Under the theory of failure to warn, what can a psychotherapist do if a patient expresses the intent to do harm?

In situations where a patient expresses the intent to harm themselves or others, psychotherapists have a legal and ethical duty to take appropriate action to prevent that harm. Under the theory of failure to warn, when a clinician has reasonable grounds to believe that a patient poses a significant threat to a specific individual or the public, they are allowed—and sometimes required—to breach confidentiality to warn the intended victim or notify law enforcement.

This duty is grounded in the responsibility to protect third parties and is informed by precedents such as the Tarasoff case, which set a standard for mental health professionals when it comes to imminent threats. By opting to warn the intended victim, the psychotherapist actively works to prevent potential harm and fulfills their ethical obligation to prioritize safety over confidentiality in this specific context.

Referral to another professional or requiring waivers does not adequately address the immediate threat to safety. Ignoring the threat could lead to tragic consequences, reflecting negligence in duty of care. Therefore, the decision to warn an intended victim is not only appropriate but necessary within the framework of mental health practice and ethics.