Clients Who Are Danger To Self Or Others

Question 1

Duty to warn/protect

1. Tarasoff Decision

Answer 1

• -orginally stated as duty to warn then changed to duty to protect.
• -psych to communicated a “serious threat of physical violence against a reasonably identifiable victim”
• -psych should notify intended victims and law enforcement
• -psych should only disclose info needed to protect the intended victim.

Question 2

2. Ewing v. Goldstein

Answer 2

2004, the court expanded the meaning of patient’s communication to include communications from the patient’s “immediate family members”; communication from a patient’s family member may trigger the psych’s duty to protect.
–“serious” and “physical violence” includes grade bodily injury

Question 3

3. Confidentiality of Medical Information Act (CMIA)

Answer 3

an exception to privilege when a client poses danger to self, others or property.
—medical info may be disclosed, consistent with appplicable law and standards of ethical conduct, by a psychotherapist..if the psychotherapist in good faith, believes the disclosure is necessary to preventer lessen a serious and immense threat to the health/safety of the victims, and the disclosure is made to a person to prevent/lessen the threat or target.

Question 4

4. Situations in Which the Duty to Protect Does NOT Apply

Answer 4

1. Someone other than the client is the dangerous 3rd party: must have patient-client rel.
2. Someone other than a family member reports that a client has threatened to harm someone: the psych does not have duty to protect if it’s reported by someone who is not a immediate family member (psych should still assess)
3. There is NO reasonably identifiable victim(s): if there is no reasonably identifiable victim, psych does not have duty to protect but may want to consider hospitalization.
4. Client threatens suicide: tarasoff cover’s a third party victim, not the client.

Question 5

5. HIV and Duty to Protect

Answer 5

• -it’s vague and unclear. For physicians and surgeons, they are protected from civim and criminal liablity.
• -Several options:

1. Initial course of action is to maintain client’s confidentiality and encourage safe practices; offer to help the client disclose their status; psych should also discuss the possible legal consequences of engaging in unsafe practices.
2. If psych believes client is danger to others is due to a mental disorder, the psych may have to involuntarily hospitalize the client.
3. The psych may decide to breach client’s confidentiality in order to protect the intended victim, but before doing so, should explain the decision to the client and try to get their consent. If the client does not consent, and the psych breaches confidentiality, he may be charged with professional misconduct
   - -consulting with a colleague is always a good option

Question 6

Involuntary Commitment and Conservatorships

Answer 6

a) client is denier to self or others is immenent or client is gravely disabled
b) danger or grave disability is a results of a mental disorder or alcoholism

c) client has refused or unable to comply with recommendation to enter a psych hospital voluntarily.

Question 7

1. Involuntary Commitment of Adults

Answer 7

5150 begins with a 72 hold, which can be followed by a 14 day hold , and then additional postcertifcation holds

Question 8

72 hour hold 5150

Answer 8

when a person, as a result of a mental disorder, is a danger to others, self, or gravely disabled, a peace office, member of state facility, mobile crisis, or prof person designated by the county, may upon probable cause, take the person into custody and place him in a facility designated by the county for a 72 hour tx and evaluation

Question 9

Grave disability

Answer 9

a) a condition in which a person, as a result of a mental disorder, is unable to provide for his basic personal needs for food, clothing, shelter;
b) a condition in which a person has been found to be mentally incompetent

–a psych may initiate a hold but only certain individuals may institute an involuntary hold

Question 10

During 72 hour hold

Answer 10

–each person admitted shall receive evaluation as soon as possible, and receive whatever tx that condition calls for the full period that they are held. The person shall e released before 72 hours is lapsed only if psychiatrist believes person no longer requires eval and tx.

Question 11

14 day hold 5250

Answer 11

–after 72 hour hold, the person can be certified for up to 14 days if a) as a result of mental disorder or chronic alcoholism, the person is a danger to self or others, or is gravely disabled and b) there person has been advised tx is required but has not voluntarily consented.

Question 12

5251 and 5253

Answer 12

require a notice of certification to be signed by two people, and then a copy of the notice is personally delivered to the patient, attorney or advocate
–person must also be informed that they are entitled to a certification review hearing to determine if there is reason to detain him or her

Question 13

Section 5256

Answer 13

unless the person requested a judicial review, the certification review hearing MUST be held within 4 days on which the person is certified unless they ask for a postponement. Hearings may be postponed for 48hrs

Question 14

Section 5276 Judicial review by writ of habeas corpus

Answer 14

judicial review shall be in the superior court where the 72 hr eval was conducted if the patient is act icing in his behalf informs the facility in writing,…”
–at the end of the 14 day hold, patient must be released, referred for voluntary tx, or certfify for involuntary tx begin process of appointing a consevator

Question 15

5260 Post certification hold for suicidal bx

Answer 15

–if person continues to be threat to self, may be confined for additional period not to exceed 14 days

Question 16

5270.15 Post certification hold for grave disabilty

Answer 16

• -person may be certified for additional 30 days if: staff believes person remains gravely disabled as a result of mental dx or alcoholism AND person is unwilling to voluntarily accept tx.
• -person must be released after 30 days or begin process or conservator

Question 17

5300 Post certification hold for serious dangerousness to others

Answer 17

• -if person rains dangers to others, person can be held for up to 180 days if client remains danger to self by a) attmpted/made serious to another person…who has a results of a mental d/o.
• -the DA must file a petition with the court and a hearing must take place within 4 days after it’s filed, or within 10 days when patient requests a jury trial. At end of 180 days, person must be released, referred for voluntary tx, or file a new petition.

Question 18

2. Conservatorship

Answer 18

Conservator may be appointed by the court for any person who is “gravely disabled as a result of a mental d/o or impairment by chronic alcoholism”;
–conservatorship may be temporary–30 days, or longer–for renewable one-year periods.

• -Def of gravely disability: person is not gravely disabled if that person can survive safely without involuntary detention with the help of responsible friends, fam, or other to help provide food, shelter, clothing, shelter…”
• -within 10 days of conservatorship, there shall be an independent unless tx is not found to be appropriate by the court…when progress review determines the goals have been reached/the person is no longer gravely disabled, a person by the county shall report so to the court and conservatorship is terminated.

Question 19

3. Involuntary Commitment of Minors

Answer 19

Authorization from parents is ordinarily required before a minor can be hospitalized. However, there is an exception to this rule: “when minor, as result of a mental d/o, is danger to self/others/gravely disabled, and authorization from parents is not available, a minor can be involuntary hospitalized for 72 hrs. The facility makes every effort to notify the parents asap

Question 20

Gravely disabled minor

Answer 20

a minor, who as a result as a mental d/o, is unable to use the elements of life which are attention to health, safety, development, including food/shelter/clothin, even though provided to the minor by others. ID, epilepsy or other developmental disabilities, alcoholism, or repeated antisocial bus by themselves do not account as a mental d/o.

Question 21

Grave disability for minor cont.

Answer 21

A clinical evaluation be conducted, and a tx plan that provides the lease restrictive placement alternative in which the minor can receive necessary tx. The family/guardian and the minor shall be consulted/informed as to the basic recommendations for further tx . Every effort shall be made to obtain consent of minor’s parent. Inability to obtain the consent shall not preclude the involuntary tx who remains gravely disabled/SI/HI