Having a patient disclose thoughts of harming another can raise a lot of concerns for psychiatrists and other mental health professionals. It puts the mental health professional in a position where they must balance between breaking patient confidentiality and a duty to protect a third party.
The mental health professional should first assess the threat and the patient’s risk of harm to themselves or others. Regardless of the level of risk, every effort should be made to reduce a patient’s risk of harm to others. This might include the need to consider voluntary hospitalization, or involuntary hospitalization to increase the level of support and symptom monitoring. In some cases where the risk is assessed as manageable in treatment, the risk can be dealt with through working with the patient to help navigate a difficult relationship (e.g., with a boss, a family member, etc.) or addressed through treatment other ways to diffuse the risk and protect the potential at-risk third party (or parties).
In considering whether to breach confidentiality to warn a potential person or persons who may be at risk it is important to be aware of the implementation of duty to protect statutes, as they are different in every state. It is also important to realize that warning someone of risk may not result in their protection. When questions arise regarding potential responsibilities of the clinician to take matters into their hands to protect potential third parties, seeking consultation with another mental health provider or malpractice attorney / hospital attorney can help provide guidance regarding the tension between duty to protect and patient confidentiality.
This answer card supplements the issue brief, Duty to Warn, Duty to Protect, And Duty to Control: The Exceptions to Mental Health Provider-Patient Confidentiality.