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As social workers, privacy and confidentiality are central to our ethical principals. The NASW Code of Ethics (1999) requires that we respect the clients’ right to privacy. Once private information is shared, the standards of confidentiality must be adhered to. There are situations in which confidential information can be disclosed (i.e. – to insurance companies), with the proper consent from the client or a person legally authorized to give the client’s consent. The purpose of this article is to present one of the lesser known and understood circumstances under which confidential information must be disclosed, with or without the client’s permission. This relates to the duty of mental health professionals to protect by warning potential third party victims.
In the late 90’s the PA Supreme Court decided the case of Emerich v. the Philadelphia Center for Human Development, which involved a client who told his counselor of plans to kill his girlfriend. Although the counselor tried to intervene with the client, the counselor did not warn the girlfriend, who was killed by the client. This resulted in the standard we are now required to follow in PA which states “when the patient has communicated to the professional a specific and immediate threat of serious bodily injury against a specifically identified or readily identifiable third party and when the professional determines or should determine under the standards of the mental health profession that his patient presents a serious danger of violence to the third party then the professional bears a duty to exercise reasonable care to protect by warning the third party against such danger”(Tepper and Knapp, 1999).
The NASW Code of Ethics (1999) specifies a related standard in which the confidentiality requirement “does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure should be revealed.”
Although this gives us a fairly clear directive regarding disclosure of private information to protect others, real life situations are rarely clear. Consider the spectrum of gray between the following two statements: “I’m so angry, I could kill someone” and “I hate my son-in-law for putting me in here and when I visit his house this Sunday I’m going to take his gun and shoot him”. The first statement is clearly too general to require a warning (although it certainly may warrant further exploration and some type of intervention). The second statement meets all of the criteria for warning the son-in-law.
What if only some of the criteria are met, but you feel there is a valid threat? There will certainly be times when professional judgment must be exercised. Better yet, if there are questionable circumstances but the possibility of a threat, other professionals should be consulted to discuss and decide on the matter. An ethics committee, professional colleagues, the ombudsman, or your facility’s legal counsel are all options that can help in various situations. Do your best to protect your clients’ confidentiality while still protecting others (and yourself).
References: Code of Ethics of the National Association of Social Workers, Approved by the 1996 NASW Delegate Assembly and revised by the 1999 NASW Delegate Assembly
Tepper, A. M. & Knapp S. (1999). Duty to Protect by Warning: When Does the Duty Arise. The PA Psychologist Quarterly. P. 15.
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