A Dangerous Mental Health Condition**

It has to be reiterated that most people diagnosed with a psychiatric illness pose no danger to others, or themselves. The majority of this population desire a well-adjusted mental health.  As positive as that reality is, we have to understand various causations in that small percentage who do become dangerous.  It’s an unpleasant subject many refuse to look at, with several media pundits unwilling to have honest discussions, talking around the issue as though if it’s left out of the conversation no one will notice.  However, until society does focus on “mental” instability and “dangerousness”, the world won’t see a reduction of this brand of criminality.  The following are several items which deserve analysis.*

  • Sudden Stoppage of Medication.  A lion pouncing on someone when it hasn’t eaten for a few days. It’s analogous to the patient who may become dangerous when they suddenly stop taking medication.  These pills are strong and take several weeks to gain traction to reduce symptoms associated with the condition.  Thus, it’s a shock to the brain when the medication is no longer in the system, which may result with the patient spinning out of control mentally.  If they wish to cease taking medication, they should inform the psychiatrist to gradually receive lesser dosages over a period of time, until they are no longer on the psychotropics.
  • Lack of Guardian.  Families have to take the initiative in getting a conservatorship when they believe a member is irresponsible in caring for their mental health.  The patient has to report to this guardian on a daily basis before proceeding with usual activities.  It’s a form of neglect, regardless the age of the patient, to allow them to enter society with an unprepared mental health.
  • Alcohol, Illegal Drugs p. 1.  A patient is setting themselves up for a mental thunderstorm when combining these substances with their mental health condition whether they’re using psychotropics, or not.
  • Alcohol, Illegal Drugs, p. 2.  The individual who begins with a healthy psychology, then starts abusing these substances, automatically has a mental illness, even if they don’t have schizophrenia, mood disorders, and other psychiatric conditions associated with a chemical breakdown from using drugs.
  • Lack of Positive Coping Mechanisms. This skill set is important for everyone, especially the patient who has to remember that disappointments are a part of life.
  • Ordinary Citizens. Failing to call the police when they observe someone they wholeheartedly believe may pose a danger to society.  Even if police can’t do anything: We have to wait until something actually happens, there’s a paper trail about the individual they can refer to.
  • Deep-Brain Injury.  An individual could begin with a healthy psychology, then experiences a deep-brain injury.  Not everyone in this category is dangerous, although some may result with a level of dangerousness (i.e., ASPD Level 2).  They have to be monitored on a regular basis with a host of evaluations because of personality changes.
  • A Blow to the Head, but not Deep-Brain Injury.  A patient may experience personality changes, temporarily, which have to be monitored on a regular basis with a host of evaluations.
  • Congenital Brain Malfunction. The individual has to be supervised on a regular basis by family (i.e., conservatorship), psychiatrists, and physicians.
  • The Lack of Workplace Personality Assessments.  The employer who refuses this instrument for the pre-employment screening could face unbelievable liability.
  • The Psychological Board. A compulsory standard Duty to Protect and Duty to Warn doctrines are required in all states and districts, instead of both doctrines in some regions, one or the other in separate regions, and the incredibly vague language nurturing confusion.
  • The Clinician.   If they fail in whatever current Duty to Protect/Duty to Warn responsibilities, they have created a series of events they will regret forever.
  • Police Officers.  Most are a community’s best friend!  They have incredible challenges which couldn’t have been recognized when joining the Police Force because of increased responsibilities.  An officer never wants to pull the trigger unless it’s absolutely necessary, and most never fire their guns.  They wish to return to their families at the end of an exhausting day.  However, if an officer fails to respond when the clinician informs them in their Duty to Warn capacity, they should turn in their badge and find a different area of employment.


A safer world becomes prevalent only when an honest dialogue about mental health begins, with additional entities becoming more involved, instead of believing it’s someone else’s problem.

*There are always unknown causations waiting to be discovered.

**Not every dangerous person has a mental illness.



The Duty to Protect and the Duty to Warn

images Clinical Psychology

Confusion still exists among members of the psychological community regarding the Duty to Protect and Duty to Warn doctrines.  They are mutually exclusive principles. Professionals will first need to learn from respective state law whether both principles apply, if only one of them is allowed, and if the language is nuanced before entering their occupation.  Let’s examine these principles to gain a better understanding what they concern.

The Duty to Protect doctrine indicates that members of the psychological community have a legal and ethical obligation to protect the patient.  One of the important aspects is the therapist engaging in the most professional behavior.  They must offer the highest, ethical treatment to their patients. Also, even though it can be difficult to predict, the therapist has the duty to protect the patient from harming themselves.  Another factor is confidentiality regarding statements from the patient made in therapy, and a solid infrastructure to keep medical records from public consumption.

The Duty to Warn* doctrine indicates that when a therapist has a reasonable belief that a patient will harm a member of the public, the therapist has a number of options available: Contact the intended victim (without revealing the patient’s name), relatives and friends of the intended victim, law enforcement giving the patient’s name and the intended victim’s, implement an aggressive out-patient therapy for the patient, or have the patient hospitalized on an emergency basis.  This doctrine gives the therapist permission to set aside patient confidentiality in order to protect the community.

Examples of Varied State Laws Concerning the Doctrines are Michigan, Ohio, and Vermont allow for both doctrines, while The Duty to Protect doctrine is applicable for Texas, but not the Duty to Warn doctrine.  Also, The Duty to Protect doctrine is allowed in Utah, including Common Law Duty of Care (in place of the Duty to Warn doctrine).

The clinical practitioner will have to remain apprised of state laws where they decide to practice, or experience disciplinary action from their Board of Psychology and malpractice from patients.

*There are regions where therapists can warn intended victims, but aren’t obligated to do so.