My psychiatrist tells me he has a "duty to warn" if I become threatening. What does that mean?

"Duty to warn" is the direct result of a famous 1974 legal case known as Tarasoff, updated to "duty to protect" after an appeal in 1976. The Tarasoff[1] case is named after the family of a girl, murdered by a man, who sued because the girl was not warned of the man's threats to murder her. "Duty to warn" refers to a legal and ethical obligation that healthcare providers have to third parties who are in danger because of threats made by their patients while under their care. This duty trumps all rights to confidentiality with respect to your privacy when confiding in a therapist or physician. In many ways it is legally similar to providers' obligation to notify the state child abuse agency if they have a suspicion of abuse. It is one of the HIPAA privacy exceptions outlined in the Notice of Privacy Acts in order "to avert serious threat to health or safety."

This duty to warn does not apply to a patient's expression of suicidal thoughts, although families of patients who committed suicide have sued clinicians for such rights because of a clinician's failure to notify them. In a case on the subject known as Bellah v. Greeson (1978) the court ruled against the idea of a Tarasoff-like warning to the patient's family, citing the greater obligation to protect confidentiality to encourage patients to seek treatment they would otherwise refuse if they knew their family would be notified. Legal experts and clinicians have, however, continued to suggest and recommend the notification of family as a serious option when a patient presents as a risk to himself or herself. Usually, under those circumstances if a clinician believes a patient is imminently suicidal, that clinician has the higher duty to protect his or her patient, which essentially obligates the clinician to hospitalize the patient either voluntarily or involuntarily.

What is NAMI? How can they help?

NAMI, an acronym for the National Alliance for the Mentally Ill, is an advocacy group made up predominantly of family members of patients and patients themselves who are suffering from mental illness. As its mission statement reports, "NAMI is dedicated to the eradication of mental illnesses and to the improvement of the quality of life of all those whose lives are affected by these diseases." From its inception in 1979 NAMI has worked very hard to advocate for the mentally ill to achieve equitable services and treatment for more than 15 million patients and their families in need. It is an all-volunteer organization with more than 1,000 local chapters in all 50 states that provide education to consumers and the community, lobby for increased research, and provide advocacy for health insurance, housing, rehabilitation, and jobs for those struggling with mental illness. Because each community has unique characteristics and needs, each chapter serves to meet these needs on an individual community basis. Their website,, can provide further information and resources for those interested in becoming involved in their local chapters.

Where can I find more information on depression?

It is not possible to discuss all possible aspects of depression in one small volume. Appendix A contains organizations, hotline numbers, and websites that can be useful to patients with depression and their families.

  • [1] the name of the family who sued the therapist involved in the care of a young man who murdered a family member. As a result of the lawsuit, therapists are now required to protect and warn potential victims from violent acts or threats made by patients under their care.
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