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Mental Health Professionals Duty to Warn

Mental Health Professionals’ Duty to Protect/Warn

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January 2013
 

Most states have laws that either require or permit mental health professionals to disclose information about patients who may become violent. Those laws are receiving increased attention following recent mass shootings, such as those in Aurora, Colo., and Newtown, Conn. A New York law enacted Jan. 15, 2013, moves that state's law from a permissive to a mandatory duty for mental health professionals to report when they believe patients may pose a danger to themselves or others but protects therapists from both civil and criminal liability for failure to report if they act "in good faith." New York's new law also allows law enforcement to remove firearms owned by patients reported to be likely to be dangerous. (Note: Please see chart below for update.)

Under ethical standards tracing back to the Roman Hippocratic Oath, doctors and mental health professionals usually must maintain the confidentiality of information disclosed to them by patients in the course of the doctor-patient relationship. With some exceptions codified in state and federal law, health professionals can be legally liable for breaching confidentiality. One exception springs from an effort to protect potential victims from a patient’s violent behavior. California courts imposed a legal duty on psychotherapists to warn third parties of patients’ threats to their safety in 1976 in Tarasoff v. The Regents of the University of California. This case triggered passage of “duty to warn” or “duty to protect” laws in almost every state as summarized in the map and, in more detail, in the chart below.

Opinions about the laws vary. The American Psychological Association has advocated allowing mental health workers to exercise professional judgment regarding the duty to warn and not to unnecessarily expand “dangerous patient” exceptions. Mandatory reporting laws, say some professionals, may discourage people from seeking professional help or fully disclosing their intentions; or providers may be reluctant to treat potentially violent patients because they fear liability for failure to properly fulfill the duty to warn.

United States map of Mental Health Professionals’ Duty to Warn





























 
A-C | D-H | I-L | M | N | O-R | S-U | V-W
State Relevant Statutes Duty
Yes/No
Mandatory/Permissive Applies To Last Modified/Effective Statutory Summary Interpretation by Case Law
Alabama Ala. Code § 34-26-2 Yes Mandatory Counselors and licensed psychologists and psychiatrists.  Oct. 1, 1997 Confidential relations and communications between licensed psychologists, licensed psychiatrists, or licensed psychological technicians and their clients are placed upon the same basis as those provided by law between attorney and client. See Donohoo v. State, 479 So.2d 1188. 
Ala. Code § 34-8A-21 1979 Confidential relations and communications between a licensed professional counselor or a certified counselor associate and client are placed upon the same basis as those provided by law between attorney and client.
Ala. Code § 34-8A-24 1975 There shall be no monetary liability on the part of, and no cause of action shall arise against a licensed professional counselor or associate licensed counselor in failing to warn of and protect from a client who has communicated a serious threat of physical violence against a reasonably identifiable victim or victims. If there is a duty to warn and protect under the limited circumstances specified above, the duty shall be discharged by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency. No monetary liability and no cause of action may arise against a counselor who breaches confidentiality or privileged communication in the discharge of their duty as specified in this chapter.
Ala. Code § 34-17A-23  Therapists 1997 There shall be no monetary liability on the part of, and no cause of action shall arise against, any person who is a licensed marriage and family therapist in failing to predict and warn of and protect from a patient's violent behavior except where the patient has communicated a serious threat of physical violence against a reasonably identifiable victim or victims. The duty shall be discharged by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency. Immunity is provided for from suit relating to disclosure of confidential information. 
Alaska Alaska Stat. § 08.29.200 Yes Permissive Licensed Professional Counselor July 1, 2012 A licensed professional counselor may not reveal any communication revealed by their client when the client has employed the counselor in a professional capacity. Exceptions allow the counselor to communicate confidential information to a potential victim, the family of a potential victim, law enforcement authorities, or other appropriate authorities concerning a clear and immediate probability of physical harm to the client, other individuals, or society. Counselors are also exempted from confidentiality as mandatory reporters of child abuse or neglect and harm or assaults suffered by vulnerable adults.  
Alaska Stat. § 08.86.200 Psychologist or Psychological Associates Sept. 4, 1996 A psychologist or psychological associate may not reveal to another person a communication made to the psychologist or psychological associate by a client about a matter concerning which the client has employed the psychologist or psychological associate in a professional capacity. This section does not apply to cases where an immediate threat of serious physical harm to an identifiable victim is communicated to a psychologist or psychological associate by a client or disclosures covered under Alaska Rule of Evidence 504. Notwithstanding the confidentiality described in this section, mental health professionals are required to report abuse to children, vulnerable adults, and people with disablities.   
Alaska Stat. § 08.95.900  Licensed Social Workers and their Employees Jan. 1, 1999 A licensed social worker and their employees may not reveal any communication revealed by their client when the client has employed the social worker in a professional capacity. Exceptions allow the social worker to communicate confidential information to a potential victim or law enforcement concerning a threat of imminent serious physical harm to an identified victim made by the client. Social workers are also excepted from confidentiality requirements as mandatory reporters of child abuse or neglect and incidents of harm to vulnerable adults.  
Alaska Stat. § 47.30.845 Welfare, Social Services, and Related Institutions  July 4, 2001 Information and records obtained in the course of a screening investigation, evaluation, examination or treatment by welfare, social services and related institutions are confidential except to be disclosed to a law enforcement agency when there is a substantiated concern over imminent danger to the community by a person presumed to have a mental illness.   
Arizona Ariz. Rev. Stat. Ann. § 32-2085 Yes Permissive Licensed Psychologists and Support Staff.  1996 Places communications between client and a licensed psychologist on the same basis as those of attorney client privilege. Privilege does not extend when psychologist has a duty to report as required by law. Applies to support staff as well.  
Ariz. Rev. Stat. Ann. § 32-3283 Yes Mandatory Behavioral Health Professionals. 2006 Behavioral health professional - client privilege does not extend when the professional has a duty to (1) inform victims and appropriate authorities that a client's condition indicates a clear and imminent danger to the client or others; or (2) to report information required by law.   
Ariz. Rev. Stat. Ann. § 36-509 Yes Permissive Health Care Entity Records April 26, 2011 A health care entity must keep records and information contained in records confidential unless a specific exception is provided for. Information may be provided to Governmental or law enforcement agencies if necessary to (1) secure the return of a patient who is on unauthorized absence from any agency where the patient was undergoing evaluation and treatment; (2) report a crime on the premises; or (3) to avert a serious and imminent threat to an individual or the public.  
Ariz. Rev. Stat. Ann. § 36-517.01 N/A N/A Immunity for mental health professionals for release of information via 36-504 or 36-509. April 25, 2005 A release of information via 36-504 or 36-509 shall, at the request of the patient, be reviewed by a member of his family or a guardian. Section provides for appeal procedures. An agency or nonagency treating professional that makes a decision to release or withhold treatment information in good faith is not subject to liability for this decision.   
Ariz. Rev. Stat. Ann. § 36.517.02 Yes Mandatory  "Extends to third persons whose circumstances place them within the reasonably foreseeable area of danger where the violent conduct of the patient is a threat." (Hammon). See also Little - Ruled statute as unconstitutional for impermissibly abrogating the right of action recognized in Hammon which is now the standard for the duty to protect.  April 25, 1989 There shall be no cause of action against a mental health provider nor shall legal liability be imposed for breaching a duty to prevent harm to a person caused by a patient, unless both of the following occur: (1) the patient has communicated to the mental health provider an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable victim or victims, and the patient has the apparent intent and ability to carry out such a threat; and (2) the mental health provider fails to take reasonable precautions. Any duty owed by a mental health provider to take reasonable precautions can be fulfilled by the following: (1) communicating when possible the threat to all identifiable victims; (2) notifying a law enforcement agency in the vicinity of where the patient or any potential victim resides; (3) taking reasonable steps to initiate proceedings for voluntary or involuntary hospitalization if appropriate; or (4) taking any other precautions that a reasonable and prudent mental health provider would take under the circumstances. Whenever a patient has explicitly threatened to cause serious harm or the mental health provider reasonably concludes the patient is likely to do so, the mental health provider, for the purpose of reducing the risk of harm, can disclose confidential communications and shall be immune from liability for such disclosure.  See interpretation by Little v. All Phoenix South Community Mental Health Center (186 Ariz. 97 1995) and its reference to Hamman. 
Arkansas Ark. Stat. Ann. § 17-27-311 Yes Permissive Licensed Counselors and Licensed Associate Counselors. No - Duty to Warn/Protect; Confidentiality Enforced. (Possibly permissive disclosure if Rules of Professional Conduct for Attorney's would apply - See opinion of attorney general Ark. Op. Atty. Gen. No. 2008-110 WL4533135).  Dec. 31, 2005 Confidential relations and communications between licensed counselors and a licensed associate counselor and their clients are placed upon the same basis as those provided by law between attorney and client. See Arkansas Rules of Professional Conduct for Attorneys, Rule 1.6 which allows for disclosure to prevent future harm, specifically refer to Comments.  The statute specifically addresses disclosure as not being required, but Attorney Rules of Professional Conduct, if applicable, could result in a standard of permissive disclosure.   
Ark. Stat. Ann. § 17-97-105 Licensed Psychologists and Psychological Examiners. No - Duty to Warn/Protect; Confidentiality Enforced. (Possibly permissive disclosure if Rules of Professional Conduct for Attorney's would apply - See opinion of attorney general Ark. Op. Atty. Gen. No. 2008-110 WL4533135).  Dec. 31, 2005 Confidential relations and communications between licensed psychologists or psychological examiners and their clients are placed upon the same basis as those provided by law between attorney and client. See Arkansas Rules of Professional Conduct for Attorneys, Rule 1.6 which allows for disclosure to prevent future harm, specifically refer to Comments.  The statute specifically address disclosure as not being required, but Attorney Rules of Professional Conduct if applied could result in a standard of permissive disclosure.  See law review article for summary and cases.
Ark. Stat. Ann. § 17-103-107 Licensed Certified Social Workers, Master Social Workers and their staff. Yes - Duty to Protect - Permissive; Applies to: licensed certified social workers, licensed master social workers, and licensed social workers or their secretaries, clerks, and stenographers. Dec. 31, 2005 No licensed certified social worker, master social worker, or his or her secretary, stenographer or clerk may disclose any information he or she may have acquired from persons consulting them in their professional capacity except these professionals shall not be required to treat as confidential a communication that reveals the contemplation for a crime or a harmful act.   
California Cal. [Evid] Code § 1010  Yes Mandatory Permissive via statute but interpreted by case law as Mandatory; Applies to: Psychotherapists and all professionals included in the definition of Psychotherapists.  Jan. 1, 2012 Provides the definition of the persons who qualify as a psychotherapist or persons who the patient reasonably believes is a psychotherapist.   
Cal. [Evid] Code § 1010.5 1985 A communication between a patient and an educational psychologist shall be privileged to the same extent, and subject to the same limitations, as a communication between a patient and a psychotherapist.
Cal. [Evid] Code § 1018 Jan. 1 1967 There is no privilege under this article if the services of the psychotherapist were sought or obtained to enable or aid anyone to commit or plan to commit a crime or a tort or to escape detection or apprehension after the commission of a crime or a tort.
Cal. [Evid] Code § 1024 Jan. 1, 1967 There is no privilege if a psychotherapist has reasonable cause to believe that the patient is in such mental or emotional condition as to be dangerous to himself or to the person or property of another and that disclosure of the communication is necessary to prevent the threatened danger.
****Cal. [Civil] Code § 43.92 Jan., 2013 There is no liability for a psychotherapist as defined by section 1010 except if the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims. 
Cal. [Civil] Code § 56.10 Jan. 1, 2011 Details authorization for compelled or permitted disclosure of medical information. Specifically Lists § 1010 for the Evidence Code under which a psychotherapist can disclose if, in good faith, they believe that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a reasonably foreseeable victim or victims, and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Colorado Colo. Rev. Stat. § 13-21-117 Yes Mandatory Physician, Social Worker, Psychiatric Nurse, Psychologist or Other Mental Health Professional or hospital or clinic or institution Aug. 7, 2006 Provides that a physician, social worker, psychiatric nurse, psychologist or other mental health professional, a mental health hospital, a community mental health center, clinic, institution or their staff shall not be liable for damages in an civil action for failure to warn or protect any person against a patient's violent behavior. Any such persons mentioned shall not be held civilly liable for failure to predict such violent behavior, except where the patient has communicated to the mental health provider a serious threat of imminent physical violence against a specific person or persons. If a duty to protect arises, that duty shall be discharged by making reasonable and timely efforts to notify any person or persons specifically threatened, as well as notifying appropriate law enforcement, or by taking other appropriate action including but not limited to hospitalizing the patient. Any persons mentioned above shall not beheld civilly liable or professionally disciplined for warning any person against or predicting a patient's violent behavior. This immunity does not cover negligent release of mental health patient information or the negligent failure to initiate involuntary seventy-two-hour treatment and evaluation after a personal patient evaluation determining that the patient appears to have a mental illness, and as a result of that illness would be an imminent danger to others.   
Connecticut Conn. Gen. Stat. § 52-146c Yes Permissive Psychologists July 1, 1992 All communications between a client and a psychologist are privileged unless consent is given. Consent is not required if the psychologist believes in good faith that there is a risk of imminent personal injury to the client or other individuals or risk of imminent injury to the property of others.   
Conn. Gen. Stat. § 52-146f 1999 Consent of a patient is not required for disclosure of information if the psychiatrist determines that there is a substantial risk of imminent physical injury by the patient to himself or others, or if over the course of treatment of the patient the psychiatrist finds it necessary to disclose information for the purpose of placing the client in a mental health facility by certification, commitment, or otherwise.   
Delaware Del. Code Ann. Tit. 16 § 1211 Yes Permissive Any information collected by the Dept. of Health and Social Services. June 27, 2012 Any use of protected information  permitted shall be limited to the minimum amount of information believed to be reasonably necessary to accomplish the legitimate public health purpose.   
Del. Code Ann. Tit. 16 § 1212 June 27, 2012 Disclosure of protected health information without informed consent of the patient is allowed to the extent necessary in an emergency to protect the health or life of the patient from serious, imminent harm. Disclosure is also allowed to the public safety authority, during a public health emergency which is defined by § 1210 as a population-based activity or individual effort primarily aimed at the prevention of injury, disease, or premature mortality or the promotion of health in the community.   
Del. Code Ann. Tit. 16 § 5402 Yes Mandatory Mental health services providers 1992 A mental health provider shall not be liable nor shall any cause of action lie against them for inability to prevent harm to person or property caused by their patient unless (1) the patient has communicated an explicit and imminent threat to kill or seriously injure a clearly identified victim or victims, or to commit a specific violent act or to destroy property under circumstances which could lead to serious personal injury or death and the patient has an apparent intent and ability to carry out the threat; and (2) the  mental health provider fails to take precautions to prevent harm. This duty can be discharged by (1) notifying a law enforcement agency near the potential victim's residence or near the patient's residence of the threat of death or serious bodily injury to the clearly identified victim or victims; or (2) arranging for immediate voluntary or involuntary hospitalization in a timely manner. Provides for immunity from a cause of action for disclosing confidential information to prevent harm. Hospitals and other facilities have the same responsibilities regarding past threats of patients set to be released.   
Del. Code Ann. Tit. 24 § 3913 Yes Permissive Licensed Clinical Social Workers July 10, 1995 No clinical social worker shall be required to treat as confidential a communication from a person that reveals the planning of any violent crime or act.  
District of Columbia D.C. Code Ann. § 7-1203.03 Yes Permissive Mental Health Professionals, Mental Health Facilities, Data Collectors or Employees or Agents of a Mental Health Professional Dec. 10, 2009 Mental health information may be disclosed on an emergency basis to: the client's spouse, parent, or legal guardian, a duly accredited officer or agent of D.C. in charge of public health, the Dept. of Mental Health, a provider, the D.C. Pretrial Services Agency, The Court Services and Offender Supervision Agency, a court exercising jurisdiction over the client as a result of a pending criminal proceeding, emergency medical personnel, an officer authorized to make arrests in D.C., or an intended victim. Any disclosure shall be limited to the minimum necessary to seek hospitalization or otherwise protect the client or another individual from a substantial risk of imminent and serious physical injury.   
Florida Fla. Stat. § 394.4615 Yes Permissive Mental Health Professionals and Administrators under the Mental Health Act Jan. 1, 2005 Information from a clinical record  may be released under the Mental Health Act when the patient has declared an intention to harm other persons. If such a declaration is made an administrator may authorize the release of sufficient information to provide adequate warning to the person threatened with harm by the patient. Any facility or private mental health practitioner who acts in good faith in releasing information under this section are not subject to criminal or civil liability.   
Fla. Stat. § 456.059  Psychiatrists July 4, 2004 Communications between a patient and a psychiatrist are confidential except (1) where a patient is engaged in a treatment relationship and (2) has made an actual threat to physically harm an identifiable victim or victims and (3) the psychiatrist makes a clinical judgment that the patient has the apparent capability to commit such an act and that it is more likely than not that in the near future the patient will carry out the threat. Under those circumstances the psychiatrist may disclose patient communications necessary to warn any potential victims or to communicate the threat to law enforcement. No civil or criminal action shall be instituted and there is no liability on account of the disclosure to prevent harm.   
Fla. Stat. § 490.0147  Psychologists July 1, 1997 Any communication between a licensed psychologist and a client is confidential unless waived when there is a clear and immediate probability of physical harm to the patient or client, to other individuals, or to society. The psychologist can communicate information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities.   
Fla. Stat. § 491.0147 Psychotherapists and Counselors July 1, 2009 Any communications between psychotherapists or counselors and patients are confidential but may be waived when in the clinical judgment of the professional there is a clear and immediate probability of physical harm to the patient, to other individuals, or to society. The professional may communicate information to the potential victim, appropriate family member, or law enforcement or other appropriate authorities. The professional is immune from liability for disclosure under this section.  
Georgia Code of Ethics of the State Board of Examiners of Psychologists Ch. 510-4-.02§ 4.05 Yes/No Duty to protect when a hospitalized patient makes threats and is released negligently. No - Duty to Warn; Yes - Duty to Protect identifiable third parties via Bradley Center v. Wessner 2004 Georgia Rules of the State Board of Examiners of Psychologists have a provision allowing for discretionary disclosure of confidential information to protect the client, the psychologist or others from harm. This does not have the force of statutory law. "Where the course of treatment of a mental patient involves an exercise of “control” over him by a physician who knows or should know that the patient is likely to cause bodily harm to others, an independent duty arises from that relationship and falls upon the physician to exercise that control with such reasonable care as to prevent harm to others at the hands of the patient." - Bradley Center v. Wessner (161 Ga. App. 576).  The case involved a hospitalized patient who had made threats and was released. The provider and facility failed to continue exercising control over the patient. Subsequent case law has enforced confidentiality laws in actions against providers for providing warnings.
Hawaii Hawaii Rev. Stat. §626-1 Rule 504.1 Yes Permissive Psychologists No information. There is no privilege under this rule as to a communication reflecting the client's intent to commit a criminal or tortuous act that the psychologist reasonably believes is likely to result in death or substantial bodily harm. See Lee v. Corregedore 925 P.2d 324 for interpretation.
Idaho Idaho Code § 6-1902 Yes Mandatory Mental Health Professionals 1991 The duty to warn arises when a patient has communicated an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable victim or victims, and the patient has the apparent intent and ability to carry out such a threat.  
Idaho Code § 6-1903 2005 Mental health professionals must make a reasonable effort to communicate, in timely manner, the threat to the victim and notify the law enforcement agency closest to the patient's or victim's residence and supply a requesting law enforcement agency with any information concerning the threat. If the victim is a minor then in addition the mental health professional must make an effort  to notify the parent, noncustodial parent, or legal guardian of the minor.  
Illinois Ill. Rev. Stat. Ch. 740 § 110/11 Yes Permissive Therapist Aug. 15, 2011 When and to the extent necessary in the therapists sole discretion, disclosure is necessary to warn or protect a specific individual against whom a recipient has made a specific threat of violence where there exists a special relationship.   
Ill. Rev. Stat. Ch. 405 § 5/6-103 Yes Mandatory Physician, Clinical Psychologist, or Qualified Examiner. June 2, 2000 Any physician, clinical psychologist, or qualified examiner is immune from failure to warn or protect from a patient's threatened or actual violent behavior except where the patient has communicated a serious threat of physical violence against a reasonably identifiable victim or victims. This duty can be discharged by making a reasonable effort to communicate the threat to the victim or to a law enforcement agency, or to hospitalize the patient.   
Indiana Ind. Code § 34-30-16-1 Yes Mandatory Mental Health Service Providers 1998 A mental health service provider is immune from civil liability to persons other than the patient for failing to predict or warn or take precautions to protect from a patient's violent behavior unless the patient has communicated an actual threat of physical violence or other means of harm against a reasonably identifiable victim or victims; or evidences conduct or makes statements indicating an imminent danger that the patient will use physical violence or other means to cause serious personal injury or death to others.  
Ind. Code § 34-30-16-2 1998 The duty from §1 is discharged by making a reasonable attempt to communicate the threat to the victim or victims, making a reasonable attempt to notify police or other law enforcement who have jurisdiction over the patient's or victim's place of residence, seeking civil commitment of the patient, taking steps reasonably available to prevent the patient from using physical violence until law enforcement can be summoned to take custody, or reporting the threat within a reasonable time period to a physical or psychologist who is designated as the individual responsible to warn under this chapter.   
Iowa No information. Yes Mandatory Mental Health Providers     See Anthony v. State 374 N.W.2d 662 for statement of the standard of duty to protect in the state of Iowa - acceptance of the Thompson standard "the duty to warn depends upon and arises from the existence of a prior threat to a specific identifiable victim."
Kansas No information. Yes Permissive See case law for interpretation. Duty does not arise if the victim already knows of the danger. If a duty does arise as defined by case law, it appears to create a permissive standard. No information. No information.  See Schmidt v. HTG, Inc., 1998, 265 Kan. 372, 961 P.2d 677, certiorari denied 119 S.Ct. 409, 525 U.S. 964, 142 L.Ed.2d 332 and Boulanger v. Pol, 258 Kan. 289, 900 P.2d 823 (1995) for interpretation of any Kansas duty that exists.
Kentucky Ky. Rev. Stat. §202A.400 Yes Mandatory Mental Health Professionals including professions defined by section; Mandatory if a duty arises under specific provisions. 2002 No duty to warn/protect exists unless the patient has communicated an actual threat of physical violence against a clearly or reasonably identified victim or if they have communicated a specific violent act.   
Ky. Rev. Stat. § 645.270  Mental Health Professionals or persons serving in a counselor role. April 10, 1988 A mental health professional or a person serving in a counselor role shall be immune from liability for failing to predict, warn, or take precautions to provide protection from a patient's violent behavior unless the patient has communicated an actual threat of physical violence against a clearly or reasonably identifiable victim or unless the patient has communicated an actual threat of some specific violent act. The duty to warn is discharged by making reasonable efforts to communicate the threat to the victim and to notify the law enforcement office closest to the patient's and the victim's residence. If no particular victim is identifiable the duty has been discharged if reasonable efforts are made to communicate the threat to law enforcement. The duty is also satisfied by seeking civil commitment. The mental health professional shall be immune from suits arising from confidences disclosed to third parties in an effort to discharge the duty under this section.   
Louisiana La. Rev. Stat. Ann. §2800.2 Yes Mandatory Psychologists, Psychiatrists, Marriage and Family Therapists, Licensed Professional Counselors, and Social Workers. Jan. 1, 2010 When a patient has communicated a threat of physical violence, which is deemed to be significant in the clinical judgment of the treating psychologist..., against a clearly identified victim or victims, coupled with the apparent intent and ability to carry out such threat, a duty to warn/protect arises. The duty is discharged if the treating professional makes a reasonable effort to communicate the threat to the potential victim or victims and to notify law enforcement authorities in the vicinity of the patient's or potential victim's residence. Also provides for immunity for disclosure.  
Maine Rule of Evidence 503 No No Duty No Duty to Warn/Protect; Confidentiality Enforced.      
Maryland Md. [Cts. & Jud. Proc] Code Ann. §5-609 Yes Mandatory  Mental Health Provider or any facility that provides treatment for mental disorders. Oct. 1, 1999 A cause of action or disciplinary action may not arise against any mental health care provider or administrator for failing to predict, warn of, or take precautions to provide protection from a patient's violent behavior unless the mental health care provider or administrator knew of the patient's propensity for violence and the patient indicated to the mental health care provider or administrator, by speech, conduct, or writing, of the patient's intention to inflict imminent physical injury upon a specified victim or group of victims. The duty is discharged by seeking civil commitment, formulating a treatment plan to eliminate the threat, or informing law enforcement in a reasonable and timely manner. Immunity provision for disclosure.  
Massachusetts Mass. Gen. Laws Ann. Ch. 123 § 36B Yes Mandatory Licensed Mental Health Professionals Oct. 1, 1999 There shall be no duty owed by a licensed mental health professional to take reasonable precautions to warn or in any other way protect a potential victim or victims of said professional's patient, and no cause of action imposed against a licensed mental health professional for failure to warn or in any other way protect a potential victim or victims of such professional's patient unless: (a) the patient has communicated to the licensed mental health professional an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims and the patient has the apparent intent and ability to carry out the threat, or (b) the patient has a history of physical violence which is known to the licensed mental health professional and the licensed mental health professional has a reasonable basis to believe that there is a clear and present danger that the patient will attempt to kill or inflict serious bodily injury against a reasonably identified victim or victims and the mental health professional fails to act.  
Michigan Mich. Comp. Laws § 330.1946 Yes Mandatory Mental Health Professionals March 28, 1996 If a patient communicates to a mental health professional who is treating the patient a threat of physical violence against a reasonably identifiable third person and the recipient has the apparent intent and ability to carry out that threat in the foreseeable future, the mental health professional has a duty to take action. The duty is discharged by hospitalization, communicating to the third person and notifying local law enforcement, warn social services or the custodial parent or guardian if the victim is a minor. Immunity from liability for disclosure.  
Minnesota Minn. Stat. §148.975 Yes Mandatory  Psychologists 1996 The duty to predict, warn of, or take reasonable precautions to provide protection from, violent behavior arises only when a client or other person has communicated to the licensee a specific, serious threat of physical violence against a specific, clearly identified or identifiable potential victim. If a duty to warn arises, the duty is discharged by the licensee if reasonable efforts are made which includes: communicating the serious, specific threat to the potential victim and if unable to make contact with the potential victim, communicating the serious, specific threat to the law enforcement agency closest to the potential victim or the client. Immunity from liability provision for disclosure.   
Mississippi Miss. Code Ann. §42-21-97 Yes Permissive Physicians, Psychologists, Licensed Master Social Workers or Licensed Professional Counselors. July 1, 2006 When the patient has communicated to the treating physician... an actual threat of physical violence against a clearly identified or reasonably identifiable potential victim or victims, and then the treating physician... may communicate the threat only to the potential victim or victims, a law enforcement agency, or the parent or guardian of a minor who is identified as a potential victim.  
Missouri Mo. Rev. Stat. §632.300 Yes Mandatory  Mental Health Coordinators. **See Common Law which makes mandatory. 1996 Procedure when physical harm possibilities are alleged. See also Virgin v. Hopewell Center discussing Bradley v. Ray (66 S.W.3d 21) for common law duty to warn. 
Montana Mont. Code Ann. § 27-1-1102 Yes Mandatory Mental Health Professionals Oct. 1, 2009 A mental health professional has the duty to warn of or take reasonable precautions to provide protection from violent behavior only if the patient communicates an actual threat of physical violence by specific means and against a clearly identified or reasonably identifiable victim. The duty is discharged by making a reasonable effort to communicate the threat to the victim, notifying the law enforcement agency closest to the patient or victims residence, and supplying any requested information concerning the threat of violence to the law enforcement agency.   
Nebraska Neb. Rev. Stat. §38-3132 Yes Mandatory Psychologists 2007 There is no cause of action or duty to warn except when a patient has communicated a serious threat of physical violence against a reasonably identifiable victim or victims. This duty is discharged if reasonable efforts are made to warn the victim or notify law enforcement. Immunity from suit for disclosure.   
Nevada No information. No No Duty No Duty to Warn/Protect.   No information.   
New Hampshire N.H. Rev. Stat. Ann. § 329-B:29 Yes Mandatory Licensed Psychologists July 1, 2013 Any person licensed via the state as a Psychologist has a duty to warn or to take reasonable precautions to provide protection from a client's violent behavior when the client or patient has communicated a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims, or a serious threat of substantial damage to real property. This duty may be discharged by making reasonable efforts to communicate the threat to the victim or victims, notifying the police department closest to the client or patient's residence, or obtaining civil commitment of the client. Provides for immunity from liability concerning breach of client privacy or confidentiality.   
New Jersey N.J. Rev. Stat. §2A:62A-16 Yes Mandatory Psychologists, Psychiatrists, MDs, Nurses, Clinical Social Workers or Marriage Counselors  Aug.11, 2010 A duty to warn arises if the patient has communicated to the practitioner a threat of imminent, serious physical violence against a readily identifiable individual or against himself and the circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out the threat; or the circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out an act of imminent, serious physical violence against a readily identifiable individual or against himself. The duty is discharged by arranging hospitalization, involuntary commitment, advising law enforcement of the identity of the intended victim, warning the victim or their parent or guardian of the patient if the threat is of self inflicted violence.   
New Mexico  No information. Yes Permissive See common law for distinctions.     See Estate of Eric S. Haar v. Ulwelling 141 N.M. 252, Wilschinsky v. Medina 108 N.M. 511 and Weitz v. Lovelace Health System 214 F.3d 1175 for interpretation of New Mexico's Duty to Warn/Protect.
New York N.Y. [Mental Hygiene] Law §9.46 Yes Mandatory Mental health professionals Enacted January 15, 2013 by Senate Bill 2230 Requires mental health professional who has determined that a patient presents a serious and imminent danger to himself or others to report. Reasons for disclosure must be documented in the clinical record. This section imposes a mandatory duty to report on mental health professional s while protecting mental health professionals who discharge the duty in good faith from both civil and criminal liability.  
North Carolina No information. No No Duty No Duty to Warn/Protect.     See Gregory v. Kilbride, 565 S.E.2d 685 (2002) specifically not recognizing Tarasoff duty to protect.
North Dakota No information. No No Duty No Duty to Warn/Protect.   No information.  
Ohio Ohio Rev. Code Ann. §2305.51 Yes Mandatory Mental Health Professionals, Services and Organizations 1999 A mental health professional or mental health organization may be held liable in damages in a civil action, or may be made subject to disciplinary action by an entity with licensing or other regulatory authority over the professional or organization, for serious physical harm or death resulting from failing to predict, warn of, or take precautions to provide protection from the violent behavior of a mental health client or patient, only if the client or patient or a knowledgeable person has communicated to the professional or organization an explicit threat of inflicting imminent and serious physical harm to or causing the death of one or more clearly identifiable potential victims, the professional or organization has reason to believe that the client or patient has the intent and ability to carry out the threat, and the professional or organization fails to take action. Acceptable action includes hospitalization, commitment, a treatment plan, notifying law enforcement, and communicate to the victim or the victims guardian.  
Oklahoma Okla. Stat. Tit.59 §1376 Yes Permissive Psychologists including clerical, academic and therapeutic, or their employees. April 27, 2004 All communications are confidential except when the patient is a clear and present danger to himself or the patient has communicated an explicit threat to kill or inflict serious bodily injury upon a reasonably identified person and has the apparent intent and ability to carry out the threat. Another circumstance is when the patient has a history of known physical violence and the professional has a reasonable basis to believe that there is clear and imminent danger that the patient will kill or inflict serious bodily injury upon a reasonably identified person. In such circumstances a duty to take reasonable precautions arises. This can be accomplished by communicating the threat to the victim, notifying law enforcement, arranging for hospitalization, or commitment.   
Oregon Or. Rev. Stat. §179.505 Yes Permissive Health Care Providers Aug. 5, 2011 Information is confidential unless during diagnosis, evaluation or treatment the professional judgment of the health care services provider indicates a clear and immediate danger to others or to society at which point the information may be reported to the appropriate authority.   
Pennsylvania No information. Yes Mandatory Mental Health Professionals     See Emerich v. Philadelphia Ctr. For Human Dev., Inc., 720 A.2d 1032 (1998) for interpretation of duty in Pennsylvania.
Puerto Rico

24 L.P.R.A.

§ 6513q

Yes Mandatory
 

Physicians, Psychiatrists, Psychologists, Social Workers, Professional Counselors, or Healthcare professionals. Requires others rendering services to a mental health patient, to inform the healthcare professional in charge, of threats.

August 6, 2008 The physician, psychiatrist, psychologist, social worker, professional counselor, or other healthcare professional shall warn the person under threat, and notify police. If the person is not able to understand or is a minor, the provider is to notify a family member of the existence of the threat. If criteria are met, provider should initiate procedures for voluntary or involuntary hospitalization. Providers must document the clinical record for threats made by hospitalized patients. If therapeutically indicated, providers are to inform the person who made the threat of their duty to warn.  
Rhode Island R.I. Gen. Laws §5-37.3-4 Yes Permissive Health Care Providers June 16, 2010  The least amount of information necessary may be disclosed by a health care provider to appropriate law enforcement personnel, or to a person if the health care provider believes that person or his or her family is in danger from a patient.  
South Carolina S.C. Code Ann. §42-22-90 Yes Permissive  Mental Health Professionals including General Physicians, Psychiatrists, Psychologists, Psychotherapists, Nurses, Social Workers, or other staff members employed in a patient therapist capacity or employees under supervision. 1991 Patients may prevent disclosure except in an emergency where information about the patient is needed to prevent the patient from causing harm to himself or others.  
South Dakota S.D. Codified Laws Ann. §27A-12-29 Yes Permissive All Record Holders 2007 The holder of the records may disclose information when the patient has communicated a serious threat of serious physical injury against a reasonably identifiable victim, the person with knowledge of the threat may disclose the threat to the potential victim or to any law enforcement officer, or both. No cause of action may arise under this chapter against the person who, in good faith, discloses the threat to a potential victim or law enforcement officer pursuant to the provisions of this subdivision.  
Tennessee Tenn. Code Ann. §33-3-206 Yes Mandatory Qualified Mental Health Professional or Behavioral Analysts. July 1, 2002 Mental health professionals may predict, warn or take precautions if and only if an actual threat of bodily harm against a clearly identified victim is communicated and the professional, using the reasonable skill, knowledge, and care ordinarily possessed and exercised by the professional's specialty under similar circumstances, has determined or reasonably should have determined that the service recipient has the apparent ability to commit such an act and is likely to carry out the threat unless prevented from doing so.  
Tenn. Code Ann. §33-3-207 March 1, 2002 The duty is discharged by voluntary admission to the hospital, warning potential victims, pursuing involuntary commission or taking a course of action consistent with professional standards.   
Tenn. Code Ann. §33-3-208 July 1, 2002 Employees of Mental Health Professional shall tell the professional if they receive communication of a threat against a specific victim from a recipient of services.   
Tenn. Code Ann. §33-3-209 March 1, 2001 Immunity from liability.  
Texas Tex. [Health and Safety] Code Ann. §611.004 Yes Permissive Mental Health Professionals Sept. 1, 2005 A mental health professional may disclose information only to medical or law enforcement personnel if the professional determines that there is a probability of imminent physical injury by the patient to the patient or others or there is a probability of immediate mental or emotional injury to the patient.  
Utah Utah Code Ann. §78B-3-502 Yes Mandatory Therapists May 12, 2009 A therapist has no duty to warn or take precautions to provide protection from any violent behavior of his client or patient, except when that client or patient communicated to the therapist an actual threat of physical violence against a clearly identified or reasonably identifiable victim. That duty shall be discharged if the therapist makes reasonable efforts to communicate the threat to the victim, and notifies a law enforcement officer or agency of the threat.  
Vermont No information. Yes Mandatory  Mental Health Agency, Psychotherapist, Counselor.      See Peck v. Counseling Serv. Of Addison County, Inc., 499 A.2d 422 (1985) for interpretation of duty - appears to apply to threats to real property in addition to threats to people. 
Virginia Va. Code §54.1-2400.1 Yes Mandatory Mental Health Service Providers as defined by statute. July 1, 2010 A mental health service provider has a duty to take precautions to protect third parties from violent behavior or other serious harm only when the client has orally, in writing, or via sign language, communicated to the provider a specific and immediate threat to cause serious bodily injury or death to an identified or readily identifiable person or persons, if the provider reasonably believes, or should believe according to the standards of his profession, that the client has the intent and ability to carry out that threat immediately or imminently. Duty is discharged by begins involuntary commitment, warns the victim or their parents, notifies law enforcement, any means necessary until law enforcement arrives, or counsels the client until it is no longer necessary. Immunity from liability for disclosure.  
Washington Wash. Rev. Code §71.05.120 Yes Mandatory Public and Private Mental Health Professionals and Agencies. June 8, 2000 Provides immunity from liability for acting in good faith. Does not exempt from the duty to warn or to take reasonable precautions to provide protection from violent behavior where the patient has communicated an actual threat of physical violence against a reasonably identifiable victim or victims. The duty to warn or to take reasonable precautions to provide protection from violent behavior is discharged if reasonable efforts are made to communicate the threat to the victim or victims and to law enforcement personnel.  
Wash. Rev. Code §71.05.390 July 22, 2011 Exception to confidentiality for threat or harassment see 10(a).   
West Virginia W.Va. Code §27-3-1 Yes Permissive Mental Health Professionals June 5, 2008 Confidential information shall not be disclosed except for to protect against a clear and substantial danger of imminent injury by a patient or client to himself, herself or another.  
Wisconsin No information. Yes Mandatory Psychotherapists     See Schuster v. Altenberg, 424 N.W.2d 159, (1988) for discussion of the duty to warn in Wisconsin.
Wyoming Wyo. Stat. §33-38-113 and 33-27-123 Yes Permissive Psychologists, Professional Counselors, Marriage and Family Therapists, Social Workers, and Chemical Dependency Specialists. March 1, 1999/July 1, 2009 Confidentiality is enforceable except where an immediate threat of physical violence against a readily identifiable victim is disclosed to the psychologist.  

Sources: NCSL Staff Research; Edwards, Griffin Sims. Database of State Tarasoff Laws, February 2010; Soulier, M., et al. "Status of the Psychiatric Duty to Protect, Circa 2006." J Am Acad Psychiatry Law 38:457-73, 2010.

 

 

 

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