Wonderful, informed comment, obviously
from a legal professional (you not only said
that you were "in trial", but it's obvious from
your grasp of the legal issues in Tarasoff-type
obligations in Colorado.

Thanks so much for researching all of this
and for weighing in with such depth and
breadth of info.

I agree that Dr. Fenton is in a very precarious
position, and I'd not want to be in her shoes
even trying to sort through session notes and/or
recordings.

If the defendant communicated anything about
his delusional content with respect to Batman/The Joker,
or even an obsessive interest in the film to be shown,
the psychiatrist again must be accountable for why she
failed to take that information seriously to the extent that
she didn't take some measures to hospitalize her patient.

There's such a fine line between what is and is not
considered aberrant in terms of "dangerousness to self or
others", but usually there are irrational indicators that just
can't be ignored.

I learned so much from your comment, so must thank
you again on my behalf, as well as that of the Current
community for enhancing the discussion.

Thanks,
TBone

Thanks for sharing some insight.

You, as a social worker, have
an understanding of the struggles that a
psychotherapist faces as to whether or not to
invoke Tarasoff. Thanks for responding about
the special case of the notebook, which is another
link to the chain of this tragedy that it went undetected
until after the massacre.

It's also of significance that Dr. Fenton, who was the
psychiatrist for James Holmes, not only specializes
in schizophrenia, but is the head of the University
student mental health services.

What's also of significance to me is that the original (1974)
Tarasoff defendant (a man from India who was studying
at UC Berkeley) had been treated for schizophrenia.

A subsequent case in New York state extended
a therapist's duty to warn under Tarasoff to also
protect the victim (as did the 1976 Tarasoff ruling
in California).

Thanks again for your comment. Below is the original legal
citation for Tarasoff (1976).

Tarasoff v. Regents of the University of California,
17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976),

Thanks, OlBlue, for raising the issue of the
prevention of acts of violence/destruction
by a psychotherapy client. Not only is the
"duty to warn" viewed as essential to protect
specific persons or groups of persons, but it
is also to protect the client who has lost the
apparent ability to think/behave rationally.

The necessary actions required to discharge
the duty to warn also vary from state to state.
For example, in California the duty is discharged
when the psychotherapist makes reasonable efforts to
communicate the threat to the victim and to law enforcement
while Delaware law provides that the therapist may notify
law enforcement and the victim or arrange for the hospitalization
of the patient as an acceptable means of discharging the duty to warn.

Many states do not designate the acceptable mode of intervention,
thus leaving the psychotherapist in a position of determining the most
appropriate contact to prevent harm while limiting the disclosure to
the smallest number of persons.

Here's the reference for the original statute:

Tarasoff vs. Regents of the University of California, 551 P2d 334 (1976).

Thanks for raising the question about
the extension of Tarasoff to other states.

While most states now have some provision for the
"duty to warn" generated by Tarasoff v. Regents of the
University of California, there is some variation as to
the type of threat that demands disclosure.

Some states (Wisconsin, Delaware, Washington, Nebraska)
require disclosure to prevent a general threat to the public
at large. Other states permit disclosure only on the basis
of a threat to harm a specific person or group of persons.
Colorado is among this group, as well as Louisiana,
Michigan, Missouri, Vermont, and New Jersey.

It's an interesting topic for discussion, but I feel way out of my league here. There's one lawyer that I know of here who makes great contributions. Perhaps he'll share some of his knowledge too.

I, however, tend to side with Progresshiv below with regards to professional confidentiality. It's bad enough that there's such a social stigma attached to mental disorders which deters people from seeking help. I'd hate for the few mental health professionals we have available to shut their doors for fear of lawsuits.

You raise an important point about
"frivolous lawsuits" affecting the mental
health profession adversely. As with the
other branches of medicine that have
been beleaguered by inordinately high
costs for malpractice insurance, and often
driven out of business by "frivolous" litigation,
the mental health profession has begun to
suffer the same fate in recent years.

Many seasoned practitioners just raise their hands
and "surrender" to the marketplace as it's much too
unwieldy and far too stressful to have to deal with
a defensive style of practice [to avoid litigation] along
with the added stress of an already demanding
professional guild.

Just imagine being the shrink who may have
heard those bizarre disclosures from the
unraveling mind of the Aurora shooter!

Thanks for your careful thought to the article.

But the whole point of the Tarasoff ruling is that
the law requires that mental health professionals
break confidentiality/privileged communication to
report if they're convinced the patient is going to
do harm to others, as well as to take steps to
ensure that those in danger are protected.

There are no ifs, ands, or buts about it. A doctor
'MUST' report to authorities and the victim(s).

At the point that danger to others is suspected, it's
no longer a question of the patient's "trust" in the
doctor to maintain secrecy. The larger ethical and
legal issue is the doctor's role in protecting society.

If this young man was so far gone (into his psychosis)
that he mailed the doctor his notebook elaborating
the crime, he was--in effect--crying out for help in
his own way.

Interesting....of course the Tarasoff ruling was never implemented in the case of Cho at Virginia Tech either, and then there was the whole fiasco about his mental health records disappearing. The Washington Post concluded that the entire process for reporting was so disorganized, that no one person every really knew enough about the shooter to sound the alarm, notwithstanding, there had been multiple alarms sounded by faculty, staff and students who dealt with him in classroom situations....which together with the disappeared records, led some to allege a cover-up.

One of the interesting things that comes up, if you read the report commissioned after the shootings by then governor of Virginia Tim Kaine, is that Cho had a history of mental/emotional health problems dating back to early childhood and his elementary and high school years, but none of that information went with him to Virginia Tech. During his pre-college school years, he had been given special education services for mental/emotional health issues, but came to Virginia Tech without any of that support, or any information about his previous need for that support. The reason that information did not come with him was linked back to interpretations of federal laws governing the release of information concerning disabilities. The question arises as to whether or not the emotional stress of attending college, very much on his own, was more than he could cope with, without those services. His academic performance was very high, also not unlike Holmes. I wonder if similar information about Holmes will surface. While the panel commissioned by Kaine noted that disclosure of a disability is entirely voluntary, and that the issue is of great importance, they did not follow up by making a recommendation....and here we are again in 2012, possibly revisiting the same issue, with disastrous consequences.

The Kaine report is a pdf on the internet listed under the following title:
"Chapter IV MENTAL HEALTH HISTORY OF SEUNG HUI CHO"

The Washington Post article:
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/19/AR2009081902380....

Allegations of a university cover-up:
http://www.naturalnews.com/026682_Chi_health_shooting.html

Don't know what happened to my
original response thanking you for this very
thorough discussion of the Virginia Tech tragedy,
and the shooter, Seung Hui Cho.

I wasn't aware of Cho's mental health history at all,
or [then] Governor Kaine's commission and findings.

Thanks for providing the links, and your summary.
Outstanding.

with so much conspiracy theory and speculation out there, it's nice to see a post like yours, and the comments accompanying it. thank you for posting.