Extended Interview: Mental Health Association President Discusses Cho Case

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• SUSAN DENTZER:

  The case of Seung-Hui Cho at Virginia Tech obviously was a horrible tragedy on multiple dimensions, but needless to say […] the mental health tragedy aspects of this are profound. In your view, what is this a case study of?

• 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 health behaviors and preventing the development of difficult behaviors. It's a failure of an opportunity to do systematic screening and identify problems early on, and getting effective care for those problems. And, of course, finally, it's a profound failure of our emergency care system to respond effectively with assertive outreach to a person who obviously, at least from what we've read and heard in the media, had profound significant problems.

• SUSAN DENTZER:

  Do you think we can even say that we have a mental health care system in this country?

• DAVID SHERN:

  Not if by system we mean really a tightly interwoven series of settings and services that respond to people with mental health needs. And not a system in the sense that we have a publicly funded system that delivers mental health services.

  But we also know that we have huge populations of individuals with severe mental health problems and addiction disorders in our corrections system.

  We know that 40 percent of people in our welfare system have significant mental health problems, and none of those settings are even part of what we ordinarily think about when we talk about the publicly funded mental health system. So no, we don't have a system of mental health in this country.

• SUSAN DENTZER:

  Let's talk about what we've got now […] What would you say to characterize our system?

• DAVID SHERN:

  Well, it's difficult to access. It's difficult to access because of system capacity issues and continuing issues of discrimination in terms of coverage.

  It's disjointed. It doesn't involve a seamless continuum of care from in-patient settings, to residential settings, emergency settings. It doesn't integrate at least contacts with people with mental illness to the degree to which it should, with other sorts of treatment settings.

  It often times doesn't promote recovery of people. Often times many of our mental health systems, particularly working with people who have severe mental illnesses, don't provide services that really get people back into their lives to the degree to which we'd like to see them get back.

• SUSAN DENTZER:

  And if we take the case of Seung-Hui Cho, he was obviously troubled as a child. His mother at one point apparently told relatives back in South Korea that he was autistic. We don't know whether he was given that diagnosis, we don't know where that came from, but [it is] a signal that people understood something was wrong, that he was either very socially isolated or something.

  What, in a perfect world, would a functioning system have done for that child at that point?

• DAVID SHERN:

  Someday maybe we'll have a system in which kids get mental health checkups just like they have their eyes checked and their ears checked to make sure that they can fully participate in the educational environment. We know that someone's socio-emotional health is a very important predictor of how well they're going to do in school.

  So he should have had–and every child should have had–a mental health checkup where there's kind of a systematic review of how they're doing.

  In his case, there were indications of problems, from what you're telling me, from his mom and others. So I think what's important then is that there be a program to assertively link him with competent care, so there should have been some outreach to him and his family. There should have been an opportunity for them to see a mental health professional, preferably someone who has a specialization in children's mental health issues. That's another issue–we have a huge shortage of child psychiatrists in this country.

  And subsequently, he should have been helped to […] understand these behaviors, to understand what was triggering them, and to start to give him sort of the skills and support that he needed to be successful in school.