Week 4 of Educational Series on Mental Health in Florida: Understanding the Duty to Warn

         When a person expresses intent to harm someone, mental health providers are required to notify the intended victim(s). This requires the disclosure of this information to the person at risk. This does not, however, allow providers to disclose other information, such as the patient’s diagnosis or treatment; the patient still has rights to privacy of their medical/mental health records.

Let’s look at two real-life scenarios in which this was applied. Identifying information has been excluded to maintain patient confidentiality.

Case #1

The patient was admitted to an inpatient crisis stabilization unit for treatment of extreme paranoia and hearing voices telling him that he was in danger. Additionally, he believed his girlfriend was trying to poison him, was carrying a knife around the house, and had threatened her. He had been receiving treatment for schizophrenia for decades, and this was not his first admission. When he took his prescribed medications, his symptoms resolved, but he had stopped taking them.

Upon admission, his medications were restarted. After 3 or 4 days, he was no longer paranoid or hearing voices. However, prior to the provider ordering his discharge, the patient shared that he believed his (adult) daughter needed to be sacrificed in order to save the world from an apocalypse. In response to this, staff located his daughter (which was not an easy task) and notified her that her father expressed intent to kill her. She stated she had been made aware of this several years ago, and that she had moved away from the area and had no contact with her father. Subsequently, because this patient no longer met the criteria for involuntary treatment, he was discharged home.

Case #2

This was an adolescent female who had been admitted for suicidal thoughts and hitting her mother in a fit of uncontrolled rage. After extensive evaluation, she was diagnosed with depression and oppositional defiant disorder. After taking medications for about 10 days accompanied by intensive therapy, her mood improved, she was no longer suicidal, and was not angry with her mother.

In the process of planning this patient’s discharge, she disclosed that she planned to take a gun to school and commit a mass shooting. Therefore, staff was required to notify the school administration of this threat. Following this, the patient was discharged to the care of her mother, who agreed to keep her at home under constant supervision. Obviously, she was not permitted to return to school.

Many people believe that when a person threatens to harm others, they should be incarcerated or placed in a mental health facility. I will abstain from sharing my opinion at this time, as I would like to hear your thoughts on this controversial topic.

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