To save lives, change psychlaws

Not every school massacre can be prevented. But we must try.

Editorial

 

Every once in a while, a mind bent on mayhem seizes a moment and turns it into a massacre. Whenever such a horror strikes, bewildered people ask the very questions they asked last time: How could this happen? Wasn't anybody watching? Couldn't this have been prevented?

The questions arise now as Americans learn the life story of Seung-Hui Cho -- the isolated, delusional English student who extinguished 32 lives at Virginia Tech last month before taking his own.

 

In the aftermath of tragedy, dozens of unrecognized clues come into focus; a catastrophe that had seemed inconceivable starts to look like a neglected certainty. That's the curse of hindsight -- and the blessing: It teaches too late what might have been done to avert a calamity.

 

The lessons are best learned tardily rather than never. The Virginia Tech bloodbath reveals the failings of the nation's mental health care system to respond properly even to the few patients thrust on its doorstep.

 

Consider what went wrong in Cho's case: Deemed psychotic and dangerous in late 2005, he was ordered by a court to "follow all recommended treatments" as an outpatient. But though compliance with the commitment order was a condition of maintaining his outpatient status, it seems that no mental health authority or court ever checked up on him. Thus from what's known so far, Cho's commitment was over before it started. As his psychosis led him to go gun shopping, no one from Virginia's mental health apparatus was around to notice.

 

Those who did notice Cho at Virginia Tech were plenty taken aback by his bizarre behavior and strange writings. But though school officials knew of Cho's troubles, they could do little to help him. Trying to nudge a paranoid person into treatment is invariably a losing proposition -- especially if vigilant treaters are in short supply. Alerting family members to worries about adult students flouts federal privacy laws. And in most states, coaxing courts to order treatment is fruitless unless an individual is "imminently dangerous."

 

It's folly to wait until someone suffering from mental illness is teetering on a window ledge -- or stockpiling Uzis -- before intervening. Minnesota doesn't wait, and it shouldn't. Its commitment law was changed several years back to enable court-assisted treatment before citizens with chronic mental illness reach rock bottom. Like Virginia and a few other states, its statute permits outpatient commitment plans -- an ingenious option too rarely used to good effect. Such orders, which typically allow patients to avoid hospital stays so long as they follow a daily medication and therapy regimen, work well and cheaply to spur recovery so long as relapses are caught early. Properly monitored, outpatient commitment can quell violence among the sliver of psychotic people prone to such impulses.

 

For decades, millions of Americans with mental illness have been deprived of needed psychiatric care. For most, the result has been needless suffering. For a frightening few, the upshot is a flourishing fantasy of destruction. The key to banishing both suffering and threat is to move beyond embracing the concept of community-based psychiatric treatment -- by turning wise theory into mind-healing and life-saving practice.