3 Things Mental Health Providers Should Know about Reporting Threats of Harm

The origins of the Tarasoff rule

In 1969, Prosenjit Poddar, a UC-Berkeley student, told his psychologist, Dr. Lawrence Moore, that he intended to kill a young woman he had dated.  Although Poddar did not identify his intended victim by name, his threat was sufficiently specific that Dr. Moore could discern that the potential victim was Tatiana Tarasoff.  Concerned that the threat was legitimate, Moore consulted a professional mentor to determine the appropriate course of action.  Together, they decided to alert campus authorities, with the hope that they could deescalate the issue.  When campus police questioned Poddar about the alleged threats, he denied having ever made them.  Poddar was released and Tarasoff was never alerted of the threats.  Soon thereafter, Poddar killed Tarasoff.

Tarasoff’s parents then sued the university and the two psychologists. Her parents argued that, if Tarasoff had known of the threats, she could have taken precautionary measures that could have prevented her death.  The court ultimately rules that psychologists are responsible for protecting or warning identifiable victims of imminent threats made by their patients.

The Tarasoff decision impacts the way in which mental health professionals practice by imposing a burden upon mental health professionals to report threats.  If a patient makes a credible threat, the provider must notify law enforcement and make reasonable efforts to notify the potential victim, or the provider must act to protect the intended victim (i.e.: by hospitalizing the patient).

What you should know

Here are 3 things mental health professionals should know about reporting threats of harm:

1.  In Illinois, a different type of duty is imposed upon different types of mental health professionals.

Reporting responsibilities vary among mental health professionals.  Psychologists and psychiatrists are legally obligated to report legitimate threats.  They have a “mandatory” duty to warn, and it’s governed by the Illinois Mental Health and Developmental Disabilities Code, Ill. Rev. Stat. Ch. 405 § 5/6-103.  In contrast, therapists can voluntarily report.  They have a “permissive” duty to warn, and it’s governed by the Illinois Mental Health and Developmental Disabilities Confidentiality Act, Ill. Rev. Stat. Ch. 740 § 110/11. 

2.  Credible threats might come from your patient’s family members, not necessarily the patient.

In many cases, mental health professionals learn of their patient’s threats from the patient’s family.  Although these providers may not witness or hear the threat directly, they often have the authority and responsibility to act upon these types of threats.  Notably, these situations are also ripe for violations of patient privacy if not handled properly.

This extension of the Tarasoff doctrine stems from the Ewing v. Goldstein case.  In Ewing, a psychotherapist was notified by his patient’s father that the patient intended to kill a specific individual.  However, the therapist did not notify law enforcement or take any action to protect the patient’s intended victim, who the patient ultimately killed.

3.  If the patient doesn’t reference a specific or identifiable victim, there is generally no duty to warn.

Sometimes, patients make threats without identifying their potential victims.  In these situations, mental health professionals are typically not responsible for reporting the threat to authorities.  This was discussed by the court in Eckhardt vs. Kirts, wherein which a patient told her therapist that she intended to kill someone who may belong to one of several different groups.  Because the patient did not identify an intended victim, the therapist was unable to adequately warn or protect the ultimate victim – the patient’s husband.  Acknowledging that “human behavior is simply too unpredictable and the field of psychotherapy presently too inexact to require that therapists be ultimately responsible for all the actions of their patients. To impose such a responsibility without limit would be to place an unacceptably severe burden on those who provide mental health care.” 

Deciding how to respond

Responding to a threat of harm can require quick action, so it’s best to consider this issue when it is not an emergent question facing your practice.  Because the repercussions of reports can be unpredictable, the decision as to how to handle a threat of harm can be challenging.  The Tarasoff doctrine simultaneously recognizes mental health professionals’ duty to uphold their patients’ confidentiality and their duty to take action when a potential victim is at risk.

Whether you’re facing an urgent situation where a disclosure may be necessary, or whether you want to implement a practice policy that allows you to act quickly in these situations, we can help you balance these duties.  Reach out today to schedule a free consultation with a Jackson LLP attorney.

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