Duties to Third Parties

The Tarasoff decisions in California have had a national impact on state laws, court decisions, and clinical practice addressing patient threats and clinicians’ duties to third parties. However, these duties remain one of the more complicated and confusing areas of psychiatric practice regulation. Although liability concerns receive much of the attention, these must be balanced with clinical and moral considerations. Beyond the critiques of various laws themselves, the difficulties inherent in violence prediction have led some to advocate for a focus on the information at hand (rather than probabilities) and on the clinical treatment directed by this information. In practice, clinicians should know their local state regulations regarding duties to third parties. When a patient makes a concerning threat or presents a danger to another person, a clinician should complete a thorough assessment of the patient, including collateral, and develop a thoughtful plan for treating the patient and managing the identified risks. The clinician should carefully document the assessment and plan and the rationale behind her or his decisions. If clinicians are unsure about how to proceed, they should consider clinical or legal consultation.