A Fragile Mental Health System: Va. Panel to Review Whether Strict State Laws Are in Tune With Experts’ Data on Violent Patients
By Jamie Talan, Newsday, Melville, N.Y.
Apr. 23–A day after a court ordered Seung-Hui Cho to undergo inpatient psychiatric evaluation, Virginia Special Justice Paul Barnett ruled he was eligible for “a less restrictive treatment,” mandating he receive outpatient care and that he “follow all recommended treatments.”
That was Dec. 14, 2005.
Signs of psychotic thinking were there, a number of experts weighing in on the rampage at Virginia Tech said last week, suggesting that Cho may have fallen through the cracks in the fragile mental health system that varies from state to state.
The physician who observed him on Dec. 14, 2005, wrote in a report, a copy of which was obtained by Newsday, that Cho exhibited a lack of emotional expression — a key sign of depression and schizophrenia.
The judge’s order did not specify what treatments Cho should receive. But in Virginia, mental health laws follow a strict statute, which means the judge had to have found Cho an “imminent danger” to himself or others to have ordered his initial inpatient psychiatric commitment on Dec. 13 for an evaluation.
“It raises the question about who was following up with his care,” said Richard Bonnie, an attorney and professor at the University of Virginia Law School.
Bonnie is leading a state commission to evaluate the strict mental health laws to see whether the law is in keeping with what experts now know about mental health patients who are violent.
According to Dr. Marvin Swartz, a professor of psychiatry at Duke University Medical School in North Carolina, patients have to be in “imminent danger” to themselves or others to be ordered into inpatient or outpatient treatment. Swartz is studying involuntary outpatient commitment laws.
The psychiatric inpatient evaluation was carried out at the Carilion St. Albans Behavioral Health Center in Radford, Va.
By contrast, states such as North Carolina and New York have preventative laws to protect the public against people with a prior history of violence and/or at least two prior psychiatric hospitalizations.
Mandated outpatient care is often a risky deal, experts say, because it is difficult to know whether people are complying with the treatment. What’s more, there are not enough outpatient programs to provide patients with the appropriate treatments and consistent follow-up.
The mental health system has long battled the vexing question about what to do with the small number of psychotic patients who are violent but who have yet to act on their thoughts. Mental health experts say only 5 percent of mentally ill patients with a history of psychosis are violent. That said, according to Dr. E. Fuller Torrey, president of the Treatment Advocacy Center in Arlington, Va., there are about 4 million people in the United States at any given time suffering from psychosis. The majority, 95 percent, of these patients are not dangerous to themselves or others.
Torrey said that there is no doubt Cho suffered from paranoid schizophrenia, given his behavior.
“Legally, in these cases, everyone’s hands are tied,” said Mary Zdanowicz, executive director of the Treatment Advocacy Center.
The organization was formed in 1998 to attempt to help states rewrite their mental health laws. “There is a lot that needs to be changed. We know too much now about the risks of these illnesses when patients are not treated.”
New York is one of the most progressive states in the country, but it took the death of Kendra Webdale in 1999 to change the way the system handled mentally ill people with a history of violence. Webdale was pushed to her death on a subway track by Andrew Goldstein, who had been in and out of mental hospitals and had a history of assaulting people. Whenever he was released from the hospital, he would stop taking his medications and his symptoms would return. He is now in prison.
Kendra’s Law allows judges to order patients like Goldstein into an outpatient treatment program. But the Virginia man, had he been in New York, would not have met the criteria for even Kendra’s Law: Two hospitalizations within a 48-month period or a history of violence or incarceration.
In North Carolina, Swartz said, there is a chance he could have been picked up and remanded for treatment. The North Carolina law says courts need to show only that a person would be dangerous without treatment to have him committed. The problem, said Dr. Sasha Bardey, a forensic psychiatrist on the clinical faculty at NYU School of Medicine, is that “we can’t predict violence and we can’t detain people because they might pose a risk in the future.”
The commission mandated to study the Virginia law is made up of three different working groups with about 200 people working on it. It could take years to wade through the law and come to any conclusion, said Zdanowicz, who is on the panel.
—–
Copyright (c) 2007, Newsday, Melville, N.Y.
Distributed by McClatchy-Tribune Business News.
For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.