7 answers
Bruce
Student
Newnan, Georgia
1
Question
Asked
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What should I do if I am a psychologist and my patient starts having a medical emergency or admits to murder?
I am just asking because I am hoping to be a psychologist or some type of counseling job that helps people without being really in the medical field, besides that I just want some tips and suggestions if that happens.
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7 answers
Kehinde Makinde
Spiritual mentor, Creative & Academic Writer
4
Answers
Uyo, Akwa Ibom, Nigeria
Updated
Kehinde’s Answer
1. In the case of Medical Emergency
The first thing that must be upheld onward and upwards is that the patient is there for guidance and reassurance. So staying calm must be your vital role.
Then, confirm the severity of the emergency with your intuition of the current situation of things. You can try dialing the appropriate emergency support number for your country or seek a nearby medical institution. However, you can administer initial aid if you are trained in first aid or emergency response. While you are at this ensure that the emotional well-being of your patient is not tampered with.
After the immediate medical needs are addressed, make sure the record of the event, actions taken, and other approaches are well documented.
2. In the case of Admitting to Murder
It is vital to consider the ethical and legal obligations in this circumstance. To address this you must:
First, consider your duty to protect yourself and others. In interpreting this, it may be necessary to contact law enforcement agencies or attempt a private arrest if you believe that your safety and/or that of others are compromised, to ensure everyone’s well-being.
Second, the theme of confidentiality is key in rendering your duty as a psychologist to your patient, to protect your patient’s privacy as a “Keeper of Secrets.” 1Hammonds v. Aetna Casualty & Surety Co., 243 F. Supp. 793,802 (N.D. Ohio 1965). However, for every rule, there is an exception. Tarasoff v. Regents of the University of California (17 Cal.3d 425 [1976]).
A sure way to look towards this is to consult a trusted colleague or a legal professional on the best practice option to determine the best course of action. This could include but is not limited to guidance on specific laws and regulations of your jurisdiction or/and that of your patient. Also, based on the circumstances and legal requirements, you may consider understanding your obligations in reporting the information to relevant law enforcement agencies or authorities.
The first thing that must be upheld onward and upwards is that the patient is there for guidance and reassurance. So staying calm must be your vital role.
Then, confirm the severity of the emergency with your intuition of the current situation of things. You can try dialing the appropriate emergency support number for your country or seek a nearby medical institution. However, you can administer initial aid if you are trained in first aid or emergency response. While you are at this ensure that the emotional well-being of your patient is not tampered with.
After the immediate medical needs are addressed, make sure the record of the event, actions taken, and other approaches are well documented.
2. In the case of Admitting to Murder
It is vital to consider the ethical and legal obligations in this circumstance. To address this you must:
First, consider your duty to protect yourself and others. In interpreting this, it may be necessary to contact law enforcement agencies or attempt a private arrest if you believe that your safety and/or that of others are compromised, to ensure everyone’s well-being.
Second, the theme of confidentiality is key in rendering your duty as a psychologist to your patient, to protect your patient’s privacy as a “Keeper of Secrets.” 1Hammonds v. Aetna Casualty & Surety Co., 243 F. Supp. 793,802 (N.D. Ohio 1965). However, for every rule, there is an exception. Tarasoff v. Regents of the University of California (17 Cal.3d 425 [1976]).
A sure way to look towards this is to consult a trusted colleague or a legal professional on the best practice option to determine the best course of action. This could include but is not limited to guidance on specific laws and regulations of your jurisdiction or/and that of your patient. Also, based on the circumstances and legal requirements, you may consider understanding your obligations in reporting the information to relevant law enforcement agencies or authorities.
Kate Hellenga
Clinical-Community Psychologist, private practice and civil service
7
Answers
San Francisco, California
Updated
Kate’s Answer
I think the best answers here so far are the ones that say, "if you are a practicing therapist, you will have taken courses and a licensing exam for your state, which will cover topics like this -- also, if you are working for an agency, they will have specific policies to guide you, and you'll be able to consult with colleagues or a supervisor."
If a client had a *medical* emergency while meeting with you, you would likely call 911, just as you would do anywhere else. When calling, you would not reveal that the person was a psychotherapy client if you didn't have to. It would not be relevant to the person's medical needs.
If client reveals that they *INTEND* to kill a specific person/group of people IN THE FUTURE, there is a very specific and clear set of rules about your "duty to warn" the intended victim and/or law enforcement. If they reveal that they committed murder IN THE PAST, you are *not* required to *contact* the police or anyone else to share that information. In fact, you are required by law NOT to share the information with anyone else. There are exceptions to confidentiality (child abuse (presumably including murder); abuse of a dependent adult), but domestic violence, murder of an adult, and other crimes are not among them. What your client tells you is kept confidential unless they sign a release or your records are subpoenaed and your attempts to protect the client's privilege/confidentiality are overridden by a court order signed by a judge. That situation, with a subpoena and then a court order, is likely what the previous respondent referred to when they said their colleague had to turn over all their notes.
If a client had a *medical* emergency while meeting with you, you would likely call 911, just as you would do anywhere else. When calling, you would not reveal that the person was a psychotherapy client if you didn't have to. It would not be relevant to the person's medical needs.
If client reveals that they *INTEND* to kill a specific person/group of people IN THE FUTURE, there is a very specific and clear set of rules about your "duty to warn" the intended victim and/or law enforcement. If they reveal that they committed murder IN THE PAST, you are *not* required to *contact* the police or anyone else to share that information. In fact, you are required by law NOT to share the information with anyone else. There are exceptions to confidentiality (child abuse (presumably including murder); abuse of a dependent adult), but domestic violence, murder of an adult, and other crimes are not among them. What your client tells you is kept confidential unless they sign a release or your records are subpoenaed and your attempts to protect the client's privilege/confidentiality are overridden by a court order signed by a judge. That situation, with a subpoena and then a court order, is likely what the previous respondent referred to when they said their colleague had to turn over all their notes.
Michelle M.
Entertainment Industry
1913
Answers
Updated
Michelle’s Answer
Hello, Bruce !
Since you have a strong interest in becoming a psychologist, it's no wonder that you're thinking about specific scenarios that may happen further down the line while you're in your career. It's good to get a heads up on things. In your studies, both of these scenarios will be discussed and the principles around these situations will be taught to you. No one in general can specifically give you an iron clad answer because human services is very spontaneous and each client is different. Each State that you work in is different, with different laws and different guidelines. Each company handles them differently. There is a basic code of ethics, patient/doctor confidentiality and other things that you will learn about in school or on your own reading the most up to date books or websites. If you really want to do one on one therapeutic counseling for people, consider going into Social Work. Learn the differences of Psychologists, Clinical Social Workers and Certified Mental Health Counselors.
If a patient/client has a medical emergency in your office while you are together, your agency will have already informed you of the procedures. In general, administer first aid and call for emergency services. Most offices that serve the types of patients and clients you will have are equipped with Narcan for opioid overdoses only. You must absolutely know that it's definitely an overdose of opioids, though, before administering it. You can go for training on how to administer it. But definitely call emergency services to come for the patient. That goes for any physical or mental health episodes.
Patient confidentiality is crucial, however, I think depending on the state you are in and current laws, if law enforcement needs information, it must be turned over. I had a colleague who had a client for which law enforcement requested the client's entire file and my colleague had to hand it over. There is no one clear answer to this, it's going to depend on your state, current law at the time and policy of your employer.
With the education and training you receive, you will know just what to do. These situations do happen so it is very insightful for you to ask. I hope this has shed some light on things for you and I wish you all the best in a satisfying career !
Since you have a strong interest in becoming a psychologist, it's no wonder that you're thinking about specific scenarios that may happen further down the line while you're in your career. It's good to get a heads up on things. In your studies, both of these scenarios will be discussed and the principles around these situations will be taught to you. No one in general can specifically give you an iron clad answer because human services is very spontaneous and each client is different. Each State that you work in is different, with different laws and different guidelines. Each company handles them differently. There is a basic code of ethics, patient/doctor confidentiality and other things that you will learn about in school or on your own reading the most up to date books or websites. If you really want to do one on one therapeutic counseling for people, consider going into Social Work. Learn the differences of Psychologists, Clinical Social Workers and Certified Mental Health Counselors.
If a patient/client has a medical emergency in your office while you are together, your agency will have already informed you of the procedures. In general, administer first aid and call for emergency services. Most offices that serve the types of patients and clients you will have are equipped with Narcan for opioid overdoses only. You must absolutely know that it's definitely an overdose of opioids, though, before administering it. You can go for training on how to administer it. But definitely call emergency services to come for the patient. That goes for any physical or mental health episodes.
Patient confidentiality is crucial, however, I think depending on the state you are in and current laws, if law enforcement needs information, it must be turned over. I had a colleague who had a client for which law enforcement requested the client's entire file and my colleague had to hand it over. There is no one clear answer to this, it's going to depend on your state, current law at the time and policy of your employer.
With the education and training you receive, you will know just what to do. These situations do happen so it is very insightful for you to ask. I hope this has shed some light on things for you and I wish you all the best in a satisfying career !
James Constantine Frangos
Consultant Dietitian & Software Developer since 1972 => Nutrition Education => Health & Longevity => Self-Actualization.
6342
Answers
Gold Coast, Queensland, Australia
Updated
James Constantine’s Answer
Hello Bruce, as an Australian dietitian, I'm here to assist you with any inquiries related to psychotherapy. It's crucial to have the contact information of local police on hand. If a client confesses to a crime such as murder, you should immediately notify the local law enforcement authorities. I would also like to share some valuable nutritional resources that I have discovered.
Certain patients may undergo a severe mental health crisis known as an acute psychotic episode (APE). This happens when the brain's thought process fails to reach a peaceful resolution or acceptance of the perceived realities. It's an unhealthy reaction from an overworked brain that isn't receiving enough nutrients. I recommend researching about B vitamin deficiencies and their impact on the brain.
This mental health issue is quite common these days, and individuals often need psychotherapeutic intervention to prevent self-harm or harm to others. Substance abuse, including alcohol and recreational drugs, can exacerbate the situation. Neuroses and burnout can occur due to lack of sleep or overwork. Stress and worry also deplete nutrients rapidly.
The complexities of mental health issues often necessitate the involvement of a psychiatrist. It's advisable to keep the contact information of local practitioners and hospitals handy. It's also beneficial to have the contact details of local psychiatric hospital registrars. Exploring the field of mental health nursing can be helpful, as people often feel helpless during a mental breakdown.
Providing reassurance and ensuring rest are key to managing these situations. Sometimes, our own mind can be our worst adversary. It's important to stop the destructive thought patterns. Remember, when feeling depressed or anxious, we can CHOOSE TO BE CONTENT by changing our internal dialogue.
Promote Positivity
Refer to Desiderata
JIM
Certain patients may undergo a severe mental health crisis known as an acute psychotic episode (APE). This happens when the brain's thought process fails to reach a peaceful resolution or acceptance of the perceived realities. It's an unhealthy reaction from an overworked brain that isn't receiving enough nutrients. I recommend researching about B vitamin deficiencies and their impact on the brain.
This mental health issue is quite common these days, and individuals often need psychotherapeutic intervention to prevent self-harm or harm to others. Substance abuse, including alcohol and recreational drugs, can exacerbate the situation. Neuroses and burnout can occur due to lack of sleep or overwork. Stress and worry also deplete nutrients rapidly.
The complexities of mental health issues often necessitate the involvement of a psychiatrist. It's advisable to keep the contact information of local practitioners and hospitals handy. It's also beneficial to have the contact details of local psychiatric hospital registrars. Exploring the field of mental health nursing can be helpful, as people often feel helpless during a mental breakdown.
Providing reassurance and ensuring rest are key to managing these situations. Sometimes, our own mind can be our worst adversary. It's important to stop the destructive thought patterns. Remember, when feeling depressed or anxious, we can CHOOSE TO BE CONTENT by changing our internal dialogue.
Promote Positivity
Refer to Desiderata
JIM
Racheal Noble, Ph.D., LMFT, LPC, NCC
Mental health, education, research, care coordinator
105
Answers
Oakland Park, Florida
Updated
Racheal’s Answer
Hello, and thank you for this question.
This question is loaded, so you may receive more responses.
In the state in which I live I would first make sure I am safe and no one else is at harm or the individual who committed murder is not intending to harm self or anyone else. I would want to ask them if they have any weapons on them and where they are or if they have any plans.
If we're are by phone or virtual talking, I will work to comfort them as well as work toward contacting law enforcement to assist with support for them because this situations has to be rectified. I can remain supportive to them, however, make sure I have as much detail information to reduce any discretion or discrepancies. I would stay in contact with police given that I was a witness to what is mentioned and speak to legal services to protect myself should any false information come against me. I also have liability insurance as well if it's needed for said issue.
Consult with another provider, and document everything.
This question is loaded, so you may receive more responses.
In the state in which I live I would first make sure I am safe and no one else is at harm or the individual who committed murder is not intending to harm self or anyone else. I would want to ask them if they have any weapons on them and where they are or if they have any plans.
If we're are by phone or virtual talking, I will work to comfort them as well as work toward contacting law enforcement to assist with support for them because this situations has to be rectified. I can remain supportive to them, however, make sure I have as much detail information to reduce any discretion or discrepancies. I would stay in contact with police given that I was a witness to what is mentioned and speak to legal services to protect myself should any false information come against me. I also have liability insurance as well if it's needed for said issue.
Consult with another provider, and document everything.
Annah Edmonds
Licensed Clinical Counselor and Art Therapist
120
Answers
Seattle, Washington
Updated
Annah’s Answer
Bruce, the truth is that this could very well happen. As a therapist I have worked with patients in crisis who are suicidal or homicidal- making threats to others. I have yet to work with someone who admits to murder- at least not prior to incarceration. You are creating a safe space that should invite patients to share openly. This work is confidential- with a few caveats! Your licensing board will have additional ethical and safety rules/regulations regarding certain situations. By the time you gain your MA or PhD or PsyD you will have ample time to gain experience and feel better prepared. The way you respond may also have to do with your work environment- whether you are in private practice, work for an agency or a hospital. There are reporting protocols. Anything that puts your patient at risk (to themself) or risk to others requires legal intervention such as emergency services or other legal action. You will take several ethics courses as a student to understand the limits and expectations of your license. The entity you work for will also have expectations regarding how the incident is charted in the electronic record. Depending on where you work and the type of work you pursue, you may be more or less likely to have such a situation occur. However, you will be trained to expect the unexpected. Ongoing supervision is always good to have in place. Being connected with other professionals in your field for consultation is also useful. While we are not responsible for what people choose to do outside of session, licensing and state law dictates steps to take that are feasible and may end up saving a life.
Buba Albert
A Copywriter and Creative Designer
2
Answers
Jos Plateau
Updated
Buba’s Answer
Hi Bruce,
So in a case of medical emergency, you have to prioritize their immediate well being here are some steps you should take;
- Call for emergency medical assistance and provide them with necessary information on the situation
- Secondly, Stay Calm and Reassure your patient about their safety and that help is on the way
- Follow emergency protocols like First Aid if needed
- Provide any necessary information on medical history or ongoing treatment on your patient
- Maintain boundaries and avoid overstepping into the role of a medical professional
- Document the incident (like what happened, actions taken or any recommendations)
- Follow Up with your patient and make sure they receive appropriate ongoing medical care and and mental health support
While if a patient admits to murder it's a serious and legally complex situation
-Firstly, stay calm and professional, don't panic, be stable and composed
- Secondly, do not promise confidentiality, make it clear that in this situation, you are obligated ethically and legally to report any information about harm to others
- Then, document everything, a detailed record of the conversation, with date, time, location and what was said including behaviors and emotions of the patient
- Next, suspend the session and contact law enforcement agencies
- Seek support and consultation from superiors or colleagues for guidance and to process your feelings and emotions
Wish You all the Best Bruce!
So in a case of medical emergency, you have to prioritize their immediate well being here are some steps you should take;
- Call for emergency medical assistance and provide them with necessary information on the situation
- Secondly, Stay Calm and Reassure your patient about their safety and that help is on the way
- Follow emergency protocols like First Aid if needed
- Provide any necessary information on medical history or ongoing treatment on your patient
- Maintain boundaries and avoid overstepping into the role of a medical professional
- Document the incident (like what happened, actions taken or any recommendations)
- Follow Up with your patient and make sure they receive appropriate ongoing medical care and and mental health support
While if a patient admits to murder it's a serious and legally complex situation
-Firstly, stay calm and professional, don't panic, be stable and composed
- Secondly, do not promise confidentiality, make it clear that in this situation, you are obligated ethically and legally to report any information about harm to others
- Then, document everything, a detailed record of the conversation, with date, time, location and what was said including behaviors and emotions of the patient
- Next, suspend the session and contact law enforcement agencies
- Seek support and consultation from superiors or colleagues for guidance and to process your feelings and emotions
Wish You all the Best Bruce!