Psych Vivas · Forensic psychiatry — duty to warn and third-party risk
Duty to warn and third-party risk — structured clinical viva
Fellowship viva on Tarasoff principles, confidentiality limits, protective options, jurisdiction humility, and documentation.
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Reveal interpretationShowHide
Do not invent statute numbers. If asked for a section, say you would verify the current local Mental Health Act criteria and organisational policy, and answer with principles: mental disorder, risk to others, least restrictive alternative, capacity interfaces, rights to review.[3][4]
Warn vs protect. Tarasoff I teaching: duty to warn identifiable victims. Tarasoff II: duty to protect via reasonable steps — warning is one tool among hospitalisation, police notification, means control, intensified treatment.[1][2][3]
Appelbaum model. (1) Assess dangerousness — named boss, bat in car, tomorrow, manic psychosis. (2) Select protective course — likely emergency containment plus disclosure. (3) Implement and document.[1]
Tonight's actions. Safety of clinic; prevent free departure if imminence high and lawful options exist; seek admission (voluntary if safe/possible; compulsory if criteria met); remove bat access via lawful help; treat mania/psychosis; notify police and warn boss with minimum necessary information; clear crisis plan. Police response varies — communicate actionably.[3][5]
Jurisdiction framing. ABPN: expect US state variation discussion (mandatory/permissive/limited duty). FRANZCP: ethics codes, privacy exceptions, local MHA — not California statute export. Multi-board answers score humility plus concrete clinical action.[4][2]
Alliance. Explain you cannot keep a secret that enables serious harm; care continues; warning may strain trust — repair explicitly.[6]
Diagnosis ≠ duty. Mania raises risk pathway here because of specific threat, means, and target — not because bipolar disorder automatically voids confidentiality.[7][1]
References7ShowHide
- [1]Appelbaum PS Tarasoff and the clinician: problems in fulfilling the duty to protect Am J Psychiatry, 1985.PMID 3976915
- [2]Anfang SA, Appelbaum PS Twenty years after Tarasoff: reviewing the duty to protect Harv Rev Psychiatry, 1996.PMID 9384976
- [3]Knoll JL The psychiatrist's duty to protect CNS Spectr, 2015.PMID 25712614
- [4]Johnson R, Persad G, Sisti D The Tarasoff rule: the implications of interstate variation and gaps in professional training J Am Acad Psychiatry Law, 2014.PMID 25492073
- [5]Guina J, Dornfeld B, Pinals DA A 20-year follow-up survey of police officers' experience with Tarasoff warnings: How law enforcement reacts to clinicians' duty to protect Behav Sci Law, 2022.PMID 35195297
- [6]Binder RL, McNiel DE Application of the Tarasoff ruling and its effect on the victim and the therapeutic relationship Psychiatr Serv, 1996.PMID 8916238
- [7]Large MM, Ryan CJ, Nielssen OB Helpful and unhelpful risk assessment practices Psychiatr Serv, 2010.PMID 20439381