732 CHAPTER 16
Confi dentiality and the Dangerous Patient:
Duty to Warn and Duty to Protect
In the 1960s, University of California college student Prosenjit Poddar liked fel-
low student Tatiana Tarasoff. However, his interest in her was greater than was
hers in him. He became depressed by her rejection and began treatment with a
psychologist. During the course of his treatment, his therapist became concerned
that Mr. Poddar might hurt or kill Ms. Tarasoff (Poddar had purchased a gun
for that purpose). The therapist informed campus police that Poddar might harm
Tarasoff. The police briefl y restrained him, but they determined that he was rational
and not a threat to Tarasoff. Ms. Tarasoff was out of the country at the time, but
neither she nor her parents were alerted to the potential danger. Two months later,
Poddar killed Tarasoff.
Her parents sued the psychologist, saying that Tarasoff should have been pro-
tected either by warning her or by having Poddar committed to a psychiatric facility.
In what has become known as the Tarasoff rule, the Supreme Court of California
(and later courts in other states) ruled that psychologists have a duty to protect
potential victims who are in imminent danger (Tarasoff v. Regents of the University
of California, 1974, 1976). This rule has been extended to other mental health cli-
nicians. There are a few options for mental health professionals who decide that a
patient is about to harm a specifi c person (Quattrocchi & Schopp, 2005):- warn the intended victim or someone else who can warn the victim,
- notify law enforcement agencies, and
- take other reasonable steps, depending on the situation, such as having the patient
voluntarily or involuntarily committed to a psychiatric facility for an extended
evaluation (that is, have the patient confi ned).
The Tarasoff rule effectively extended a clinician’s duty to warn of imminent
harm to a duty to protect. The clinician must violate confi dentiality in order to take
reasonable care to protect an identifi able—or reasonably foreseeable—victim (Brady
v. Hopper, 1983; Cairl v. State, 1982; Egley, 1991; Emerich v. Philadelphia Center
for Human Development, 1998; Schopp, 1991; Thompson v. County of Alameda,
1980). Note, however, that potential danger to property is not suffi cient to compel
clinicians to violate confi dentiality (Meyer & Weaver, 2006).Maintaining Safety: Confi ning the Dangerously
Mentally Ill Patient
A dangerously mentally ill person can be confi ned via criminal commitment or civil
commitment, described in the following sections.Criminal Commitment
Criminal commitment is the involuntary commitment to a mental health facility of
a person charged with a crime. This can happen before trial or after trial:- If the defendant hasn’t yet had a trial, the time at the mental health facility is used to
º
evaluate whether he or she is competent to proceed with the legal process (for
instance, is the defendant competent to stand trial?) andº
provide treatment so that the defendant can become competent to participate in
the legal proceedings.- If the defendant has had a trial and was acquitted due to insanity (Meyer &
Weaver, 2006).
Based on a 1972 ruling (Jackson v. Indiana, 1972), it is illegal to confi ne some-
one indefi nitely under a criminal commitment. Thus, a defendant found not com-
petent to stand trial cannot remain in a mental health facility for life. But the law
is unclear as to exactly how long is long enough. Judges have discretion about howTarasoff rule
A ruling by the Supreme Court of California
(and later other courts) that psychologists
have a duty to protect potential victims who
are in imminent danger.
Criminal commitment
The involuntary commitment to a mental
health facility of a person charged with a
crime.