Cho (VT shooter) Didn't Get Court-Ordered Treatment

[babylonsister]

http://www.washingtonpost.com/wp-dyn/content/article/2007/05/06/AR2007050601403_pf.html

Cho Didn't Get Court-Ordered Treatment

By Brigid Schulte and Chris L. Jenkins
Washington Post Staff Writers
Monday, May 7, 2007; A01

Seung Hui Cho never received the treatment ordered by a judge who declared him dangerously mentally ill less than two years before his rampage at Virginia Tech, law enforcement officials said, exposing flaws in Virginia's labyrinthine mental health system, including confusion about the law, spotty enforcement and inadequate funding.

Neither the court, the university nor community services officials followed up on the judge's order, according to dozens of interviews. Cho never got the treatment, according to authorities who have seen his medical files. And although state law says the community services board should have made sure Cho got help, a board official said that was "news to us."

more...

[jody]

1. IMO the judge was first in line for blame because he did not insure his order was enforced.

I also expect the judge did not have the funds nor the authority to do that task.

In that sense, the issue is just one of many where a court issues an order and the executive branch of government does nothing because the legislative branch has not funded such enforcement programs.

[SoCalDem]

2. You appear before a judge. he tells you to get mental health care

It costs $150 an hour. You are a troubled student who is ashamed to call your parents and ask for money or maybe they don't have the extra money.. What do you do?

You do without , and hope that the judge forgets about you..then you snap and do what he did

If a judge orders it, it ought to be immediate, mandatory and paid for by the state.county/whatever. Once the treatment ends, they can set out to figure out how to get reimbursed.

[Sydnie]

3. According to my sister, who worked in the mental health office that

did the initial intake on Cho, he was asked if he would go for treatment voluntarily. Once he said that he would, all the "mandatory" elements fell away. He had to spend two days in-house at a facility and then could appear back before the judge. If he appeared to be in control of himself then the judge had no choice but to release his previous order and allow him to leave the facility. BTW, all his treatment WAS paid for by the state and follow up treatment could have been free of cost to him as well. The office where he was initially taken works in concert with VT, located just blocks from the campus. He could have gotten free treatment there at any time but he would had to want it himself as not all their hours there are "non-billable/no insurance" hours. As far as the local authorities were concerned, treatment ended when the judge released him from the facility.

That's the loophole he found in the system. Because he volunteered to go in for an evaluation, he slipped through the cracks as far as follow up is concerned.

[jody]

4. IMO the loophole is the judge did not have a system to insure his order was enforced. Either that or

his order was not mandatory.

[Sydnie]

8. It lost it's mandatory teeth when he volunteered to go for an evaluation

That's how he got released so easily. All he had to tell a judge was that he was back in control, prove to the judge that he APPEARED to no longer be a threat to himself or others and the judge released him from the order. Had he refused to go voluntarily, he would have remained in the net of the mandatory portion of the order.

My sister said that once they agree to go for the evaluation, all "court enforced" procedures became moot and were not a consideration by the state at that point. Since he agreed, he went to a "better, private facility" closer to the campus than he would have if he had not agreed. He was transported there by the police, but he was not handcuffed nor treated in any way as "involuntary". Had he refused and the state would have placed him, he would have gone to a different facility many miles away, transported in handcuffs and processed much differently than he was.

[Giant Robot]

13. I do not know about VA

But in my state if someone is court ordered into treatment, they can opt out of that and go in voluntarily. But that does not mean the court order disappears. It just gets set aside as long as the person is compliant. If at any time the person becomes non compliant then the court order can come back out and be put back into effect.

Basically it sounds like he worked the system to stay out of it. I would not spend a lot of time feeling sorry for him that the system let him down. It could have done a better job yes, but I imagine he worked hard to keep as much control over the situation as he could and figured out what to say and do to get out of there as quickly as possible. Think about it, a man that has paranoid tendencies and feels victimized by the world is not necessarily going to feel too ashamed or too confused by the system to get help. He is going to feel persecuted and work to find ways to get out of that situation. As much as I usually think the system needs help, this one is more on him than it. Yes the process could have gone better and maybe could have stopped this if the system were changed....but this one is on him more than anything.

[EFerrari]

26. I agree with you about responsibility but if we look for points

of intervention, that's something else again.

[jody]

15. If what you say is correct, then the judge lost control voluntarily unless state law proscribes

judicial involvement.

If it's the latter, then Virginia's Legislature could be negligent if it could have reasonably foreseen that mental patients who were a risk to others would not be placed in custody.

[EFerrari]

6. A person who go in and out of psychosis needs an advocate

to navigate the whole process.

[Sydnie]

9. And honestly, there is no way they could have fully evaluated him

in two days. Not with the pathology that he had. He was just good enough and in control enough to appear stable enough to slip right through the system, both the mental health system and the gun control system as well.

[EFerrari]

11. True and he would had needed at least two weeks to get

the full benefit of an anti psychotic even if the doctor started his meds as soon as he crossed the hospital threshhold. :(

[EstimatedProphet]

14. I would think that the student health center should have been able to handle it

Since he was a student, wouldn't he qualify for going to the student health center?

[Kber]

20. Sure, where, if it was anything like my student health center

they would have given him some cough syrup and an asperin and sent him on his way.

[Cabcere]

22. LOL - great minds, Kber

:hi: Or maybe we just went to the same school? :shrug: :P

[Cabcere]

21. I don't know what the student health center is like at VT,

but at my college (another VA public school) it's widely considered to be a joke. In fact, many students refer to it as the "Death Center," and almost anybody you talk to on campus can tell you horror stories about red tape, the frequent misdiagnosis of illnesses (almost everything is diagnosed as either allergies or pregnancy - sometimes with no regard to the gender of the patient for the latter!), and general incompetence. The people who work there are nice enough, and I think they really do try to help, but honestly I wouldn't go to them for anything more complicated than the flu. And I certainly wouldn't go to them for mental health issues. It may be different at VT or other colleges, but if it's similar to mine, then I can't say I blame the shooter for not seeking help with mental health issues at the student health center. :shrug:

[EstimatedProphet]

25. OK

My undergrad SHC was pretty good, actually. My grad SHC was worse than pathetic. I guess I would expect a school the size of VT to have a really good one, but they may not.

[Cabcere]

30. I guess it varies from place to place.

I wasn't trying to slam you or say that you were wrong, btw - just saying that if VT's health center was anything like mine (and granted, my school is quite a bit smaller than VT), it probably wasn't great. :hi: Peace.

[EstimatedProphet]

31. Alright - didn't figure you were trying to slam me

Peace be unto you

[Cabcere]

33. OK, good

It occurred to me after I wrote it that it might have come across that way, and I certainly didn't intend for it to. :hi:

[EFerrari]

34. Really? Ours was great at Berkeley. Probably the best in

not only the city and county but in the whole damn state.

[fasttense]

5. What a tangled mess of laws and inaction.

"The court doesn't follow up, he said. "We have no authority.""

The judge doesn't have the authority to follow up? The judge issued the order but he can't follow up and make sure it is followed? So if I'm found in contempt of court and given jail time, the judge doesn't have the authority to make sure I'm put in jail? I don't buy it.

"Virginia law says community services boards -- the local agencies responsible for a range of mental health services -- "shall recommend a specific course of treatment and programs" for people such as Cho who are ordered to receive outpatient treatment. The law also says these boards "shall monitor the person's compliance."

When read those portions of the statute, Wade said, "That's news to us."

In fact, the law even says that when a dangerously mentally ill person ordered into treatment doesn't show up, as was the case with Cho, he or she can be brought back before the special judge, and if found still in crisis, can be committed to a psychiatric institution for up to 180 days.

None of that happened in Cho's case."

So Virginia law makers passed this law but somehow the community service boards didn't know about it? They didn't know the law says they were suppose to follow up on this guy?

So what's the use of passing the law if no one is paying any attention?

[EFerrari]

7. This happens all over the country every day. Nobody is

paying attention because usually the only person who gets hurt is the mentally ill person and sometimes, someone in their family.

[RobinA]

10. There's Not Enough Money

time, personnel or system capacity to go tracking down people who are "court-ordered" for treatment and don't show up. Hell, there's not enough money, personnel or system capacity to treat the people who WANT treatment adequately. Court orders of this nature are routinely ignored. Frankly, I've often wondered if they are even enforceable, as in the child welfare system I've seen judges routinely ignore noncompliance with their own orders.

This being America, you can only go so far in forcing people to do what they don't want to do if they haven't broken any laws. I've often had this fight with school and medical professionals who seem to think that someone can be ORDERED to take psychtropic medication. Sorry, no, it doesn't work that way.

The only possible way out of the Cho mess as I see it was to ease up on involuntary committment, and even that depends on how he actually presented himself at the time. You can't lock up every mentally ill person who might, just might, snap one day.

[EFerrari]

12. That's right. There's not enough money, personnel or capacity

to treat people who are well enough to want treatment. People who have no insight into their situation are screwed and so are the people who live with them.

In some places, people can be ordered to take psychotropic drugs. We worked on getting Laura's law passed in CA so a family could step in if their schizophrenic relative went off their meds and was in danger. It's a good compromise. There are similar laws in other places and people working on getting them passed in more. These tragedies are largely preventable. There's more info here:www . psychlaws. org

[Giant Robot]

16. Realistically

all passing more laws to force compliance is going to do is aggravate and frustrate more than anything because there will be NO money available to fund that service, and it will be done half assed. My advice is to forget about trying to get more laws passed to force treatment upon someone and work harder and lobby more to get mental health agencies the funding they desperately need to do this work, and maybe more folks would willingly stay on their meds. Force legislatures to fund these programs liked was promised back when the hospital system was shut down. That is my suggestion.

[EFerrari]

17. The problem is, there is actually a medical term for people

who suddenly believe they are fine -- anosognosia. They have very or no awareness of what they are risking by going off their meds. And sure, there is potential for abuse of these laws: that needs to be monitored. But they help people like my friend whose brother does this every so often, becomes violent, blows up his living situation and believes his sister is a robot when she tries to help him back on track before he goes homeless. :(

I couldn't agree more that we need to pump more resources into mental health. One of the problems is that our families are so stressed out and tired most of the time, it's a very big effort to keep up the pressure on these issues. Ditto for most of the clinicians I know.

But, I still feel hopeful. It only took a day or so before DU started talking about mental health resources instead of about good and evil. We'll get there.

/oops

[Giant Robot]

18. It is a hallmark of mental illness that

those folks coping with it often are unaware that there is anything wrong; that is pretty standard fare actually. It takes time, effort, training, and compassion, but that can be overcome and the persons involved can become aware of the challenges they face. But it takes time, effort, training, compassion, etc. Most mental health systems struggle with those. With more funding, these can be overcome, I believe. My point is, we need more of that than more laws. I am glad you are hopeful, that is wonderful to hear, and maybe one day there can be changes to the system, with a little hope.

:hi:

[EFerrari]

19. Right on, Giant Robot! And you are right. Our brains try to protect us

from stuff that is too hard. It's sort of like why cats hide when they are unwell, isn't it?

lol

One foot, the other foot. :hi:

[Giant Robot]

23. I heard this story once

And it will lose something in the re-telling. There was a seminar (I am a social worker) that some of my co-workers went to, and the subject was on that facet of mental illness specifically. The doctor who was doing the training asked for a volunteer from the audience, and a woman next to my co-worker volunteered. The doctor asked her some personal questions, which she answered. He then said that who she thought was her husband was not, he has filed a protection order against her as she had been stalking him, that they had no children, and that there were people waiting outside to take her into protective custody. The result was mildly humorous, but very anxiety producing to put her in that place. I think we all react very protectively when our realities are challenged.

[EFerrari]

24. LOL! No kidding.

My borderline (now ex) partner told everyone I was having a breakdown last summer and I got calls and visits from some very, very concerned friends and family. It was so disturbing to me and I am very familiar with that kind of situation, having talked with by now hundreds of families that tilt with it.

Some part of me wondered if he was right! Oh dear.

Don't mess with my reality, man.

:rofl:

[RobinA]

28. But In Reality

how do you enforce such laws? Leaving aside the slippery slope argument, how do you MAKE an adult take a med? I understand the use of these laws, but I don't know how they would work. I would prefer to change committment laws so that when cousin Ruth goes off her meds and starts walking up and down the street muttering obscenities to all passersby she could be put in the hospital BEFORE she climbs out on the side of the bridge and either does or does not jump.

[EFerrari]

29. What usually happens is that Cousin Ruth's advocate -- relative

or friend or neighbor -- goes to court and gets a court order for involuntary commitment so Cousin Ruth can get her meds. If they aren't too tired already and if they can get the day off to go to court.

We're not talking about a formal system, we're talking about mostly just concerned people with their own limitations and limited resources who try to follow up and do the right thing by Cousin Ruth and by the family/community in a system that keeps trying to shunt them aside because there really is no system except the criminal justice system that handles these situations.

And the CJS doesn't really handle them except for locking people up and that's not either prevention or therapeutic. Prison is not a therapeutic community and it's not a real solution, just an inhumane stop gap.

[AngryAmish]

37. Horror story I heard last week

I was in court and the case that came in front of the judge was a condemnation case. From what I gathered this man owned three houses in a town and was not maintaining them - so the city started a condemnation action against him. He stopped using city water (the meter was speaking to him) and used a neighbor's hose for water. The guy was obviously mad but there was no family or friends helping him out.

Anyway the court case is up and the defendant is not there. The city's attorney tells the judge he wants her to order a psychological exam of the defendant (which is clearly allowed by statute). The city's attorney says he does not want to knock this guy's houses down - he just wants them fixed and this guy to get some help. He had spoken with the Illinois Public Guardian (who protects the assets of the insane) but they cannot become involved without an order from the judge.

The judge would not order the exam because she thought it was someone else's job to order it. This is clearly not true and showed cowardice and ignorance on her part. I just sat there getting more upset when this authority figure - whose job it is to protect the crazy guy and the community at large - would not do her job.

[EFerrari]

38. Oh geeze.

My ex is mounting a one man show here in town that's being described as an "Odyssey of recovery" in a pretty good venue. Because he's very talented, nobody is attending to what he needs. He's entertaining, why should they?

I know he's dancing on tables and nobody is listening. Whenever I try to alert anyone, they think I'm criticizing or some other negative thing. Nobody is listening. Nobody is thinking beyond this one minute; nobody wants to step up. When bad things happen, people will shake their heads and reiterate the Condi Rice line, "Nobody could have imagined . . ." :(

It breaks my heart because he's worked so hard to get a handle on his situation and because, just for tilting with this dysfunctional system alone, he deserves all the credit and success in the world.

I don't know what it's going to take. But I also will never give up. This is a very hard problem but we also have very committed people and very good tech on our side. We will win this one -- it's just a matter of how many casualties we will take first. And I don't mean to sound bombastic or to exaggerate.

This is a battle we can win. It's a battle we have to win.

[Marie26]

27. What was his mental illness?

Has that been reported anywhere?

[EFerrari]

32. He was never tested or diagnosed, as far as I can tell. n/t

[Marie26]

35. Thanks

I'm still trying to understand how he could have been declared "dangerously mentally ill", institutionalized briefly, & ordered to seek treatment, w/o anyone ever diagnosing what that illness was.

[EFerrari]

36. It's my understanding that what he turned in to his creative writing

class was so disturbing, most of the class didn't show up to discuss it.

Mental illness can be so very subtle until, it's not.

I can tell you this if only from my personal experience: most people that have severe mental health issues need to eat babies in a police station before they get attention. :(

[Sydnie]

39. As I understand it from my sister

he was labeled as a danger to himself, not to others, and that is what was used to get him into the system for that 48 hour period. Once he showed the judge that he was no longer a danger to himself, (read that as not going to kill himself) he was released from the system.

There was a long list of diagnosed disorders that my sister said were observed, but none that compelled them to seek treatment for him other than the danger to himself.

For example, there is no law that says that you must seek treatment if you are schizophrenic UNLESS it can be proven that you pose a danger to others or yourself. You can converse with the voices in your head all day long as long as those voices aren't telling you to hurt yourself or someone else.

He succeeded to convince them in that 48 hour period that he was stable enough to be released and the judge did just that.

I am sure that it was explained to him what the difference of a voluntary stay and a court ordered stay would mean to him and he was in enough control to pick the lesser of the two consequences.

[EFerrari]

40. But the thing is, how can someone be a threat to himself

and then, magically, not a threat to himself?

As soon as you push on the (il)logic, it caves.

If I go out on a ledge and then, under pressure, step off of it, I'm fine, right? :wtf:

[Sydnie]

41. It was the state's dime, they were probably happy to get him out

of there with no order for follow up. My sister said the state paid for his evaluation even though he went voluntarily. I don't get that part at all. but, most likely, he was URGED to get additional help and that too would have probably been on the state's dime, but since he didn't and he didn't hurt himself ... or even pose a threat to others before he went out in a blaze.

Even with the stalking cases that they were investigating against him, he went just to the letter of the law but did not cross it. My sister said the law was very specific on where stalking began and what could be prosecuted as stalking and he stopped just short of that line in the two cases they were investigating. He kept himself just low profile enough to eek by.

Think about it, they probably dismissed it all as collegiate stress ... lots of kids have trouble adjusting in college so they probably figured he was just having a rough year educationally and dismissed it. He could have led them to believe as much himself too.

[EFerrari]

42. They were probably happy to dump him.

I taught freshman English. There was always someone in my class that set off my belly and yes, I was always limited in the resources I could mobilize.

What is it going to take. :(