The Awful Sound of a Ball Dropping - Update!

UPDATE: Since I first wrote this piece yesterday, I saw an excellent post from Catzmaw on Raising Kaine. Catzmaw is a lawyer and she explains in great detail the differences in the legal code under which a mentally ill person can be involuntarily committed and the flaws in the system.

I'm not going to try to summarize her very fine explanation. Instead, I'm just going to urge you to click on the link and read her superb diary on this subject. Thanks Catzmaw for shedding light on a topic that we cannot let fade from the public view.

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Virginia definitely dropped the ball on Seung Hui Cho. And what makes this all the more disturbing is that it is not as rare as we would like to believe. According to an article in today’s Washington Post, journalists Brigid Schulte and Chris L. Jenkins report that Cho never received treatment that a judge in Blacksburg ordered for him after he was declared a danger to himself and others.

As the article points out, it is impossible to predict whether treatment would have prevented the terrible tragedy at Virginia Tech, but it might have averted it or at least made it far more difficult for Cho to purchase a gun.

Because of loopholes in Virginia law, Cho neither received court ordered treatment nor was he placed on a list that would have alerted gun shop owners not to sell to him. Given Cho’s serious lack of interpersonal skills, I suspect it would have been difficult for him to go out and buy illegal weapons on the street. The fact that he was so uncommunicative would have posed a serious barrier to his purchasing weapons from an illegal dealer.

But perhaps, even more important than limiting Cho’s access to weapons, timely therapy might have helped Cho back to a normal productive life. The greatest part of this tragedy was that this was a smart person who had a lot to offer society. He could have built a productive life rather than been the cause of so much destruction and tragedy.

And he’s not the first young person in Virginia for whom lack of effective mental health treatment and too easy access to guns led to a lethal result for others. Last year, Fairfax teenager, Michael Kennedy, shot and killed two police officers in a Sully District police substation after he walked out of a mental health facility. There were significant differences between the cases to be sure, but one thing was the same in both situations. These were two troubled young men whose behavior set off alarm bells among those who knew them yet didn’t receive treatment that might have saved their lives and the lives of their victims.

According to the Post, about Cho:

"Cho, they said, slipped through a porous mental health system that suffers from muddled, seldom-enforced laws and inconsistent practices. Special justices who oversee hearings such as the one for Cho said they know that some people they have ordered into treatment have not gotten it. They find out when the person "does something crazy again," in the words of one justice -- when they are brought back into court because they are considered in imminent danger of harming themselves or others.

" 'The system doesn't work well,' said Tom Diggs, executive director of the Commission on Mental Health Law Reform, which has been studying the state mental health system and will report to the General Assembly next year.

"Involuntary outpatient commitments are relatively uncommon in Virginia, officials said, because those in the system know they are not enforced. They are almost an act of faith."

I think society does have to proceed carefully when declaring any person a danger to himself or herself. To be sure, forty years ago, there were terrible abuses of the mental health system.

At that time, it was far too easy for a parent to have an adult child – usually a young woman – committed to a mental hospital as a method of interfering with his offspring’s choice of lifestyle. And adult children often had an elderly parent declared mentally incompetent and sent to facilities so that they could get their hands on their parent’s money. And in general, people were simply warehoused for years in substandard back building wards rather than treated and released. And all of that lack of care often cost the state lots of money. So, the move during the 60s to de-institutionalize mental patients was viewed as humane and pragmatic. That was especially true when new generations of drugs appeared that seemed to be capable of treating serious mental disorders while allowing patients to return to normal lives.

All of that was a positive development that ended years of abuse of people’s civil liberties and returned truly mentally ill people to society as fully functioning and productive citizens. But because of past abuses, the pendulum has swung too far. In many cases, such as those in Virginia, it’s extremely difficult to impose treatment on the mentally ill against their will no matter how desperately they need it.

But mental illness, by definition, is different from diabetes or heart disease. If I want to ignore my doctor and not take insulin or a statin for cholesterol, I have the right to make an informed decision. If I want to try chanting OM instead of taking a beta-blocker to lower my blood pressure, I’m guaranteed the right to make that choice. Nobody should protect me from my choices regardless of how foolish they might be as long as I hurt nobody else in the process.

But with mental illness, the sicker you are, the less you are able to make a decision based on informed consent. Unlike a physical illness, the more serious a mental illness is, the more likely it also is that the patient is out of touch with reality. The hallmark of a serious mental illness is the fact that the patient is delusional and is incapable of choosing care for himself. Such a person does not even realize that he is sick and out of touch with reality. To be blunt, he thinks the space men really are out to kill him in a devious plot and that he is totally justified in killing all of them to save himself. It’s self-defense. And such a person may also think that you or I are those deadly space aliens posing as human beings.

That’s an extreme and very over simplified example. But the impact of some mental disorders is that they can be dangerous to others besides the individual patient. So society has an interest in and a right to restrain that patient or to compel him to get treatment.

The problem is that we have no will and little resources to do this. Some extreme libertarians will argue that it is not the government’s place to provide care to sick people. That may be a valid argument for a diabetic who isn’t a threat to others. It may even be true for somebody with a depression who poses no risk to the public. But just as nobody in their right mind would argue that we ought to let dangerous criminals out of high security prisons because it’s expensive to keep them there for their full sentences, it’s ridiculous to argue that we shouldn’t ensure treatment, whether institutionalization or outpatient, for those whose mental illness makes them dangerous to others. That’s not being punitive.

In fact, in addition to the lives of innocent victims, the dangerously mentally deranged person is also a victim whose life might be saved. But only if Virginia stops dropping the ball and instead makes treatment a priority.
But with each passing tragedy, the sound of that ball dropping is getting too deafening to ignore.