McNiel D E, Binder R L, Fulton F M
Department of Psychiatry, School of Medicine, University of California, San Francisco, USA.
Am J Psychiatry. 1998 Aug;155(8):1097-101. doi: 10.1176/ajp.155.8.1097.
This is the first study to assess clinical practices under one of the new duty-to-protect statutes, some version of which has been passed in many states. In 1985, California enacted a statute enabling psychotherapists to limit their liability when a patient makes a serious threat of violence by 1) making reasonable efforts to warn the victim of the threat and 2) notifying local police.
The authors examined all duty-to-protect notifications over a 5-year period in San Francisco by reviewing police and court records.
Police received only 337 notifications, typically made by nondoctoral staff members at public facilities such as psychiatric hospitals and crisis clinics. Patients most commonly directed their threats toward family members. Of the patients who made threats resulting in notifications, 51% had prior arrest records, and 14% had subsequent arrests. Only 52% of the patients who made threats were civilly committed.
The findings suggest that 1) clinicians rarely discharge the duty to protect in the manner specified by the law, 2) many patients whose threats result in notifications have extensive involvement with the criminal justice system, and 3) family intervention may have clinical relevance in many duty-to-protect situations.
