LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 303.01 Tarasoff
 
  PROCEDURES
  1. A client’s risk of harm to others shall be assessed and managed during the initial assessment process and when indicated during treatment.
     
    1. When a threat and/or risk of harming others is present, the risk shall be clinically monitored, assessed, and documented at each encounter until staff determine the risk has sufficiently dissipated or has escalated to a threshold risk necessitating action.
       
  2. Reporting of a client’s threshold risk of harm to others:
     
    1. When a client, a member of the client's immediate family, or other credible informant communicates to any staff during initial contact or the course of service that a client has made a serious threat of physical violence against a reasonably identifiable victim(s), actions pursuant to Civil Code § 43.92 and the Tarasoff decision must be implemented to protect the third party. Only the minimum information necessary to protect the intended victim(s) shall be released.
       
    2. This exception to client confidentiality must be carried out with the maintenance of public safety and therapeutic relationship as the objective.
       
  3. The following steps are applicable to staff when a client, a member of the client’s immediate family, or other credible informant communicates to any staff a serious threat of physical violence against a reasonably identifiable victim(s):
     
    1. Non-clinical staff must immediately report any such communication to a clinical supervisor (or designee) for action.
       
    2. Clinical staff, bearing in mind the urgency of the danger, shall consult with a clinical supervisor (who shall notify the Program Manager or designee of the facility) to determine whether the client presents a serious danger to a reasonably identifiable/foreseeable victim(s) and the need for a Lanterman-Petris-Short (LPS) evaluation.
       
      1. If client cannot be located, clinician shall:
         
        1. Make reasonable efforts to notify the intended victim(s) whether or not the client is hospitalized. Contact may be made through telephone or visitation. Document in the client's record specific efforts to contact the intended victim; names of family or friends with whom contact was made; dates and times of contact attempts; and copies of written correspondence.
           
        2. Contact the local law enforcement agency having jurisdiction where the intended victim resides and document in the record the name of the person to whom the report was made, date, time, and content released.
           
    3. The LPS-designated evaluator shall:
       
      1. Review available past and present history and treatment of the client.
         
      2. If the threat involves staff, procedures in accordance with DMH Policy 109.01, Security/Safety/Threat Management and Violence Prevention, shall be followed.
         
      3. In the event of threats related to National Security and Intelligence Activities, medical information and Protected Health Information (PHI) may be disclosed to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
         
      4. In the event of threats related to the President or Vice-President of the United States or to foreign heads of state, medical information and PHI may be disclosed.
         
      5. Should a question remain as to whether the threshold risk triggers a duty to protect a third party, then the following shall occur:
         
        1. A higher-level clinical supervisor shall be consulted.
        2. Should a question still remain, County Counsel shall be consulted through Clinical Risk Management or by an Executive Staff member.
           
      6. If it is decided that the client does not present a serious danger to an identifiable/foreseeable victim(s), this fact shall be documented including the rationale.
         
        1. The LPS-designated evaluator who finds that the client does not meet criteria for involuntary detention shall consult with a higher-level clinical supervisor.
           
      7. If it is decided that the client presents a threshold risk to a reasonably identifiable/foreseeable victim(s), the following actions shall be taken:
         
        1. Make reasonable efforts to notify the intended victim(s) whether or not the client is hospitalized. Contact may be made through telephone or visitation. Document in the client's record specific efforts to contact the intended victim; names of family or friends with whom contact was made; dates and times of contact attempts; and copies of written correspondence.
        2. Contact the local law enforcement agency having jurisdiction where the intended victim resides and document in the record the name of the person to whom the report was made, date, time, and content released.
        3. Notify the receiving LPS-designated facility of the efforts to protect the intended victim.
           
      8. Involuntary hospitalization of the client does not discharge the duty to protect which includes contacting the intended victim(s) and notifying law enforcement.