The Duty to Protect: Ethical, Legal, and Professional Considerations


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Book advises about ‘duty to protect’ obligation

"The Duty to Protect: Ethical, Legal, and Professional Considerations for Mental Health Professionals”
Edited by James L. Werth Jr., Elizabeth Reynolds Welfel, and G. Andrew H. Benjamin
American Psychological Association
Washington, D.C., 2009

By James K. Luiselli, Ed.D., ABPP, BCBA

In 1974, the California Supreme Court ruled that mental health professionals have a duty to warn third parties about threatened violence against them from psychotherapy patients. The so called Tarasoff decision was subsequently amended in 1976 as a duty to protect, meaning that clinicians are obliged to not only inform but to take steps that minimize the risk of violence.

This edited book goes a long way in educating us about duty to protect laws, guidelines and practices. Its 16 chapters are authored by experienced mental health professionals who are well versed in legal matters that impact clinical decision making.

Several chapters describe the evolution of duty to protect subsequent to the initial Tarasoff ruling. Knowing this history clarifies the creation of protection standards as currently constituted. However, the book explains the variability in policy development across states and the inconsistency in application that is found in different jurisdictions.

When and how is a mental health professional responsible for protecting a threatened third party? On this topic, the book advises about specific types of harm such as homicide, stalking, transmitting a communicable disease and driving to endanger. Various types of self-harm and suicide also are addressed in several illuminating chapters.

Violating mandatory duty to protect laws exposes a mental health professional to lawsuits and ethical violations but not criminal charges. Furthermore, the conditions that permit a breach of patient confidentiality are not uniform across jurisdictions. Most impressive is how astutely the book addresses these and other legal conundrums through carefully crafted chapters and numerous case illustrations.

Reading this book is the best way I know for mental health professionals to become fully informed about their legal duties relative to patients who are dangerous to others. It can be adopted for academic coursework, internship training and post-doctoral supervision, is easy to read and is tied to the American Psychological Association ethical principles of psychologists and code of conduct. My copy is close at hand with other highly valued reference volumes, as it should be for any practicing clinician.

James K. Luiselli, Ed.D., ABPP, BCBA, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.