How do you approach disposition planning when a patient makes homicidal threats on presentation to the emergency department but later recants?

Tarasoff rules.

Tarasoff v. Regents of the University of California

The ER department remains in the purview of all medicine in the USA, in my opinion.

“How do you approach” is the same regardless of the setting. The thought of the clinician remains superordinate. Is this really a question?

Recant... ”imminent”. vs. ”persistent” vs “occasional“.

Who has not had a patient who has “occasionally” threatened another human? Really. (Punctuation here is intentional).

(We all (every human) have had some 30-50 thousand thoughts a day). Not everyone (thought) is fully conscious, sustained, and ongoing with intentionality.

If you, as the physician/clinician, believe your patient poses a serious and ongoing threat to another… then in the USA generally...

We are psychiatrists, and we have our area of expertise... the legal system has theirs... the legal system, NOT the medical system, has created Tarasoff or more specifically THE DUTY TO WARN. I have taught residents, medical students, and nurse practitioners for many years, and I present a very simple approach that renders this a non-problem for the mental health professional. If you feel that someone presents a potential danger of violence to another, pursue an involuntary commitment to an inpatient setting... in all states, I believe this sets in motion two things.

I. The decision is thrown into the legal arena, and a judge or judge substitute (some states refer to these people as mental health masters, which I believe is CUTE).

II. The p...