Threats to Secret Service protectees: guidelines on the mental health services provider's duty to report.

This article presents a set of proposed guidelines for mental health care providers faced with the not uncommon problem of having a patient under treatment who makes statements that can be interpreted as threatening the life of the President of the United States or another protectee of the Secret Service. What is the provider's duty in this situation? When should such a "threat" be reported? What should be reported? And to whom? The questions are difficult ones that confront both the dictates of the federal presidential threat statute and the general duty-to-warn law of the state where the provider resides and practices. Professional ethics and common sense must, of course, also figure in the calculus of the proper course of action. This article begins with a brief history of the Secret Service, its formal responsibilities, as well as its evolving contacts with the mental health community, driven by the Service's own recognition of the need for mental health expertise in evaluating the intentions and capacities of those who issue presidential threats. Next, this article presents the guidelines themselves, followed by commentary that sets out their legal, ethical, and pragmatic underpinnings.