Mental Health Experts and Their Obligation to Safety

Our paramount professional responsibility is safety.

Posted Jun 11, 2018

As National Safety Month follows National Mental Health Month, it is useful to remember that paramount in psychiatrists’ code of ethics is the health, wellbeing, and safety of their patients and the public. All the rest of their ethical guidelines derive from these principles. In ordinary practice, the patient’s right to confidentiality is the bedrock of mental health care that dates back to the Hippocratic oath. However, even this sacrosanct rule is not absolute when a patient’s or others’ safety is at stake.

Similarly, in ordinary practice, a public figure has a right not to be diagnosed frivolously from afar and without authorization, as “the Goldwater rule” indicates. However, even this basic courtesy agreement should not be absolute, according to basic professional guidelines, when a public figure poses a threat to public safety.

If all 50 U.S. states have mandatory guidelines that mental health professionals breach patient confidentiality, if necessary, for the sake of the patient’s and the public’s safety, then how much more important is it that we supersede the Goldwater rule, against a public figure who is a non-patient, to protect public safety? The preamble of the psychiatric ethical code states that a psychiatrist’s responsibility is first and foremost to the patient “as well as to society” (American Psychiatric Association, 2013). This primary obligation does not extend to the public figure, and certainly not when he poses a threat to the safety of patients or the public.

This was the ethical reasoning when I and several hundred mental health professionals issued our first public warning, below, after the president’s comment five months ago: “North Korean Leader Kim Jong Un just stated that the ‘Nuclear Button is on his desk at all times.’ Will someone from his depleted and food starved regime please inform him that I too have a Nuclear Button, but it is a much bigger & more powerful one than his, and my Button works!” (Baker and Tackett, 2018). Our warning was summarized in a story in Politico (Karni, 2018).

Things have gravely worsened since this warning in January 2018, just as the predictions made by me, as editor, and 26 other mental health professionals, in The Dangerous Case of Donald Trump (Lee, 2017) have borne out to be true—in contrast to national sentiment in April 2017, when we held the conference that led to the book, when most believed the president would “pivot” and become more normal.

Now, the president agreed to hold a summit with North Korea following substantial war preparations (U.S. Department of Defense, 2018) accompanied by extraordinarily denigrating and threatening language (“Rocket Man,” “fire and fury,” and “totally destroy North Korea”).  South Korea’s extraordinary intervention helped to prevent a nuclear showdown, but we cannot always rely on such luck. Even in the short intervening time, the president replaced his secretary of state and national security adviser; pulled out of the treaty that kept Iran from developing nuclear weapons; canceled the North Korea summit and rescheduled it again; and threatened North Korea with “total decimation.”

Then, after leaders of the G-7 alliance carefully crafted a closing communiqué outlining a fragile agreement, Trump rescinded his decision to sign it. The host’s comments apparently offended him: “Based on Justin’s false statements at his news conference, and the fact that Canada is charging massive Tariffs to our U.S. farmers, workers and companies, I have instructed our U.S. Reps not to endorse the Communique as we look at Tariffs on automobiles flooding the U.S. Market!” he wrote in a tweet (Shear and Porter, 2018). What is left if we create an enemy out of Canada, our closest ally, not to mention rupture the alliance we have forged with the rest of the West over more than a century? While he might have been seeking to isolate North Korea, he seems to be the one isolated just before entering negotiations on Tuesday.

Many mental health professionals (and others) have been raising alarms, since the very beginning, about the president’s apparent lack of capacity to make sound, rational decisions that serve the interests of our nation and international security. While there has been a learning curve on the part of world leaders, many now seem to be catching on to the reality that he does not respond to reason or logic, or to multilateral cooperation that would be in his nation’s, or the developed world’s, interest of peace (Andelman, 2018). The question is, when will our own leaders come to the same recognition? When will they act to ensure the nation’s safety, a national emergency when a president is so obviously incapable of fulfilling his role? When the authorities are not showing an ability or willingness to place public safety first, then the role, in this case, falls on mental health professionals.

Our Duty to Warn:

Statement on Trump by the National Coalition of Concerned Mental Health Experts

January 3, 2018

We write as mental health professionals who have been deeply concerned about Donald Trump’s psychological aberrations. We believe that he is now further unraveling in ways that contribute to his belligerent nuclear threats. We are aware that statements coming from North Korea contribute greatly to the problem, but our concern is with the behavior of our own President. We urge that those around him, and our elected representatives in general, take urgent steps to restrain his behavior and head off the potential nuclear catastrophe that endangers not only Korea and the United States but all of humankind.

Bandy X. Lee, M.D., M.Div.

Judith L. Herman, M.D.

Robert Jay Lifton, M.D.

+322 Additional Co-Signatories


American Psychiatric Association (2013).  Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. Retrievable at:

Andelman, D. A. (2018).  The realization has finally dawned that Donald Trump does not respond to reason.  CNN.  Retrievable at:

Baker, P., and Tackett, M. (2018).  Trump Says His ‘Nuclear Button’ Is ‘Much Bigger’ Than North Korea’s.  New York Times.  Retrievable at:

Karni, A. (2018).  Washington’s growing obsession: The 25th Amendment.  Politico.  Retrievable at:

Lee, B. X. (2017).  The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.  New York, NY: Macmillan.

Shear, M. D., and Porter, C. (2018).  Trump refuses to sign G-7 statement and calls Trudeau ‘weak’.  New York Times.  Retrievable at:

U.S. Department of Defense (2018).  Nuclear Posture Review.  Washington, DC: U.S. Department of Defense.  Retrievable at: