Twenty Years after Tarasoff: Reviewing the Duty to Protect

Anfang, Stuart A.; Appelbaum, Paul S.

doi:10.3109/10673229609030526

Cited by 25 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Violent behavior and mental illness, unlike suicidality and mental illness, are not tightly linked (2,3). Findings of the Epidemiologic Catchment Area Study indicate, for instance, that 90% of persons with mental illness are nonviolent (4).…”

Section: Suicide Violent Behavior and Mental Illnessmentioning

confidence: 99%

“…The 1974 and 1976 Tarasoff rulings in California changed the climate of psychiatric practice, mandating a duty both to warn and to protect individuals who are endangered by a potentially violent person with mental illness. In such situations, the patient's privilege of confidentiality is overridden by the imperative to seek to preserve others' safety (3). The standard of care in these emergency situations is to inform the endangered individual of a threat and to try to ensure his or her safety and to obtain collateral information from police officers, family members, friends, or staff of health care and social service agencies.…”

Section: Duty To Warn and Duty To Protectmentioning

confidence: 99%

See 1 more Smart Citation

Ethics Commentary: Ethical Use of Power in High-Risk Situations

Roberts¹

2012

FOC

View full text Add to dashboard Cite

Section: Suicide Violent Behavior and Mental Illnessmentioning

confidence: 99%

Section: Duty To Warn and Duty To Protectmentioning

confidence: 99%

Ethics Commentary: Ethical Use of Power in High-Risk Situations

Roberts¹

2012

FOC

View full text Add to dashboard Cite

“…Psychiatrists have an understandable desire to protect both their patients and people who might be harmed by them, as well as a requirement to abide by local mental health laws and statutory and common law duties of care to patients and to others. 35 Clinical assessment remains the most common way of estimating the likelihood of future harm. 36 In mental health, the costs and losses involved cannot always be defined in financial terms, but the core principles of risk assessment are the same as those of insurance.…”

Section: Risk Assessment In Mental Healthmentioning

confidence: 99%

Probability and loss: two sides of the risk assessment coin

Nielssen

2011

Psychiatrist

View full text Add to dashboard Cite

Assessment of the probability of future harm, often referred to as a 'risk assessment', has been widely adopted in mental healthcare settings in an attempt to reduce the incidence of violence and self-harm. The aim of risk assessment is to identify individuals who are at greater risk of harm and provide those patients with a higher level of treatment and supervision, thereby reducing the incidence of harm. The term 'risk assessment' is used in a variety of ways, from the opinion of an experienced clinician about dangerousness to the use of a score derived from a checklist of factors associated with a range of harmful behaviours, particularly violence to others or suicide. The ability to assess risk is regarded as an essential skill for mental health practitioners 1 and the practice guidelines issued by governments and by professional bodies suggest that we are able to predict and prevent many forms of harm. [2][3][4] Assessing whether an individual is likely to harm themselves or others is part of the mental health law in most high-income countries, 5-7 and the routine use of structured instruments to estimate the probability of future harm, often referred to as actuarial methods, are widely believed to be a way of reducing the incidence of violence 8-12 and self-harm. [13][14][15] Criticisms of risk assessment have been made on statistical, ethical and empirical grounds. Statistical arguments note the lack of accuracy of predictions and highlight both the high rates of false-positive predictions for most forms of harm and the failure to identify many cases. [16][17][18][19][20] Ethical arguments against risk assessment include the potential for the denial of care to those classified as at low risk 7 and the discriminatory treatment of people who have been categorised as being at high risk but do not go on to cause or experience harm. 21,22 Another ethical problem with risk assessment is the way it devalues patients by underestimating their capacity for choice 23 and alienates them from participating in decisions about their own care. 24 The empirical arguments against risk assessment include the near complete absence of published evidence that the adoption of risk assessment can result in a reduction in any form of harm. The one exception to this is a clusterrandomised trial of nine psychiatric wards that examined violence for 3 months after the adoption of structured risk assessment. 9 This study reported a significant reduction in violence in the experimental wards. However, the two groups of wards were not matched for levels of violence before the trial and after the intervention the incidence of violence in the experimental wards returned to the level of the control wards, suggesting that the results obtained were a result of regression to the mean rather than a true effect. 25 Moreover, the vast majority of predictions of harm were false positives. A more recent study, also of violence in psychiatric wards found that violence risk assessment was not associated with a sustained reduction in violent incidents...

show abstract

“…The establishment of what has become known as a ‘duty to warn’ caused considerable concern among mental health professionals (Mason 1998). The Court ruling was thus promptly challenged by the APA (1974) who asserted that as psychiatrists and other mental health professionals had no ability to predict violence, the requirement to warn would result in many false positive reports creating fear and alarm in potential victims when there was no real danger and that the requirement to warn would undermine the confidentiality of therapist and patient unnecessarily (Anfang & Applebaum 1996). The Supreme Court agreed to hear the case again and in 1976 (Tarasoff v Regents of California 551 P2d 333 Cal 1976) they issued a second opinion.…”

Section: Before Tarasoffmentioning

confidence: 99%

New evidence or changing population? Reviewing the evidence of a link between mental illness and violence

Paterson

Claughan

McComish

2004

Int J Mental Health Nurs

View full text Add to dashboard Cite

There has been an apparent shift in majority opinion within psychiatry over the last 20 years on the nature of the relationship between mental illness and violence. Where once there was perhaps widespread scepticism, research, while sometimes producing conflicting results, appears ultimately to have led to the emergence of an almost universal consensus that there is a link. This paper will review the nature of the evidence for such a link between mental illness and violence and explore some of the newer suggestions about why mental illness may sometimes be related to violence.

show abstract

Twenty Years after Tarasoff: Reviewing the Duty to Protect

Cited by 25 publications

References 22 publications

Ethics Commentary: Ethical Use of Power in High-Risk Situations

Ethics Commentary: Ethical Use of Power in High-Risk Situations

Probability and loss: two sides of the risk assessment coin

New evidence or changing population? Reviewing the evidence of a link between mental illness and violence

Contact Info

Product

Resources

About