Duty to Warn

Submitted by lcmisoi@mainsl.com on Mon, 04/06/2020 - 12:19
Policy: 

The Health Insurance Portability and Accountability Act (HIPAA) stipulates that an individual’s personal information may be released without consent for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or a group of persons.

Mains’l protects the confidentiality of information related to clients within limits. These limits are discussed with all clients prior to beginning service and clients are asked to sign the Informed Consent document acknowledging that they have had these limits explained to them. This document also outlines the types of situations in which Mains’l may breach confidentiality.

Mains’l reserves the right to breach confidentiality to notify authorities, persons who know the client and/or persons who are at risk of harm in situations where the individual presents a significant and imminent risk of harm to himself/herself or others. This right is known as “duty to warn”. Mains’l clinical employees are not under a duty to voluntarily inform authorities regarding a client’s past or intended criminal act, except where there is a risk of imminent physical harm. Involving authorities may lead to the determination that the client needs to be detained for an involuntary assessment.

MN state statute: 148.975 sets out circumstances in which a physician, justice of the peace or police officer may detain a person for psychiatric assessment (i.e., an involuntary assessment) and the procedures for doing so.

Wherever possible, Mains’l clinical employees will obtain the client’s voluntary agreement to seek medical assistance.
 

Procedure: 

The criteria for determining whether a disclosure of information is warranted should be based on the following guidelines:

  1. There is a clear risk to an identifiable person or group of persons
  2. There is a clear risk of serious bodily harm or death and
  3. The danger is imminent

Once it is determined disclosure of information is warranted, follow the procedures below for the identified harm.

Suicidal Clients
Whenever possible, Mains’l clinical employees will obtain the client’s voluntary agreement to seek medical assistance.

When a client is not willing to seek assistance, Mains’l employees have a duty to disclose a client’s active suicidal ideation and/or plan to commit suicide. The employee’s disclosure may include, without being limited to:

  1. Notifying a family member, a physician or other appropriate person who can ensure the safety of the client
  2. Contacting the police or a mental health crisis team with a request to escort the person to a hospital for a psychiatric examination (i.e., a voluntary or involuntary assessment).
  3. Mains’l clinical employees report, as soon as possible, the suicidal intent to the behavioral and mental health senior manager and vice president of administration. 

Clients who present a clear risk of violence or harm to others

Mains’l clinical employees have a duty to warn the intended potential victims of threatened violence. 

  1. Mains’l clinical employees report, as soon as possible, the threat to the identifiable person or group of persons.
  2. The threat gets reported to the police when the intended victim(s) cannot be reached or in situations of immediate danger. 
  3. The police will determine the most appropriate next steps, including whether there are grounds to detain the client for an involuntary assessment. 
  4. Mains’l clinical employees report, as soon as possible, the threat to the behavioral and mental health senior manager and vice president of administration. 

Assaultive Partners
Persons who are assaultive may be seen on a voluntary basis. Mains’l remains obligated to initiate contact with the partner (or others threatened) where there is a risk of imminent harm to the partner. 

In all situations, Mains’l clinical employees document the situation, including 

  • Their assessment of the risk of harm or death, 
  • The information on which their assessment is based 
  • Any actions taken, in the client file in Therapy Notes software system.
     
Reference: 

Health Insurance Portability and Accountability Act (HIPAA)

MN state statute: 148.975