Following the recent shootings at a Colorado movie theater, various media outlets have reported that shortly before the shootings, the suspect’s treating psychiatrist had taken steps to warn officials at the university where the suspect was enrolled that he might be dangerous. When is a psychiatrist—one who is hired to provide confidential mental health counseling—obligated to breach the duty of confidentiality owed to a patient and warn or take other steps to protect others? Forty years ago, the answer–in every state–was: “never.” Now, the answer is: “It depends.” In 1976, California Supreme Court issued a seminal decision holding that when a therapist determines (or should determine, by the profession’s standards), that a patient “presents a serious danger of violence to another,” the therapist owes a duty to the intended victim to take reasonable steps to protect that potential victim. Since that decision, most states have—through case law or by specific legislation—imposed a similar measure of duty.
This places the treating psychiatrist in a difficult position, because it may not be clear at the time of treatment how serious the patient is about causing harm, or even on whom that harm might befall. “I have a gun and I’m going to kill Mr. So-and-So tonight, because he is sleeping with my wife” is different than, “I think people who go to movie theaters don’t deserve to live.” Are psychiatrists reliably capable of predicting who poses a real threat to cause harm to others? And if there is reason for sufficient concern, what steps would be reasonable to take? Tell a specific individual of a threat? Inform the police? Take steps to involuntarily commit the patient to a locked psychiatric facility? The answers to these and other related questions usually seem (rightly or wrongly) much clearer after an event than during treatment, when the psychiatrist must determine whether something rises to the level requiring him or her to breach the very delicate relationship of trust necessary for successful treatment of a patient. Hindsight is 20-20. In our desire to place blame (and also thereby possibly provide financial compensation to innocent victims) we should not ignore the important and difficult service that mental health counselors provide to countless individuals and to society as a whole. // Michael Racette