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Virginia Tech Case Reveals Flaws in Mental Health System

July 2, 2007 at 12:00 AM EDT

SUSAN DENTZER, NewsHour Health Correspondent: Behind the slaughter at Virginia Tech last April was the troubled history of the shooter, Seung-Hui Cho. As with one-in-five Americans, he had a mental disorder such as depression. And like one in 20, he may have had a serious mental illness, like schizophrenia.

Of course, only a tiny minority of people with mental illness become violent. All the same, the tragic shootings reflect a major problem, says David Shern. He’s president and CEO of the nonprofit group Mental Health America.z

DAVID SHERN, CEO, Mental Health America: We don’t have a system of mental health in this country. It’s a series of disjointed efforts that sometimes tragically fail.

SUSAN DENTZER: Cho’s problems most likely began years earlier, mental health experts say. And they say the absence of effective mental health interventions during his lifetime is a symptom of pervasive problems.

DAVID SHERN: Well, it’s really a case study, I think, in missed opportunities, some horribly missed opportunities, both to intervene effectively early, in terms of promoting healthy behaviors and preventing the development of difficult behaviors.

SUSAN DENTZER: Dr. Bela Sood is a child and adolescent psychiatrist at Virginia Commonwealth University and a member of a state review panel investigating the shootings.

DR. BELA SOOD, Virginia Commonwealth University: There are many complicated kind of reasons why this young man sort of slipped through the cracks, but this is a major societal problem for us: stigma, access to care, workforce shortage issues, poor funding of mental health.

SUSAN DENTZER: Sood and other mental health experts say Cho apparently fell through the cracks in various ways, beginning in his troubled childhood.

DR. BELA SOOD: Certainly, the media talks about this young man being very withdrawn, very isolated, extremely and painfully shy as he was growing up. Shyness by itself, what we call introversion, is not a sign of mental illness. It is really a combination of that, along with other symptoms, which sort of come together as a constellation of mental illness.

SUSAN DENTZER: Although Cho’s mother reportedly spoke with relatives back in South Korea about her son’s problems, there’s no sign the family sought treatment. Sood says that’s hardly surprising, given his parents’ socioeconomic status and their immigrant backgrounds.

DR. BELA SOOD: We know, within mainstream culture, mental health carries with it a great deal of stigma and that it is seen as a personal failure of probably a much higher magnitude in the Eastern culture.

Finding appropriate care

SUSAN DENTZER: Sood adds that the family may well have faced other issues, including finding appropriate care.

DR. BELA SOOD: Even in the best of situations, access to care is a problem. There are workforce shortage issues. We have very much fewer trained people for individuals to even come out forward and seek treatment. To get an appointment with a child psychiatrist, at least my waiting list is about eight months.

SUSAN DENTZER: After one Virginia Tech student complained about Cho's behavior in 2005, Cho threatened to kill himself. He was detained by campus police and sent to a local psychiatric facility for evaluation. Under state law, Cho then had a so-called commitment hearing. A special judge ordered him into involuntary outpatient treatment, but then nothing happened. That's at least in part because the law didn't specify who was responsible to see that Cho was treated.

DAVID SHERN: That's exactly the problem. Who is responsible? If there was a system in place, it would be clear how responsibility was delegated. And, again, it's not just Virginia; this is a very common problem across the United States.

SUSAN DENTZER: Congress and the state of Virginia are now moving to correct lapses that allowed Cho to buy guns, despite being ruled a danger to himself. And in a report to President Bush, top administration officials wrote that "it's critical to make sure that people with mental illness get the services they need."

Mental health experts agree and point to examples of interventions that have been proven to work. One's being used here at Livingston High School in New Jersey. Bonnie Granatir, a member of the Livingston school board, says two student suicides here several years ago galvanized the community.

BONNIE GRANATIR, Livingston Board of Education: During the course of the 2002, 2003 school year, Livingston lost two teens very tragically, and it was a moment in time where the community, after really going through a grieving process together, realized that we had to take a hard look at ourselves, and what we were doing, and what we might not be doing to create an environment where our kids are safe and healthy.

The TeenScreen initiative

SUSAN DENTZER: The school district launched a broad-based suicide prevention initiative that included a computerized mental health screening tool called TeenScreen. Laurie Flynn is national executive director of the TeenScreen program, which was developed by child and adolescent psychiatrists at Columbia University.

LAURIE FLYNN, National Executive Director, TeenScreen: Over 600,000 youth every year make a suicide attempt that's serious enough that it requires medical attention. TeenScreen is a science-based national program that is designed to identify youngsters who may be at risk for serious mental disorders or suicide. It's a voluntary program; it's now offered in over 475 sites across the country.

SUSAN DENTZER: At Livingston High, Harry Dietrich is the school's psychological coordinator for the TeenScreen program.

HARRY DIETRICH, TeenScreen Coordinator, Livingston High School: The way the program works is we send a letter describing what TeenScreen is to every family in the high school. Also attached to that letter is a permission slip that a parent has to give active consent. That then winds up being sent back to the high school.

We then, at that point, based on the permission slips that we have, we ask those students -- we sit down with them, and then we also get their permission. So it's the parents' permission and also the students' permission to be able to be screened.

LAURIE FLYNN: So they are asked about feelings of depression, irritability, sadness, interruption in their sleep. We ask the question, "Have you ever thought about killing yourself? Have you ever made an attempt? Are you thinking about it right now, today?"

And the youngsters will talk to us. They tell us. And very often, we can intervene right then, get a hold of the family, and begin the process of getting crisis or emergency help, if it's necessary. Very often, we can open a conversation and begin a process for the family and the mental health professionals so the youngster gets whatever level of assistance they may need.

SUSAN DENTZER: At Livingston High, the screening has identified that about one in every 10 kids is in need of some intervention; that can include anything from counseling with clergy to more advanced treatment and medication.

HARRY DIETRICH: This tends to pick up students that we would not normally see in the school community as being in need of services, you know, the person, quote, unquote, "who might be suffering in silence." It's an added tool that we did not have before the suicides, and we have not had one since.

SUSAN DENTZER: Flynn says a tool like TeenScreen may be helpful in cases like Cho's, where early indications of trouble in childhood later evolve into full-blown mental illness in young adulthood.

LAURIE FLYNN: We know from a lot of studies that the time between the first symptoms and actual identification and treatment can be 5 to 10 years with mental disorders. We can never know what might have been, but it seems as though he was deteriorating over a long period of time. And one can only hope that, had he been able to get help earlier, had he been screened, that he might have had a different outcome, and that this tragedy might have been prevented.

Project Link community treatment

SUSAN DENTZER: Another approach that could have helped in Cho's case is evident here in Rochester, New York.

DR. ROBERT WEISMAN, University of Rochester Medical Center: Do you get angry or upset?

BYRON WATSON, Paranoid Schizophrenia Patient: I get angry a lot. And I lately I haven't been upset or angry, but I used to. I used to feel a lot of anger.

SUSAN DENTZER: Byron Watson, age 35, has paranoid schizophrenia. For the past several years, he's been under the care of a so-called assertive community treatment program, called Project Link. It's designed to make certain that mentally ill persons who've had encounters with the criminal justice system and then been ordered into treatment actually receive it.

Dr. Robert Weisman of the University of Rochester Medical Center is Project Link's director.

DR. ROBERT WEISMAN: Byron started out as a healthy young male, had odd jobs, went to school. Around the late teens, early adulthood, he started expressing symptoms of his mental illness, and that included hearing voices, being hostile, having paranoid delusions. People with severe mental illness often deny that illness and don't feel that they need the treatment that's offered to them.

BYRON WATSON: I was young, you know? I had a lot of energy and always good work. I didn't want to keep coming back and forth and taking medication.

DR. ROBERT WEISMAN: And in Byron's case, there have been lapses. He's ended up back in the hospital. He's ended up entangled with police and has put himself and sometimes other people at risk as a result.

SUSAN DENTZER: Project Link's case advocates, like Louwelle Priester, check in frequently with Watson to make sure he's all right and that his basic needs are being met. Above all, they make sure he's making regular visits to the mental health clinic and receiving his injectable anti-psychotic drug.

THERAPIST: You feel it's working for you?

BYRON WATSON: Yes, it's working.

THERAPIST: Will you continue taking medication?

BYRON WATSON: Yes, I will.

DR. ROBERT WEISMAN: We consider ourselves the mobile intensive care unit for the mentally ill in our community. That means that we go visit them where they are, whether it's in the street, whether they're locked up, or whether they're in their own apartment.

SUSAN DENTZER: Is this a good thing for people with mental illness?

BYRON WATSON: Yes, it's a good thing to help you stay out of trouble, and a good stable life, have a stable life.

SUSAN DENTZER: In the 12 years since Project Link started, about 130 mentally ill patients like Watson have come through the program. Once in it, their likelihood of being jailed for nuisance behavior, or hospitalized, has fallen by half. Local Monroe County officials are so certain the program works that they're funding much of the cost, yet there are only a scattering of such programs around the country.

DAVID SHERN: I think that the moral of the story for us is we have to start to garner the political will necessary to say, "Enough is enough." We know what to do. We can't stand sort of this level of carnage anymore.

SUSAN DENTZER: And experts like Shern say no better memorial could be created to honor the victims of Virginia Tech.