Volk: More Fallout

Some of my comments on the Washington State Bree Collaborative Risk of Violence to Others draft report, much of which stems from the Volk decision which builds on Tarasoff, increasing the burden on psychiatric providers to predict, protect and warn potential victims of their patients:

• I closed my private psychiatric practice more than 3 years ago, in part due to absurd laws as prompted by the Volk decision. 

• Lawmakers should make it clear and consistent to which providers the law applies. Call them covered entities as in HIPAA? The draft document refers to psychotherapists, mental health - clinicians, providers, professionals. I assume that includes psychiatrists and psychologists. What about physicians in other specialties? Counselors? Osteopathic physicians? Naturopaths? Definitions would help.

• These "covered entities" should inform all patients of the duty to protect and the potential violation of their confidentiality, including the possibility that they might be committed or incarcerated, BEFORE soliciting any information. Lawmakers and judges should know that this might lead to failure of the patient to provide information essential to their treatment.

• According to the draft, screening should be done "During the initial visit or more frequently if needed". This kind of perfunctory process will quickly become burdensome, leading to failure and interfering with treatment.

• "Suicidality": This term is too vague. Define or describe in detail.

• These requirements will discourage the people who most need it from getting help and will encourage them to lie. 

• From the provider’s perspective, this constitutes a form of abuse that will contribute to burnout, lead people to choose other kinds of work, and, as in my case, lead to early retirement.

• Suicide should not be (and cannot be) “prevented.” It can be postponed. Assisted suicide is legal in the State of Washington. A better approach would be to stop stigmatizing suicide as crazy by locking "suicidal" people up. It is a legitimate choice for adults competent to make such a choice. A better approach would be to educate and offer treatment (where indicated), then let competent adults have access to non-violent methods to end their lives with dignity when they choose. This would likely lead to fewer murder-suicides and certainly fewer violent suicides. (We need a legal standard for competence to choose to die.)

-Berry Edwards, MD