Wednesday, April 18, 2007

Virginia Tech and which way to turn coming out of the subway at Chicago & State

The AP's Adam Geller reports today on Yahoo! News that Cho Seung-Hui had prior contacts with local police concerning "stalking," that a professor once had campus security remove him from a poetry class, and that the chair of his department referred him for counseling.

Cho was even "taken to a mental health facility in 2005 after an acquaintance worried he might be suicidal," according to today's report.

AP also reports that Cho may have been taking medications for depression; that presumably means he'd been seen by a doctor.

And yet none of these warning signs, none of these past brushes with the law, ripened into any meaningful treatment for Cho. (Charges were never filed in the stalking incidents.) Nor was he removed from the college community -- even though he was scaring all sorts of people with whom he was coming in contact.

A lot of commentators are suggesting that this tragedy comes from Cho's easy access to weapons -- but I think a more basic problem is Cho's lack of access to mental health care... or maybe his right to reject mental health care.

We know he was referred for counseling; we don't (yet) know if he went.

I am not a mental health professional, not like MJ, a psychiatric nurse.

But I have observed the consequences of changes in mental health laws and attitudes... and I wonder today as I mourn with the rest of the nation for the lives lost at Virginia Tech how those changes may have -- inadvertently -- and despite the best of intentions -- led to this tragedy.

I had an office for many years in the River North area of Chicago, west of the subway stop at Chicago and State.

Chicago and State was a very busy stop -- Loyola University's downtown campus is there, as is Holy Name Cathedral... and if you walk just a little further east you would come to the Michigan Avenue Shopping District -- the Magnificent Mile. You'd pass by the famous Water Tower -- famous because it survived the Chicago Fire.

Keep going just a little further east and you'll be on the downtown campus of Northwestern University. That's where the university hospital is -- and mental patients heading for that hospital were among those who'd get off the train at Chicago and State.

It's just that -- sometimes -- they'd go west instead. And then I'd see them.

Look: I think its wonderful that modern medicine can treat so many mental illnesses. People who take their medications faithfully have a chance to live normal lives and contribute to society -- when in a not yet too distant age they could look forward to nothing but an institutionalized existence.

But, you know, my wife and my doctor both want me to take a multivitamin every morning. My wife reminds me nearly every day. And sometimes I take the pill... and a lot of times I don't.

I may not be the clinical picture of perfect mental health, but I'm reasonably functional -- and sometimes I forget to take one pill.

How can we assume that people who are struggling with mental illness and who may not have a strong support system like I do -- who may even be homeless -- how can we assume that these people will remember to take their pills as prescribed?

I'm not a doctor and I don't have access to anyone's mental health records... but I'd bet any sum you care to wager that many of the characters I saw wandering in the wrong direction down Chicago Avenue were mental patients who'd gone off their meds.

We used to warehouse people... and we, as a society, determined that that was bad. But as we've emptied mental hospitals we've also filled up jails: I don't have statistics at my fingertips, but I've read appalling figures about how many people in the criminal justice system have mental health issues. If they'd had supportive families and homes, they may never have become ensnared in criminal activity... but they didn't. And they leave victims in their wake as they drift toward jail....

We know Cho Seung-Hui was referred for counseling. We don't know if he went.

Could he have been forced to go?

And if (as I assume) he could not have been forced, should he have been?

I have no answers now -- just questions.


Linda said...

As an ambulance dispatcher, I deal with a multitude of transfers for mental health patients on a daily basis and the numbers just amaze me - constantly.

There used to be a State Hospital for the developmentally disabled on the outskirts of town here in Norwich but it was closed down in the 90's when the State decided that it was more economically feasible to mainstream all of the residents and clients that were there. This put a large number of people on the streets of Norwich who had nowhere else to go and no way to get there. The homeless population skyrocketed and the downtown area emptied as it became a haven to the poor, the mentally ill, and the drunks.

I think that the intentions of trying not to make these people feel "different" is all well, good, and fine but when you just take them and toss them out amongst everyone else and basically say "well, you're on your own" then you are just asking for trouble.

As much as we might not like to admit it, as much as it might seem horribly politically incorrect to say so, there are people who are different - who suffer from mental illness or were born with developmental disabilities that affect their quality of life and don't allow them to be part of the mainstream. I doubt we have done any of them a favor by just "turning them loose", for lack of a better term.

Not to say that the young man responsible for the shootings at Virginia Tech should have been institutionalized but he should have been treated for his obvious problems. Sadly, even when patients are admitted to psych facilities on a PEC (Physician's Emergency Committal) they can still check themselves out anytime. And most of them do only to find themselves being readmitted a short time later with the same problems that they had before.

We're so busy trying not to hurt people's feelings and labeling them "different" or "sick" that we end up with tragedies like this. This young man sent out many silent calls for help, whether he knew it or not, and yet nothing was done for him because he "couldn't be forced". Maybe those rules need to be rethought - maybe people should be forced to get treatment when there is so obviously something wrong. I can think of 33 very good reasons for those rules to be rethought.

SQT said...

A former boyfriend of mine had a brother who was homeless off-and-on, primarily due to mental illness. Even with the family trying to intervene, it was tough to get him to accept treatment or even housing.

Like you, I have more questions than answers. How do you force someone to take care of themselves? And how do you know when they are a danger to others?

Mother Jones RN said...

Hello Counsellor:

I was thinking about you while I was writing my post. I think we must be on the same wavelength.
You are right, there are more questions than answers, but I think things are going to change in Virginia.

The Virginia legislature started looking at a bill this year that would modify the criteria for ordering outpatient mental health treatment. Virginia Senate Bill 763 strikes the requirement that a person be found to be a danger to himself or others and instead requires a finding that assisted outpatient treatment will be sufficient to prevent him from harming himself or others. In other words, a doctor or judge would no longer need to hear the magic words, “I want to kill myself,” or “I want to kill someone else” in order to force someone like Cho Seung-Hui to receive treatment. How much do you want to bet that this bill now gets put of the fast track, and is passed in a heartbeat. The bill comes too late for the victims of this tragedy, but maybe it can help prevent something like this from happening again.


Mz Jackson said...

I have a family member who has a mental illness. She married a man who has a completely different type mental condition, far less severe mental illness than hers. He has been wonderful over the years, making sure she takes her medicine and visits her counsellor faithfully. As a result, she has been able to have a quasi-normal life. I don't know what she would have done without that support system and I truly worry about those who do not have it. Thank you for broaching this subject.

Jean-Luc Picard said...

Curmudgeon, it is a very sorry event.

On a lighter note, you're listed as a Favourite in my Technorati Faves Train! Be sure to catch it. See below Part 3.

Empress Bee (of the high sea) said...

well curmy i only have one question for you, did you take the vitamin?

smiles, bee

The Curmudgeon said...

I forgot again this morning, Bee....

Empress Bee (of the high sea) said...

curmy, take your vitamin!!!

smiles, bee

susan said...

One could almost argue that there are only questions in this whole sad affair. That seems to be the downside of hindsight and playing the "what if" game. And even going forward and making changes to "prevent" further occurances just raises more questions and more previously unprepared for scenarios. So like you, I have no answers. What a heavy issue.

Barb said...

This whole thing was terribly sad of course, and it was bound to happen that it would be newsworthy for a very long time.

The mental health system, at least in Michigan, is VERY hard to get into. Without excellent insurance you can't even admit yourself unless you practically have a gun at your head.. or someone else's. And once released it is up to the individual to take responsibility for any follow up and, like you said, staying on their medications.

There are no easy answers.

landgirl said...

I have been a faculty member reading very disturbing essays. I have referred students to campus counseling. I have been followed by an upset student and have had students come into class drunk or high or both. I have had a student tower over me physically and had two other students rise up to try to take him out. I have had police come to my office when a student threatened me. All of those incidents came back to mind as I watch the VA tech episode. The balance between safety and civil rights and the cherished ideal of a place where young people can be eccentric and free thinking and safe is so important for us all. I wish I knew how to balance them all and get it right.