Hey There,

Its interesting to compare how different cultures handle the same situation.

I am not sure if the laws for this are the same across all states, but I can tell you what the laws are locally where I am at. (that would be in California).

A mental health professional or para professional have complete confidentiality unless they have reason to believe that the client is a danger to themselves or others. The question that was touched on above is if the clinician is obligated to ask certain questions to find out if the client is a danger to themselves or others. I absolutely think the clinician is obligated to ask, and to fully asses the answers. Even in situations where they "think" they might already know the answer.

In effect this means that any professional or para professional can contact the emergency response phone numbers and report a client as a danger to themselves or others. The police is then subsequently send out to the person and most often they follow the recommendations of the reporting professional and pick up the individual to be taken to the nearest emergency psychiatric unit for observation. A person that has been picked up will be put on a 72 hour observation during which time they are effectively restrained from leaving. They might be let go before the 72 hours are up if they have been fully evaluated and the risk to anyone's life seems to be contained. The 72 hour hold is to give the professionals enough time to completely evaluate the situation.

If a person is to be held against their will for more than 72 hours then the hospital need to gather evidence that this person is an ongoing risk to have in society and convince a judge that it is so. In practice this does not happen often because there is a considerable expense to society and this being such a capitalistic society no-one really wants to foot the bill for it. Most often the person is put on meds, given some time to settle down, and then released back into society with a prescription for meds. Some places the person might be offered further help after they are released. Other places no further help is offered.

The fact that it can be only the word of one professional or even a para professional that can land a person in a psychiatric unit can seem rather lax, but I personally like it. I will rather have one too many person fully evaluated, than one person to few. Of course clients around the country have to be careful of carelessly saying "damn it, I am just gonna kill myself or someone else" as a way to let off steam. If they do that around a mental health worker then they should expect some quite probing questions about when, where and how such an act would take place. THreats like that can land a person in some trouble, so its best not to say it carelessly. Again, I would rather that people who makes threats are offered help BEFORE they carry out the threats than after. If they never meant it to begin with maybe they need to look for a more constructive way to let off steam.

While we certainly cant make mental health workers responsible for every dangerous act a client might engage in, I do think we can expect mental health workers to be trained to ask some hard questions to fully evaluate a clients risk level, and to be ready and willing to respond to the answers given.

In the situation of Mrs. Yeates who was psychotic and under psychiatric care I absolutely think the doctors should be able to prove that they asked her if she wanted to kill anyone including herself. Or if the voices told her to hurt anyone. Answers to such questions could possibly have prevented the death of three innocent children. Even if she lied the professionals would have known that they at least did their best, and they would not be vulnerable to lawsuits. Neglecting to ask the questions is NOT "doing their best". Its down and out sloppy work. *If* the professionals really neglected to ask Mrs. Yeates the hard questions I think they should be sanctioned or at least given further training.

As a former mentor on the suicide and crisis hotline told me, asking the questions shows caring and concern. It provides a person the space to truly share what is going on inside them.

Da Friendly Puter Tech.

ADMIN. NOTE: If you would like to respond to this post, please consider going to the same post in the "Criminal Responsibility . . ." thread and responding there unless your comments are related to the initial "suicide" topic. Thanks, Bill Reid