Duty of Mental Health Professionals to Warn Third Parties of Threats by Patients

Duty of Mental Health Professionals to Warn Third Parties of Threats by Patients

When is a mental health care provider required to breach patient confidentiality and warn third parties of threats made against them by a patient? In 1976, the California Supreme Court ruled that a psychiatrist was liable to the family of a woman murdered by the psychiatrist's patient for the failure to warn the woman that the patient had told the psychiatrist of his plan to kill her. In the California decision, the psychiatrist had notified the local police that the patient was a threat to himself or others but did not warn the intended victim. Thus, the California ruling imposed an affirmative duty on therapists in California to warn intended victims of their patients of threatened harm. Since that decision, other states have addressed the issue of when a duty to warn arises. Many states followed California and likewise imposed a duty to warn on its mental health care providers. Other states, such as Texas, have rejected the imposition of such a duty, and a few have not ruled on the issue at all. Under New York law, providers are permitted but not required to report dangerous patients to third parties.

States imposing a duty to warn on mental health care providers generally find that a duty to warn begins when the provider:

  • reasonably believes that a patient is dangerous or potentially dangerous,
  • that a victim or victims are reasonably identifiable,
  • that the potential harm is foreseeable, and
  • that the psychotherapist reasonably believes that the potential harm is imminent.

These duty to warn laws require that the provider make a reasonable effort to notify the intended victim and that the provider notify the local police. Under these laws, providers who comply with the notification laws are immune from liability for actions by their patients.

Under Texas law, a mental health care provider warning an intended victim of a threat of harm does so in violation of state law governing patient confidentiality. The Texas law does permit, but does not require, a provider to notify the local police of an intended threat. However, there is no immunity from liability for good faith reporting by the provider. Thus, the provider could be liable to the patient for breach of confidentiality, invasion of privacy, or defamation.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.