Should the psychiatry field be responsible for crimes?

[Jayburner]

You tend to a patient that is clearly psycopathic and delusional but of course you have to keep your client privileges or else you'd be out of business. But what happens when that client goes and kills a lot of people. How do you live with yourself when that happens?

When does money/ethics become to much?

[Jersovic]

I don't think Psychiatrists should be held liable because myself, and every other Veteran I know has told their psychiatrists about violent thoughts they have about other people. I think the frequency of patients that show warning signs is too frequent for a Psychiatrist to risk their reputation for violating patient-doctor confidentiality every time someone says something crazy. You could treat thousands of patients who never do anything crazy, and then that one random dude who goes out and kills a bunch of people.

I would like to see Judges and Prosecutors receive more liability for wrongful convictions. Anytime a Texas inmate is wrongfully execution, and it's later proven that he was innocent, no one is held accountable for this. No one at all. That just blows my mind.

[Jayburner]

Thats all and good. I understand what you are saying. But when does it come to a point where its like "...go on" and "your hour is up" before your conscience says "hold on a second...i got a real loon on my hands"

or is it all about the money?

[Chouzan]

No.

Psychiatrists are actually still required to report if they know someone has committed a crime or is likely to commit a crime that harms themselves or others.

There's an exception to the patient-client confidentiality for these kinds of situations.

[Deleted]

Thats all and good. I understand what you are saying. But when does it come to a point where its like "...go on" and "your hour is up" before your conscience says "hold on a second...i got a real loon on my hands"

or is it all about the money?

You can't arrest someone for thinking something. It's like any criminal case, you need substantial evidence in order to pursecute. If a person says they want to beat the everyliving crap out of people and kill others, that's one thing. If said person has planned it, tells you about how they're gonna do it and so on, if they admit to planning a violent act rather than just admitting that they've had violent thoughts, that's when they actually report their patient as liable. They can do that you know.
Greater minds than yours have already thought about this, mate

Still watching that womens football or have you moved on to something even more philosophical?

[Annamarine]

You can't arrest someone for thinking something. It's like any criminal case, you need substantial evidence in order to pursecute. If a person says they want to beat the everyliving crap out of people and kill others, that's one thing. If said person has planned it, tells you about how they're gonna do it and so on, if they admit to planning a violent act rather than just admitting that they've had violent thoughts, that's when they actually report their patient as liable. They can do that you know.
Greater minds than yours have already thought about this, mate

Still watching that womens football or have you moved on to something even more philosophical?

Actually it is possible too commit a crime for just thinking it up. Its called conspiracy to commit a crime, it does require two people but when two people plan to commit a felony a crime as been committed and you can be arrested and jailed for that. A kinda scary thought along these vein, lets say you and a friend sit in a basement and discuss that neighbor, colleague, classmate what ever you dislike and how you can hurt, rob or take him out. At that moment you have already committed conspiracy and can be arrested. If ether one of you then go out and actually commit the crime you are both responsible for the actions of the other 100%. Even worse lets say you just talked about taking a 1000 painting from your neighbor. You then go home and your friend takes the painting and kills the neighbor he didn't expect to be there. You can then both be arrested and tried for robbery and felony murder.

Also under the patriot act you can also commit a crime for just thinking up a terrorist act, but never acting on it. This can be taken quite far and you would be surprised of the power the Patriot act and how far reaching it is.

[Deleted]

I doubt that simple explanation, "it's all about money" in this case. As a practicing (either independent or clinical) psychiatrist, the patients who express violent thought in a session would far outnumber the ones who actually commit acts of violence, and those mostly use their violence against themselves (suicide). It would be difficult to screen the actually dangerous patients. Second casem, forensic psychiatrist, who deal with suspected criminals: Their employer is always the state, so pure financial interest would tend towards the opposite, more cautious case.

[Greeney]

Thats all and good. I understand what you are saying. But when does it come to a point where its like "...go on" and "your hour is up" before your conscience says "hold on a second...i got a real loon on my hands"

or is it all about the money?

http://mentalhealth.about.com/librar.../aa040901a.htm

[frogger237]

Thats like saying the parents of murderers should be sent to prison as well because environment and genetics are like 99% of what a person ends up doing.

Also You can tell the authorities if you think your patient is a harm to others/themselves.

[Albert the fish]

well psychiatrists and clinical psychologists... ok the entire therapist family really, are required by law to ignore the patient/therapist confidentiality agreement if they feel the patient/client/whatever that field calls their 'therapees' poses a threat to themselves or others.
most are told to try to keep the 'patient' in their office until more qualified staff (like police) arrive.

and if you want to say "well what if they don't THINK they are posing a threat, but the guy goes and kills 20 babies?!"
well in that case how would the therapist be held responsible at all?

[oblivionx]

We don't hold gun makers responsible for gun crimes...

How are we going to hold a shrink responsible for someone being crazy. Even if they had warning signs, hindsight is 20/20.

[The Casualty]

To be seen, a mental health consumer will have to sign not only a Consent for Treatment, but a Notice of Privacy Practices. Now I am not going to cut and paste the text from our forms, but there is a clause - as is for every agency I can think of - regarding Public Health. This allows the clinician to disclose information based on a substantial probability of harm toward the client or others. This includes anything from injury/death to controlling the spread of infectious disease.

As that relates to the real world: The client has to tell you something very specific before you just go violate HIPAA privacy rules.

In regards to living with yourself - well that is something that each person has to square with themselves. People commit suicide and do terrible things to other people. You cannot give them therapy 24/7, and you can't be there at every moment a person has a psychotic break with a clinical cert, ready to put them in the hospital.

That being said, I hope people don't have a picture in their heads of mentally ill people (including schizophrenic/schizoaffective clients) as being an unstable and violent bomb waiting to explode on the populace. It really isn't anything like that for the vast majority of the mentally ill.

[Shostie]

Thats all and good. I understand what you are saying. But when does it come to a point where its like "...go on" and "your hour is up" before your conscience says "hold on a second...i got a real loon on my hands"

or is it all about the money?

Psychiatrists don't do talk therapy anymore (the smart ones, anyway) because insurance reimbursements are too small. Insurance reimbursements for prescriptions are greater, so psychiatrists have become "vending machines". It's psychologists (they're not MDs and can't write prescriptions) who do the talk therapy these days.

P.S. I'm talking about the US, of course. I'm sure other countries don't have this problem.

[superstarz]

i love all your threads dude.. there entertainment for me hahaha

[Mukki]

Thats all and good. I understand what you are saying. But when does it come to a point where its like "...go on" and "your hour is up" before your conscience says "hold on a second...i got a real loon on my hands"

or is it all about the money?

I don't know if you've really thought this through. If there was no doctor-patient confidentiality, then a lot of people in therapy would be hesitant to really open up to their shrink. That would cause even more problems.

[Ohgodspiders]

Being a psychologist myself, I can state that there's may clauses in which, if a person is actively planning to cause harm to themselves, to the public, to their family, to their friends, or really to anyone it is actually required by law to violate the privacy policy because the information obtained could prevent deaths of other people. In essence, when the patient says they have plans and weapons and all of these other things ready to go, and that they're actually going to harm someone, it is against the law to NOT normally do something that would be a massive betrayal of trust. There's exceptions for everything. To merely have THOUGHTS about these things is not enough to violate the privacy agreement, but if they say something like "Oh, I'm going to kill my mother after we're done here, I have the guns and knives ready for it and everything." then that's a dead giveaway to report that to the authorities. To not do so is on par with being involved with it themselves: they knew it was wrong, knew that it was a crime, and knew that it was going to cause harm or death to others. It is about on par as being "in" on the crime. When that information is reported, the responsibility is taken off the psychologists shoulders.

On this subject, and while it's a minor caveat, I would like to point out the difference between a psychologist and a psychiatrist. A psychiatrist is, more often than not, the person responsible for the distribution of medication and the admission of psychological and psychiatrical tests, which range between test from depression and tests that look for many more things, such as the Minnesota Multiphasic Personality Inventory or MMPI.

A Psychologist is a person who administers therapy, of which there are many different kinds, and usually does not have authorization to prescribe medication, as doing so requires medical expertise and an understanding of dosages, half-lives, secretion of the chemicals, etc etc.

[Lynarii]

That being said, I hope people don't have a picture in their heads of mentally ill people (including schizophrenic/schizoaffective clients) as being an unstable and violent bomb waiting to explode on the populace. It really isn't anything like that for the vast majority of the mentally ill.

I'd like to strongly second this. Most mental health patients are actually less dangerous to the general public than the 'average person'. More dangerous to themselves, for certain, but less dangerous to the general public. The high-profile cases are statistical outliers and not a good representation of what you'll find in a normal cross-section of the people.

That being said, here's the problem that you have. There are VERY few people who do not have violent thoughts at one point or another. Casual death threats "I could just kill the guy who keeps jamming up the copier every day!" are considered to be a fairly normal way of releasing stress and are generally considered very distinct from actual targeted death threats "I just bought a gun and will be killing Joe from accounting when he gets out of his car monday morning". When you start talking about therapy, if you're doing it right you're going to be discussing sensitive and emotional topics, so things on the level of the first quote are not really all that unusual at all. And anyone involved in therapy who runs off to the cops every time someone vents a little is not doing ANYONE any good. The patients lose trust in not only the specific person, but the system as a whole. And the cops start seeing 'boy who cried wolf' when nothing comes of all these reports.

Ultimately, when a patient is venting vs when they are serious is a judgment call that has to be made on the spot, and like any judgment call it can be wrong. It's easy to look back on what happened and say how things were, it's difficult to look into the future and say how things will be. And believe me, you don't have a lot of psychiatrists or psychologists who wake up to the news that a patient of theirs committed an atrocity and have their first thought be "Well, he won't be paying me any more..."

[Deleted]

Did you ever see "the minority report" ? It's another setting but the same problem.

The main question: If a psychiatrist reports someone, what should happen? You wanna jail the for .. ever? There are eg many studies about men having pedophiliac conceivabilitys, but only few (i remember a percentage of about 3%) are going to look for pedophiliac pictures or movies.. and far, far less (far less then 1% .. pretty sure it was something like <0,1%) ever commit a "direct" pedophiliac crime (more then watching pictures/videos).

[Lynarii]

or is it all about the money?

As a side note, I have a relative who is a psychologist that works with some of the more unstable people, including many who are in prison. Listening to them can be an absolutely soul-crushing job, many of them have gone through some pretty horrific levels of abuse (often when they were children), and how do you 'fix' things like that? Hell, the place that my relative works out of has a special private room for when the psychologists that work there need to go have a good cry between patients. There are far easier ways to make a buck, the people on the therapy side of the mental health care are NOT getting paid in gold-plated BMWs.

[Deleted]

As a side note, I have a relative who is a psychologist that works with some of the more unstable people, including many who are in prison. Listening to them can be an absolutely soul-crushing job, many of them have gone through some pretty horrific levels of abuse (often when they were children), and how do you 'fix' things like that? Hell, the place that my relative works out of has a special private room for when the psychologists that work there need to go have a good cry between patients. There are far easier ways to make a buck, the people on the therapy side of the mental health care are NOT getting paid in gold-plated BMWs.

How would you actually describe a psychologist's wages? Above average?