Psychiatry, particularly community psychiatry, involves dealing with risk. There is a balance: you must keep patient information confidential. particularly in therapy, where you will be talking about fantasies, ideas you dislike, and very personal and private events in your life. However, there is a limit, and generally that is if someone threatens a particular person.

A general duke of a subgroup of people — men, or whites — does not count. It has to pe a particular person. A particular event, a particular time.

However, some lawyers want to make therapists responsible in retrospect for a more general threat. The APA is getting involved, and here with good reason.

The case, Rosen v. Regents of the UCLA, arose when Damon Thompson, a student treated by UCLA’s counseling service, attacked and stabbed a fellow student, Katherine Rosen.

Under California law, a therapist has a “duty to protect” a potential victim if the patient makes a reasonably identifiable threat to harm a specific person.

“If the patient makes a threat, the therapist takes action,” said forensic psychiatrist Steven Kenny Hoge, M.D., chair of APA’s Council on Psychiatry and the Law. This approach is realistic, given that prediction of specific violent acts remains an uncertain art, he said.

The therapist also can use information given by third parties, like a patient’s family, as the source for a warning, said Hoge. The duty is discharged by informing the intended victim and/or law enforcement officials.

However, according to testimony in the original trial, Thompson made no such identifiable threats or even indicated any intention to commit violence to his therapist, Nicole Green, Ph.D.

Rosen sued Green and the university and the trial judge agreed, stating that Green “may have voluntarily assumed the duty” to protect Rosen simply by providing Thompson with mental health care. Rosen’s lawyers, in essence, now argue that the overall behavior of the patient rather than a specific threat should be taken as “communication” of a threat, placing liability onto the therapist.

The judge also said that the immunity clause of the relevant California statute—which rules out monetary liability or even any “cause of action” against a therapist without a specific threat—did not apply in this case.

The judgment in favor of Rosen was overturned on appeal, but Rosen has now appealed to the Supreme Court of California.

“APA usually gets involved with cases when they rise above the state level, but this case had the potential to have national significance so we got involved now,” said Marvin Swartz, M.D., a professor of psychiatry and behavioral sciences at Duke University School of Medicine and chair of APA’s Committee on Judicial Action. “If the plaintiff prevails, it could have a chilling effect on the field of psychiatry because it would eliminate any expectation of confidentiality in the therapeutic relationship.”

When something goes horribly wrong (and this did go horribly wrong) there is always a question of utu: retribution. People want another to take the blame. Lawyers get involved: many lawyers will go where a weasel would not.

The reality is that there is a balance between confidentiality and keeping the public safe. There is a balance between autonomy (letting people do what they want to) and keeping he person (or others) safe. The law and society swings.

Blut these very swings have consequences. If you want a safe space, you have to accept that there will be large psychiatric hospitals and larger jails, with people held because of a general fear of their risk. You have to accept that others may consider your beliefs threatening, or hold you to the same standard you hold others to.

For the though of risk is not the assault or murder. Psychiatrists are not prophets. And to ascribe, by legal precedent, powers to any human that they do no have, and to hold them to a standard beyond what is reasonable, is not merely evil

It will destroy access to any care, for anyone.