuits -- and perhaps even save someone's life.

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