Suicide / Self Harm – The Practitioner’s Role

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Avoiding Liability Bulletin – December 2008

… Occasionally I am asked to opine on the subject of a mental health practitioner’s participation in what can be called “supportive therapy” for someone who has decided to take his or her life. The reasons for the decision to end one’s life can vary widely, but the result, at least for me, is always the same. One scenario that I have been asked about more than once involves a client suffering from an eating disorder resulting in weight loss and malnutrition to the point of dangerousness to life. Attempted suicide is a crime in many states. Aiding or abetting a patient or client to commit suicide, or simply providing supportive counseling or therapy, might likewise, depending upon the circumstances, constitute a crime.

In most states, therapists and counselors are permitted (sometimes required) to break confidentiality when the patient is a danger to self as the result of a mental or emotional condition. If the disclosure is required, the practitioner is expected to comply with the law. If the disclosure is permitted, the practitioner must make a very important judgment. In my view, that judgment should favor those disclosures calculated to prevent the threatened or imminent suicide or serious danger to self.

I would be uncomfortable taking the position (e.g., arguing in court) that since the practitioner was not mandated to warn, notify or alert anyone, he or she was therefore without blame when nothing was done to try to prevent the intended self-harm, or when supportive counseling was provided to assist the patient with his or her plans. I would much rather be defending the practitioner who made reasonable efforts to prevent the self-harm – including, if necessary, breaking the patient’s confidentiality. When states pass laws that allow people to take their own lives under specified circumstances, then mental health practitioners can perhaps more safely provide supportive counseling or therapy that is consistent with the terms and conditions of such a law. Until then, practitioners must be very cautious when confronted with this kind of a situation.


Richard Leslie

"At the Intersection of Law and Psychotherapy" Richard S. Leslie is an attorney who has practiced at the intersection of law and psychotherapy for the past twenty-five years. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT), where he worked with their various state divisions to develop and implement their legislative agendas. He also provided telephone consultation services to AAMFT members regarding legal and ethical issues confronting practitioners of diverse licensure nationwide. Additionally, he wrote articles regarding legal and ethical issues for their Family Therapy Magazine and presented at workshops on a variety of legal issues. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. He was director of Government Relations for CAMFT, and as such was the architect of CAMFT’s widely regarded and successful legislative agenda. He represented CAMFT before the regulatory board (the Board of Behavioral Sciences) and was a tireless advocate for due process and fairness for licensees and applicants. He was a regular presenter at workshops and was consistently evaluated as CAMFT’s most highly rated presenter. He also sat with the CAMFT Ethics Committee and acted as their advisor on matters pertaining to the enforcement of ethical standards. Richard is an acknowledged expert on matters pertaining to the interrelationship between law and the practice of marriage and family therapy and psychotherapy. For many years, he taught Law and Ethics courses for a number of colleges and universities in their marriage and family therapy degree programs. While at CAMFT, he provided telephone consultation services with thousands of therapists in California and elsewhere for over twenty years. He is highly regarded for his judgment, his expertise, his direct style, and his clarity. Richard has been the driving force for many of the changes and additions to the laws of the State of California that affect MFTs. In 1980, he was primarily responsible for achieving passage of the "Freedom of Choice Law" that required insurance companies to pay for psychotherapy services performed by MFTs. Passage of that law allowed MFTs to earn a living, allowed them to better compete in the marketplace, and strengthened the profession in California by leading to a great increase in the number of licensees and CAMFT membership. Currently, about half of the licensed marriage and family therapists in the country are licensed in California. While at CAMFT, Richard was primarily responsible for, among other things, the successful effort to criminalize sex between a patient and a therapist. He was successful in extending the laws of psychotherapist-patient privilege to MFTs, thereby giving patients the same level of privacy protection as when seeing a psychiatrist or psychologist. He fought tirelessly and successfully for the right of MFTs to refer to themselves as "psychotherapists," to perform psychological testing services, to be appropriately reimbursed by California’s Victims of Crime Program, and to be employed in county mental health agencies throughout California. Richard was admitted to the Bar in New York (1969) and in California (1973). While practicing in New York, he served as a public defender, and later, as an Assistant District Attorney. Shortly after moving to California, he worked for the San Diego County Human Relations Commission as their Law and Justice Officer. While there, he worked successfully to achieve greater racial diversity in the criminal jury selection system and to expose and stop police abuse. For such work with that agency, he was the recipient of the Civil Libertarian of the Year Award by the San Diego Chapter of the American Civil Liberties Union.

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