CLEE Crisis Intervention and Suicidality 1 — Questions and Answers
Question 1: Under California law, a therapist may breach confidentiality without client consent when:
- The client misses multiple appointments without explanation
- There is a serious and imminent threat of harm to an identifiable third party (Correct answer)
- The client discloses past criminal activity
- The therapist believes the client is withholding information
Correct answer: There is a serious and imminent threat of harm to an identifiable third party
California's Tarasoff duty requires therapists to take reasonable protective steps, including breaching confidentiality, when a client poses a serious and imminent threat to an identifiable third party.
Question 2: The 'duty to protect' established in Tarasoff v. Regents of the University of California requires therapists to:
- Report all violent thoughts to law enforcement automatically
- Warn or protect identifiable potential victims when a client poses a serious threat (Correct answer)
- Immediately hospitalize any client who expresses anger toward another person
- Consult with a supervisor whenever a client discusses interpersonal conflict
Correct answer: Warn or protect identifiable potential victims when a client poses a serious threat
Tarasoff established that therapists must take reasonable steps—including warning identifiable potential victims—when a client poses a serious, credible threat.
Question 3: California Welfare and Institutions Code Section 5150 authorizes an involuntary 72-hour psychiatric hold when a person:
- Has a history of mental illness and voluntarily stops taking medication
- Is a danger to themselves, others, or is gravely disabled due to a mental disorder (Correct answer)
- Requests hospitalization voluntarily but then changes their mind
- Has been diagnosed with a serious mental illness by two independent physicians
Correct answer: Is a danger to themselves, others, or is gravely disabled due to a mental disorder
WIC 5150 authorizes a 72-hour evaluation hold when a person, as a result of a mental disorder, poses a danger to self, others, or is gravely disabled.
Question 4: When conducting a suicide risk assessment, which of the following is considered a static (historical) risk factor?
- Current substance intoxication
- A specific plan with available means
- Previous suicide attempts (Correct answer)
- Recent significant loss or bereavement
Correct answer: Previous suicide attempts
Previous suicide attempts are static/historical factors—they have already occurred and cannot change—and are among the strongest predictors of future attempts.
Question 5: A therapist learns a client has a specific, credible plan to harm a neighbor. Under the Tarasoff duty, the therapist should FIRST:
- Immediately call 911 without further clinical assessment
- Conduct a thorough clinical assessment to evaluate seriousness and imminence of the threat (Correct answer)
- Terminate treatment immediately to avoid liability
- Contact the client's family members to warn them
Correct answer: Conduct a thorough clinical assessment to evaluate seriousness and imminence of the threat
Clinical assessment of the threat's seriousness and imminence must precede action to determine the appropriate protective response.
Question 6: Which action does NOT fulfill a therapist's 'duty to protect' obligation under California law?
- Warning the potential victim directly
- Notifying local law enforcement of the threat
- Seeking voluntary or involuntary hospitalization for the client
- Terminating the therapeutic relationship without any follow-up or protective action (Correct answer)
Correct answer: Terminating the therapeutic relationship without any follow-up or protective action
Simply ending treatment without taking affirmative protective steps does not satisfy the duty to protect; therapists must take reasonable action to safeguard identifiable victims.
Question 7: Under California law, when is a therapist legally REQUIRED (not merely permitted) to break confidentiality for a suicidal client?
- Whenever the client expresses any level of suicidal ideation
- When the client has a specific plan, means, and a stated timeline
- There is no absolute legal requirement—breaching confidentiality for suicidality is a matter of clinical judgment (Correct answer)
- When the client's family requests disclosure of the client's risk level
Correct answer: There is no absolute legal requirement—breaching confidentiality for suicidality is a matter of clinical judgment
California law permits therapists to breach confidentiality for suicidal clients but does not universally mandate it; therapists must exercise clinical judgment based on imminence and severity.
CLEE Crisis Intervention and Suicidality 1
Under California law, a therapist may breach confidentiality without client consent when: