Dear Alex The THREAT acronym is a stand-in for a Tarasoff type situation where there is a duty to warn and protect. While this may not be a legal, professional or ethical requirement in countries other than the USA, the issue of whether there exists a likely, identifiable, targeted victim remains urgent. While in Canada we have not had clear case law to parallel the California Tarasoff ruling, our courts have signalled that should such a case come to court, the bench would follow the Tarasoff reasoning and require that arranging for the safety of an identified and targeted victim would take preference over client confidentiality. The scenario that you describe would thus not in my view qualify as a THREAT. Best regards Johann Johann Brink MB ChB BA Hons FCPsych(SA) FRCPC Director, Clinical Services & Scientific Director Forensic Psychiatric Services Commission BC Mental Health and Addiction Services 70 Colony Farm Road Coquitlam, BC V3C 5X9 Clinical Professor Dept Psychiatry, UBC Adjunct Professor School of Criminology, SFU ph: 604-524-7702 fax: 604-524-7905 Admin Assistant: Lynn White ph: 604-524-7749 fax: 604-524-7905 lwhite@xxxxxxxxxxxxxx -----Original Message----- From: startgroup-bounce@xxxxxxxxxxxxx [mailto:startgroup-bounce@xxxxxxxxxxxxx] On Behalf Of Alexander M MILLKEY Sent: April 5, 2010 12:39 PM To: startgroup@xxxxxxxxxxxxx Cc: Brooke HOWARD; Darci WALKER; ebalduzzi622@xxxxxxxxx; Nicholls, Tonia Subject: [startgroup] Use of T.H.R.E.A.T. Hello Colleagues, We are debating the proper use of the THREAT at our hospital, and I am hoping that we can benefit from the experience of others on the list. We are attempting to rate a patient who is violent on perhaps a weekly basis. The violence is not targeted - the people being assaulted are selected due to convenience, not premeditation. Others have been seriously injured by this patient. This patient's PRESENT risk for violence is high. Would this patient be rated a Yes or No on THREAT? The risk of violence is real, enactable, and perhaps acute. However, it is not targeted. Must the risk for violence be targeted to be a THREAT on the START, or are the latter three sufficient? Thanks in Advance, Alex Alexander M. Millkey, Psy.D. Evaluation Psychologist Forensic Evaluation Service Oregon State Hospital Office: (503) 945-9262 Fax: (503) 945-9747 Confidentiality Notice: This message is intended solely for the entity or individual to whom it is addressed. Any unauthorized disclosure, copying , or distribution of this message is strictly prohibited. Nothing in this e-mail, including any attachment, is intended to be a legally binding signature. If you are not the intended addressee, you should contact the sender immediately and delete this message. Thank you.