Discussion Do you think that therapy could be improved by removing mandatory reporting?

[CrazyDiamond04]

I think that one of the biggest drawbacks to therapy is the existence of mandatory reporting and how it prevents people from being entirely honest when it comes to how they're feeling, especially when it comes to suicide. Instead of having an honest conversation i think a lot of people often feel as though they have to dance around the topic and try to convey what they mean indirectly, which isn't very effective in tackling the issue. However, i don't blame therapists for erring on the side of caution when it comes to deciding what they should report, especially if it could harm them career-wise. The system, as it currently stands, perpetuates a status-quo where everybody loses and deriving something fruitful from the practice can be difficult. I feel that removing mandatory reporting can help a lot in terms of solving this problem. What do you think?

 

[Maeve]

Maby idk i do wish i could be honest with my therapist tho just to up the chances i make it

 

[Sluggish_Slump]

I think it might burden the therapists too much if they didn't report real plans people are making to hurt themselves or others (because of the real life connection)

 

[TransilvanianHunger]

Mandatory reporting is misunderstood and misused by therapists a lot. A therapist has a legal duty to make a report when they believe a patient's life or the lives of others are in immediate danger, not whenever a patient mentions suicide. Context matters. If a patient talks about having suicidal thoughts, the therapist should pay attention to that and work on it within the therapeutic frame. If a patient walks out of the consulting room saying that they're going to shoot their family and then themselves, then a report is absolutely justified.

I believe the answer is not removing all mandatory reporting, but rather educating therapists on which situations are to be explored with the patient during therapy and which merit actually getting some sort of authority involved.

There's also a problem of liability, though I don't really know how I'd approach that one. A patient killing themselves at some point after having discussed suicidal ideation with their therapist. I've talked about it with my therapist, for example, and she didn't make a report. If I were to decide right now to kill myself, is my therapist responsible for that? I don't think so, but she could be in deep legal trouble anyway. That being a possibility, a therapist might choose to report any indication of suicidality just to be on the safe side.

It's a tricky issue, really. There are no easy answers or solutions.

 

[CrazyDiamond04]

Mandatory reporting is misunderstood and misused by therapists a lot. A therapist has a legal duty to make a report when they believe a patient's life or the lives of others are in immediate danger, not whenever a patient mentions suicide. Context matters. If a patient talks about having suicidal thoughts, the therapist should pay attention to that and work on it within the therapeutic frame. If a patient walks out of the consulting room saying that they're going to shoot their family and then themselves, then a report is absolutely justified.

I believe the answer is not removing all mandatory reporting, but rather educating therapists on which situations are to be explored with the patient during therapy and which merit actually getting some sort of authority involved.

There's also a problem of liability, though I don't really know how I'd approach that one. A patient killing themselves at some point after having discussed suicidal ideation with their therapist. I've talked about it with my therapist, for example, and she didn't make a report. If I were to decide right now to kill myself, is my therapist responsible for that? I don't think so, but she could be in deep legal trouble anyway. That being a possibility, a therapist might choose to report any indication of suicidality just to be on the safe side.

It's a tricky issue, really. There are no easy answers or solutions.

Yeah, the problem with liability is the biggest hurdle to cross imo. I'm not well versed on what the potential consequences could be if a therapist's client dies from suicide so I can't give a concrete solution on how to reform it. I do think that mandatory reporting should exist if a person says that they're going to commit a crime, but suicide isn't a crime in the US. I was talking purely about a situation where someone talks about suicide and nothing else.

 

[TransilvanianHunger]

I was talking purely about a situation where someone talks about suicide and nothing else.

In that instance, mandatory reporting shouldn't even be part of the conversation. Any competent therapist should be able to conduct a risk assessment when the subject comes up to ensure that the patient is not in imminent danger, and then the topic should be explored in the context of the therapy. Of course, there is an emotional element at play here, because suicide is a taboo subject and many therapists aren't prepared to approach it in a level-headed way, even if the patient is simply describing their feelings and thoughts. The fear of death and suicide can make a therapist overreact.

An interesting thing is that we don't really know how prevalent this phenomenon is, of therapist reporting patients who simply talk about suicide without presenting any immediate danger to themselves or others. We hear the stories of those who were reported, institutionalised, and so on. But how often does it actually happen? A therapist who deals properly with a patient expressing suicidal ideation is not going to talk about it due to confidentiality, and the patient probably won't feel the need to openly discuss their suicidal thoughts with the world if they can do it in safety and confidence with their therapist.

Still, the fact that stories about therapist overreacting and reporting are out there shows that there's work to be done.

 

[cold_severance]

personally i dont think so. being suicidal has a cause behind it, so in therapy you should work on the reason rather than the consequence. removing mandatory reporting would make things a bit easier i guess, but wouldnt change much.

 

[Forever Sleep]

I agree that it must hold people back from being honest which seems ludicrous in a health setting. Imagine if a doctor had to guess about whether you had a broken arm or cancer according to a very vague description by the patient because they didn't want to reveal specifics!

There again- it all stems from 'blame culture'. I think it's that that needs to change before anything else can. Which is kind of difficult I guess because in some negligence or wilful harm cases- maybe they are to blame!

Even if they don't need to report someone if they only hint at suicide- if the person still does it, people start pointing fingers. Especially if they are young. It will most likely be the parents. To everyone but themselves I imagine- Why didn't their school 'do' something? Why didn't their friends or therapist 'do' something? Why did a company sell them a legal product to CTB with? Why were they able to find that information on the internet?

I think they need to be honest with themselves. How many of these people were so vulnerable and mentally unsound that they couldn't reason to make decisions for themselves? People need to acknowledge that we are all responsible for our own decisions. Hopefully their child wasn't a minor because in that case- I think maybe the therapist might have more cause to report them. As an adult though- of sound mind- ie. reasoning mind- it's down to us- or- should be.

I just think the whole mental illness side of healthcare needs an overhaul though. I don't really understand how they diagnose mental illness to begin with. It all seems so woolly. I think they also need to make clear distinctions on who they consider are mentally capable to make decisions for themself despite having mental illness. Maybe disclaimers would be the way forward- so therapists could feel confident to try and help with no cosequences to them if it fails.

Ideally though- it shouldn't be a case of reporting someone without their knowledge. If a person isn't in a place where they are willing to accept being helped or stopped then I imagine they are one of two things. They are either psychotic and about to act impulsively- which it probably would be reasonable to stop or- they are much calmer than that but have reasoned that they want out. Personally, I'd try to insist they prove I am of unsound mind before they committed me! I'd be willing to listen to someone suggest I might have depression etc and would I be willing to try a course of this or that but- no one should be forced into doing things. Especially when they show the capability to reason.

But- a lot of waffle to say- I think the whole idea of culpability needs to shift (unless there is real negligence or wilful harm at work) so that therapists don't feel so pressured to report people unless they truly do seem to be having a psychotic episode. If they seem of sound (rational) mind- they shouldn't be being treated like they are psychotic!