Threats from patients are both clinical and legal events. The patient who threatens you, staff, third parties, or self is producing a situation that requires structured response — clinical risk assessment, legal duty assessment (Tarasoff or equivalent), personal safety management, and documentation. Handle threats systematically; don't manage them alone.
Take threats seriously without panic. Most threats are not enacted. Some are. The clinical question is which category this threat falls in, and the assessment uses structured violence risk evaluation — history of violence, current symptoms, target specificity, means access, intent versus venting.
Specific threats toward identifiable persons require Tarasoff duty assessment. When a credible threat against an identifiable third party exists and the patient has capacity to act on it, the legal duty applies. The options vary by jurisdiction — warn the target, hospitalize the patient, contact law enforcement, or some combination. Consult institutional protocol and state law.
Threats against your safety are also clinical events. Document specifically, consult colleagues and risk management, involve security if needed. The clinical relationship may be recoverable or may require transfer to a different clinician depending on the nature and pattern of threats.
Don't capitulate to threats. The patient who learns that threatening behavior produces clinical concessions will continue. Your prescription decision should not change because the patient threatened to file a complaint, harm themselves, or report you. The decision may change because new clinical information emerged through their distress, but not because the threat itself pressured the change.
Document carefully. Verbatim threats when possible. Context and apparent intent. Actions taken — consultation, security notification, Tarasoff warning, hospitalization, termination of clinical relationship if appropriate. The documentation supports both clinical care continuity and legal protection.
Don't handle alone. Threats are not solo events. Consult colleagues. Use supervision. Involve risk management. Coordinate with institutional protocols. The system supports you in these moments; use it.