Steps:
(1) Clarify the threat
(2) Determine the severity and actuality of danger
(3) Identify potential victim(s).
(4) Determine the imminence of danger.
(5) Classify the potential victim(s).
(6) Determine the suitability of family therapy.
(7) Take appropriate action.
All decisions should be clearly documented with the rationale for the choices made. The clinician is held to the standard of reasonable care.
Step 1: Clarify the threat.
(1a) The threat should be assessed to determine if it is a clear threat of injury vs a vague threat unlikely to be acted upon.
(1b) In cases where there is uncertainty, a reasonable inquiry should be made.
(1c) If the threat is clear, then proceed to Step 2.
Step 2: Determine the severity and actuality of danger.
(2a) The danger should be assessed as being serious vs marginal.
(2b) The patient's rights should be recognized and inappropriate interventions should be avoided.
(2c) The clinician may want to consult with a colleague, supervisor or other professional.
(2d) If a serious danger is felt to exist, then proceed to Step 3.
Step 3: Identify potential victim(s).
(3a) The clinician should then try to identify the potential target or targets against which the serious threat may be directed.
(3b) If the potential target or targets can be identified, then the clinician needs to proceed to Step 4.
(3c) In some jurisdictions the clinician may need to proceed even if a victim cannot be identified.
Step 4: Determine the imminence of danger.
(4a) If the threat does not appear to be imminent, then the clinician should take steps to reduce the patient's potential for violence.
(4b) If the danger appears imminent, then the clinician needs to proceed to Step 5.
Step 5: Classify the potential victim(s).
(5a) The possible target or targets are classified as one of the following groups: (a) public official, (b) family members or significant other, (c) all other persons.
(5b) If the target is a public official, then the police should be notified immediately.
(5c) If the target is a family member or significant other, then proceed to Step 6.
(5d) If the target is anyone else, then proceed to Step 7.
Step 6: Determine the suitability of family therapy.
(6a) If the target is a family member or significant other, then the situation should be evaluated for the suitability of family therapy to safely address the underlying issues.
(6b) If family therapy does not appropriate, then the clinician should proceed to Step 7.
Step 7: Take appropriate action.
(7a) Options include (a) committing the patient to a mental institution, (b) warn the victim, (c) warn the victim's relatives, (d) notify the police, (e) any other steps that seem reasonable.
Limitations:
• The recommendations here were made in 1987 and new legal developments may have occurred in the interim that would modify the recommendations.
