And for someone who is delusional, this may be one more reason not to trust psychiatrists and not to get treatment. The New York SAFE Act may well have the unintended consequence of increasing suicide rates and violence, and there is no doubt that other states will follow suit with similar legislation if we don’t reconsider the quick response of New York state.
While other laws have overridden doctor-patient confidentiality – for example, requirements to report sexually transmitted diseases and abuse of vulnerable populations – those laws address illnesses and acts that have already happened. These laws require clinicians to report their suspicions and beliefs about a patient’s intentions, and they set the stage to require state-mandated reporting of any number of fantasies told to a therapist. Violent ideas are very common, and mental health professionals are not particularly good at predicting who will act on them. What else might we extend reporting requirements to include? The sexual activities of patients with HIV? The financial behaviors of those running Ponzi schemes?
Is this really what we want? Interestingly, in New York, you can still tell your internist or dermatologist that you’re feeling suicidal, and that doesn’t need to be reported to the state.
—Dinah Miller, M.D.
Dr. Miller is co-author of Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011)