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Opportunity born from tragedy

August 1, 2007
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The Virginia Tech tragedy should motivate changes in Virginia's mental healthcare system

The Virginia Tech tragedy has placed the nation's mental healthcare system under the microscope—with Virginia's public system being examined under high magnification. After the shootings, the American public was justifiably upset. People who normally don't think about mental healthcare wondered, “How can something like this happen in rural America?” “Could someone have stopped this from happening?” “Is the mental healthcare system broken?”

Responsibility for the Virginia Tech tragedy is being placed squarely on Virginia's public mental healthcare system. The general public's reaction is understandable, but from a realistic point of view, this condemnation is totally unjustified. After all, the public mental healthcare system lacks adequate funding and the necessary resources to be able to prevent incidences like the Virginia Tech tragedy.

What We Know So Far

Yet there's no doubt about it: Seung-Hui Cho definitely slipped through the system's cracks. As early as a year and a half before the incident, Virginia Tech officials and students became aware of Cho's delusional and disturbing behavior. His writings depicted graphic and macabre violence. Virginia Tech Professor Lucinda Roy, former chairwoman of Virginia Tech's English Department, was so concerned that she pulled Cho from another instructor's class and taught him one-on-one. In December 2005, campus police met with Cho, acting on two female students' complaints that he had left graphic messages on their doors. Later that evening, Cho sent an e-mail to his roommate threatening suicide. The roommate relayed the message to his father, who called the campus police.

Following the campus police's intervention, Cho was taken to their campus headquarters, where the emergency staff from New River Valley Community Services Board, the local mental health agency in Blacksburg, prescreened Cho. The prescreening staff determined that Cho met commitment criteria and recommended hospitalization. A temporary detention order was issued, and Cho was taken to Carilion Saint Albans Behavioral Health clinic, a few miles from the Virginia Tech campus. New River Valley staff recommended that Cho receive medication management and outpatient counseling services upon his release.

The next day the actual commitment hearing was held by Special Justice Paul M. Barnett to determine whether to continue hospitalization or to release Cho back to the community. Although Cho was judged to be an “imminent danger to self or others as a result of mental illness,” Barnett released Cho under an involuntary outpatient treatment order with a recommendation that he seek professional counseling. Cho did make an appointment at that time with the Cook Counseling Center on the Virginia Tech campus.

Records obtained from the University Counseling Center failed to clarify whether Cho ever received counseling. Gerald Massengill, chairman of the panel appointed by Gov. Tim Kaine to investigate the event, stated, “I think the absence of documentation might tell you something within itself.” He added, “If in fact there was never any sign of violence, any indication of violence on his part, how would you anticipate anything like this?” He also said, “It's unfair to point a finger and blame the mental health community for something that may not have been detectable.”

Until the investigation began immediately following the shootings, New River Valley CSB was never aware that an involuntary outpatient commitment order had been issued, according to Les Saltzberg, the former executive director of New River Valley CSB. No further information was available at press time.

The History of Virginia's Community-Based System

The Virginia Tech tragedy has brought to light the fragmented and poorly funded mental healthcare system in Virginia—and the entire nation. Understanding the history of the commonwealth's system will help decision makers take steps to prevent future tragedies across the state and country.

Virginia's public, community-based mental health system was created by legislation in 1968, which directed every political jurisdiction, either separately or in combination, to create an organization, referred to in the legislation as a community services board, to provide mental health, mental retardation, and substance abuse services to the citizens of the board's identified service area. Eventually, 40 CSBs were created. For the next 25 years, CSBs' primary funding source was state general fund dollars.

Virginia's community mental health system was transformed in the early '90s from a state-funded system into a Medicaid-driven system. Tens of millions of state general fund dollars previously allocated to community-based services were reallotted to Medicaid to receive matching federal dollars, but Medicaid funds can be used only for Medicaid-eligible consumers. At the same time, the state identified populations it considered priorities for treatment, which included the chronic populations within each of the disability areas.

These moves eroded the system's ability to provide services to thousands of previously served consumers in more traditional outpatient services. Although many new programs and millions of new state and Medicaid dollars have been put into the community system in the past few years, funding increases have not kept up with inflation, again causing CSBs to limit or eliminate services.