A treating psychiatrist was charged with liability for his patient's homicidal actions in 2010. A lower court decided that the psychiatrist could not have identified the actual victims as targets because the patient had communicated no threats against them during his treatment. An appeal court then examined the duty of a mental health professional to protect a third party when an outpatient occasionally expresses homicidal ideas without identifying the ultimate target. The majority reversed the trial court and ruled that mental health professionals who treat voluntary outpatients may owe a duty to protect "all foreseeable victims, not only those reasonably identifiable victims who were actually threatened by the patient".
However, a state law designed to protect doctor-patient confidentiality provides that mental health professionals owe a duty to third parties only when a patient has "communicated an actual threat of physical violence against a reasonably identifiable victim or victims".
This case illustrates the difficulties in treating patients who have combinations of serious problems, are not under the control of the psychiatrist and do not meet the criteria for involuntary commitment. Any diminution in patient confidentiality (as the court of appeals decision) will jeoparidize the chances for continued and successful mental health treatment and will cause some practitioners to cease serving such patients.
# American Medical Association
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