What if a therapist sees danger signs?

Aug 1, 2012

When do psychiatrists have a responsibility to break doctor, patient confidentiality? Credit: AP

Court documents in the Colorado massacre case show the suspect was seeing a psychiatrist. Dr. Lynne Fenton of the University of Colorado specializes in schizophrenia and is medical director of student mental health services.

Some are asking whether it’s possible she saw signs that James Eagan Holmes was dangerous. A question that will likely emerge during the investigation and trial is whether she could have warned police he had psychotic tendencies.

The American Psychiatric Association cautions the public on this issue. Its official position says, “[Psychiatrists] cannot predict dangerousness with definitive accuracy. Over any given period some individuals assessed to be at low risk will act violently while others assessed to be at high risk will not.”

What types of patients or behaviors are therapists required to report? Could random acts of violence be averted with different reporting rules? How often do mental health professionals loop in law enforcement on problematic patients? What are the rules around that process?


Dr. Renee Binder, M.D., Professor of Psychiatry & Director, Psychiatry and the Law program, University of California, San Francisco; Member of the Workgroup on Violence Risk, American Psychiatric Association

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