Clients who are a danger to self or others Flashcards
Tarasoff v Regents of the University of California
Parents of student at UC filed suit vs psych/MD at schools counseling center after Ms Tarasoff was murdered by former boyfriend, Prosenjit Podar. Podar informed psych of intent to kill her. This defined therapists duty to warn and protect potential victim of therapy clients.
Tarasoff Decision
Established “duty to warn” the intended victim, in the rehearing it was changed to “duty to protect” the intended victim by warning them, the police, or other reasonably necessary steps. CA adopted immunity statue designed to protect therapists from montary liability if patient communicates serious threat of physical violence.
Reasonably identifiable victim
Reasonably identifiable victim + serious threat of physical violence
If there’s no identifiable victim(s) there is no duty to protect, specific name not necessary, it could be readily identifiable (e.g. employees at their company)
Ewing v Goldstein (2004)
expanded patient’s communication in duty to protect to include patient’s immediate family members (Family members may trigger therapists duty to protect)
Confidentiality of medical information act (CMIA)
Exception to therapist-patient privilege when client poses danger to self, others, property of others. Disclosure may be disclosed if the therapist, in good faith, believes the disclosure is necessary to prevent or lessen a serious and imminent threat of safety to foreseeable victim(s).
Situations in which duty to protect does NOT apply
Someone other than the client is the dangerous party (If client says coworker threats to murder someone) - Therapist would want to encourage client to report this to police
Someone other than family member reports the client has threatened to harm someone
There is no reasonably identifiable victim(s)
The client threatens suicide
HIV and the duty to protect
Duty to protect when a client who is HIV positive reveals they are sharing needles or engaging in unprotected sex with an identifiable partner remains grey. CA law protects physicians and surgeons from criminal/civil when they notify the spouse, sexual partners, or needle-sharing partners, but no legislation exists for psychotherapists.
Options:
a) Maintain confidentiality and encourage client to engage in safe practice and/or notify partners themselves, discuss possible legal consequences
b) If psychologist believes the clients danger to others is due to a mental disorder, the psychologist may involuntarily hospitalize the client
c) May decide to breach confidentiality to protect the intended victim, but should explain the decision to do so, and attempt to get the client’s consent. If the client does not consent and psychologist breaches confidentiality they may be charged with professional misconduct
Involuntary commitment and conservatorship
a) Danger the client poses to self or others is imminent or the client is gravely disabled
b) Danger or grave disbaility is the result of a mental disorder or chronic alcoholism
c) The client has refused or is unable to comply with recommendation to enter psycniatric hospital voluntarily
Involuntary commitment of adults
Lanterman-Petris-Short Act
Commitment begins with a 72 hour hold (5150) followd by a 14 day hold (5250) and then additional postcertification holds
72 hour hold
5150
“when any person, as a result of a mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, a member of the attending staff of an evaluation facility designated by the county, designated members of a mobile crisis team, or other professional pdrson designated by a county, may upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the state department or mental health as a facility for 72 hour treatment and evaluation
5230 hold - Similar to 5150 but applies to individuals who are impaired as a result of alcohol or drug use
5230 hold
Similar to 5150 but applies to individuals who are impaired as a result of alcohol or drug use
gravely disabled
a) condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing or shelter
b) Condition in which person has been found mentally incompetent and:
1) Indictment or information pending aginst the defendant at the time of commitment charges a felony involving death, bodiloy harm, serious threat to the well being of another
2) Indictment or information has not been dismissed
3) Result of mental disorder, person unable to understand the nature and purpose of the proceedings taken against him or her and to assist counsel in the conduct of his or her defense in a rational manner
Section 5152
Each person admitted to a facility for 72 hour treatment and evaluation receives an evaluation as soon after he or she is admitted as possible and shall receive whatever treatment and care his or her condition requires for the full period that he or she is held. The person shall be released before 72 hours have elapsed only if the psychiatrist directly responsible for the persons treatment believes, as a result of his or her personal observations, that the person no longer requires evaluation or treatment.
Initial 14 day hold
Permits person who has been detained for 72 hours and received an evaluation to be certified for up to 14 additional days for intensive treatment related to mental disorder or chronic alcoholism when the following conditions are met
a) As a result of mental disorder or alcoholism the person is a danger to self o rothers or is gravely disabled
b) Person has been advised that the treatment is required but has not voluntarily consented to it
Certification review hearing
Probable cause hearing
Must be held within 4 days of the date ton which the person is certified unless the attorney or advocate requests a postponement. may be postponed for up to 48 hours (counties with 100k population or less postponed until next scheduled hearing date).
Section 5276
Judicial review by writ of habeas corpus
Judicial review shall be in the superior court for the county in wh ich the facility providing intensive treatment is located or in the county in which the 72 hour evaluation was conducted if the patient or a person acting in his or her behalf informs the professional staff that judicial review will be sought.
Postcertification holds
Second 14-day hold for suicidal behavior:
Continues to be imminent threat of taking own life, may be confined for further intensive treatment not to exceed 14 days (after 72 hour hold or 14 day hold). Person held may request habeas corpus at any time.
second 14-day hold for gravely disabled:
Person remains gravely disabled as a result of mental disorder, unwilling or unable to accept treatment voluntarily, at the end of 30 days the facility must release the person, refer the person for voluntary treatment, certify the treatment as an imminently dangerous person, or begin the process of appointing a conservator.
second 14-day hold for danger to others:
Not to exceed 180 days if the person has attempted, inflicnted, or made serious threat of substantial physical harm upon the person of another after having been taken into custody, the person attempted harm upon another, made serious threat of substantial physical harm upon the person within 7 days of being taken into custody
Conservatorship
May be appointed by the court for any person who is gravely disabled as the result of a mental disorder or impairment by chronic alcoholism
Not gravely disabled if person can survive without involutnary detention with the help of family, friends, or others willing and able to provide basic personal needs
Involuntary commitment of minors
Authorization from parent/guardian ordinarily required before minor can be hospitalized.
Exception WIC section 5585.50 states when any minor as a result of mental disorder is a danger to self, others, or gravely disabled, and authorization for voluntary treatment is not availble, peace officer, attending staff, facility or designated person may take minor into custody
