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Va. Tech Shooting Sparks Discussion of Va., Md. Commitment Laws

By Bernie Becker
Capital News Service
Tuesday, April 24, 2007

COLLEGE PARK, Md.- Seung-Hui Cho, the Virginia Tech shooter, did not spend significant time in a psychiatric hospital before last week's mass slaying -- a fact that has intensified the debate on mental health laws in Virginia, Maryland and around the country.

"I don't think anyone would say that if the law was different in Virginia, it would've definitely made a difference," said Lynn Albizo, a mental health lawyer and the executive director of the Maryland chapter of the National Alliance on Mental Illness. "But it does raise the issue of mental health laws up for discussion."

Cho's history seems full of red flags, according to various news sources investigating his life after he killed 32 people in two incidents in a single day, April 16, on the Blacksburg, Va., campus.

The English major's violent writings frightened professors and fellow students so much that he was removed from class and received individual tutoring. And his pestering of two female students about a year ago led to contact with campus police and then a local hospital, where he was found to be possibly a danger to himself and was prescribed outpatient treatment.

Since last week's shootings, Virginia's mental health laws have been criticized for making it too difficult to involuntarily commit individuals who might be a danger to themselves or others.

But some mental health advocates say Maryland's law is just as restrictive.

Both fall into the category of states that have among the strictest laws in the country, said Jonathan Stanley, assistant director of the Treatment Advocacy Center, an Arlington, Va.-based group that advocates for broader commitment laws.

Both Maryland and Virginia should be "more willing to let police officers, judges and doctors step in" and allow both involuntary inpatient and outpatient commitment to be more of an option, Stanley says.

But other mental health experts disagree.

"We're opposed to any further relaxation of the (commitment) standard that would lead to involuntary admissions" for mentally ill persons that might be considered dangerous, said Laura Cain, an attorney for the Maryland Disability Law Center in Baltimore.

Broadened commitment laws "cut back on the civil liberties" of persons with a mental illness and have not been proven to work, Cain said.

Virginia law states that individuals may only be committed involuntarily if they pose an "imminent danger" to themselves or others or are "substantially" unable to care for themselves.

According to the Treatment Advocacy Center, Virginia is one of only five states with an "imminent danger" threshold for commitment.

Until 2003, Maryland had the same "imminent danger" standard. But it was changed that October to allow police officers, doctors, or anyone "with a legitimate interest" to petition for commitment when an individual presented "a danger to the life or safety" of themselves or others. Two separate doctors must agree with that assessment before an individual can be involuntarily committed to inpatient care.

"With 'imminent danger,' you almost have to have someone coming at you at that very moment," said Albizo.

Now, "if it can be shown an individual has made threats in the past and has access to weapons," he or she might be evaluated for commitment when released from police custody or a hospital emergency room, Albizo said.

But Cain believes the current law "is just way too broad."

"What does danger mean?" she asked. "There's no objective criteria, no limitation on what that can mean."

The current law "allows a judge to say anybody is a danger . . . like someone who's walking outside in 30-degree weather" without a coat, said Cain.

Maryland is also one of eight states that doesn't have assisted or involuntary outpatient treatment, which occurs when a judge orders an individual to take medication or seek treatment in order to avoid hospitalization.

Virginia does allow mandated outpatient treatment. Both The Washington Post and The Associated Press reported that Cho was approved for outpatient treatment after being taken to Carilion St. Albans Psychiatric Hospital in nearby Radford, Va., in December 2005.

"It looks like it might have been" an assisted outpatient treatment order, said Stanley, whose organization is among the main advocates of the practice.

"If so, it's one of the few times" assisted outpatient treatment has been used in Virginia.

But even if Cho did receive an outpatient treatment order in Virginia, Stanley said both Maryland and Virginia should enact commitment laws similar to states like North Carolina.

An individual can be committed in North Carolina if there is a "reasonable probability" that the individual would be a danger in the near future to himself or others absent adequate treatment, an easier commitment threshold to meet, Stanley said.

"No one's suggesting that people with mental illness should be at the whim of the state," said Stanley, who has bipolar disorder. "I personally would be a fool to advocate for that."

But sometimes "an individual reaches a point where they can't think of what's in their own best interest," Stanley said.

Manuel Trujillo, the director of psychiatry at Bellevue Hospital Center and co-author of a study of involuntary outpatient commitment at Bellevue, said mandated outpatient treatment "results in a significant improvement in care" for mentally ill persons.

Patients who receive involuntary outpatient care are re-hospitalized and arrested at a significantly lower rate and stay employed at a higher rate, Trujillo said.

"But it's not an absolute panacea," he added. "Many of the patients may need this kind of care for years and may even need lifelong care."

But Cain said the study found "it wasn't the presence of the (outpatient) commitment order" that stabilized an individual's mental health, but the fact that those under the orders received significant state mental health services, which is not always the case.

Cain said states have often enacted commitment laws as a "knee-jerk reaction to an isolated incident," then don't put enough money behind those laws.

"In Maryland, there's not enough services, there's not enough housing for persons with a mental illness," Cain said. "There's lots of clients who want services in this state, and they have to jump through hoops to get them."

"We do need more money," said Albizo. "We need more money for community-based services and more money for hospitals. And we need smart spending on programs that work."

While Albizo and Cain both hope last week's shooting can be an opportunity to educate the public on mental health laws and treatment in Maryland, at least one of them is skeptical that will occur.

"There should be some time to pause and time to reflect on what happened (at Virginia Tech) and what the best way to proceed is," Cain added. "But there never is."

Copyright 2007 University of Maryland Philip Merrill College of Journalism


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