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Discussion Starter · #1 ·
I read the long thread about the shooter at Virginia Tech and wanted to mention the changes in mental health treatment over the last century.

It may seem that someone at Viginia Tech in a position of responsibility really goofed in the Cho mass murder case -- and perhaps the committee investigating the events will find that -- but I think it's more probable they will not.

Mental health laws vary from state to state in what rights/protections they give to the individual and to society.

They've changed a lot over the last 50 years. In Kansas, in the 1960s when I joined the staff at Topeka State Hospital, it was easy to get a person committed to a state mental hospital -- all it took was getting a local judge to issue the order. At that time it was unlawful to be insane. People with psychosis or even personality disorders could be committed for treatment at any of the three state mental hospitals. If they were lucky and came to one of the better active treatment wards of TSH (in the 60s), the odds were good that they'd improve enough to leave. At that time, we'd request a hearing before a judge, present our findings, and the judge would usually order the patient released. If they were not lucky enough to receive good active treatment -- they could be there a very long time. While in the hospital, the patient lost a lot of rights -- voting, buying and selling property, power to make decisions for dependents, etc.

It was much worse in the decades before then. E.g., there were instances of family members colluding with corrupt judges to gain control of another's property. If the committed patient went to one of the poorly staffed state hospitals, they could spend decades, the rest of their lives, there. In the late 1800s and early 1900s, when a family member went to a state hospital, sometimes the family published an obituary as if they'd died because they were rarely seen again.

In the 1970s-80s, very significant changes in the rights/protections of the presumed mentally ill individual took place not only in Kansas but throughout the country culminating in the laws states have today.

It is no longer illegal to be insane (psychotic) or mentally ill in Kansas. As in most/all states, hurting another person or property is illegal but thinking about it is not. The test for the Qualified Mental Health Professional assessing the person is not whether this person is capable of hurting a person some time in the future -- it's whether this is judged to very likely happen in the next few hours, days or weeks in the patient's present state.

As these changes in laws and regulations were taking place, I remember talking with our state MH agency's top attorney, wondering if things were going too far. He said that the relation between the rights/protection of the individual and those of the society in which the individual lives will always be a case of "one at the expense of the other" -- the rights and protection of the individual comes at the expense of society and vice-versa.

If my facts are correct, Cho was briefly committed for evaluation in 2005 and released. Quite properly probably, depending on Virginia state law. Cho didn't harm anyone (that I know of) after that in 2005, or in 2006, or in the first 105 days of 2007.

If Cho (or anyone with his outlook) had been living in Kansas in 1950s-1960s, he could have been committed to long term treatment in a state hospital simply because his attitude would indicate he could be more likely to be a danger to others than people without those fixations. Since then, state laws have changed to make the act or attempted act a crime but not the mental condition which would foster it.

It's true in some states now, VA also perhaps, that by state law the colleges cannot contact the student's parents to tell them their child is depressed, suicidal, or needs counseling without the student's written permission. As a result, colleges/universities have expanded MH/counseling services, trying to make access easy and non-stigmatizing.

I think no system of laws and regulations will be fair and just to all. In this case, society paid the greater price. Perhaps some laws and regs can be tweaked just a little to offer more protection?

But maybe society won't be willing to pay the financial price?

In the 1970s-80s, there was a movement to shift the bulk of treatment from state hospitals to community MH centers on the grounds that it would be significantly cheaper and better. As result, over half of the homeless on city streets are mentally ill but are not getting treatment in either a hospital or a MH center. And, instead of putting the money saved which formerly went to the MH hospitals (many, like TSH, now closed down) into expanded staff and services of the community MH centers, state governments have preferred to shift the funds elsewhere.


"For every complex situation there is a simple solution -- which will not work" - Anonymous
 

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Most states have still civil commitments to one degree or another.

My mother is trained as a clinical psychologist (no longer practicing, like you, Bob)- and I sought her opinion on it. She felt that it is, especially here in MO, too frequently abused. People get committed for suicidal feelings in 1972 and don't see the light of day again. Do they kill themselves or anyone else? No. Do they lose their civil liberties? Absolutely.

I worked for the Missouri State Public Defender System last summer, and we dealt with civil commitments in that regard as well. In order to be released from prison after being convicted as a sex offender here, you have to go through some sort of "12 step" program- you have to admit guilt, you have apologize in writing to the victim, etc. If you insist that you are innocent (because you are, because you are mentally ill, for reasons of appeal, etc), you get civilly committed because you have not completed "recovery."

I, like the majority of the judicial system, feel it is a much greater crime to have one innocent man locked up than ten guilty men free-- be it in a civil commitment (where there are no systems of appeals unless your family petitions for you) or in jail.

Locking up the mentally ill is not the answer. Early treatment, effective counseling, mentoring, supervision, sure. A denial of civil rights simply because one is mentally ill is draconian.
 

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Bob Pr. said:
It was much worse in the decades before then. E.g., there were instances of family members colluding with corrupt judges to gain control of another's property. If the committed patient went to one of the poorly staffed state hospitals, they could spend decades, the rest of their lives, there.
I used to volunteer for a local mental health center and we had clients who had spent years, sometimes decades in the state hospital before coming to us. Some had family who years before just dropped them off in front of the state hospital and never returned. I was told by one of the supervisors that years before, when our state hospital became over crowded and under funded, they would give bus tickets and some pocket money to those who they felt were the "least mentally ill" and send them on their way.

I have known individuals that have gotten lost in an under funded mental health system. They were released too soon, had outpatient therapy with no follow up, prescribed anti-psychotics without follow up. It was all very sad.

Thank you for sharing Bob!
 

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I think (and correct me if I'm wrong, because I have absolutely no knowledge of this)...that perhaps the people that can be helped by counselling and being mentored are only the ones that have the will to change. ??? What I'm reading about this kid...doesn't seem like any amount of counselling would have helped him at this point, because I don't think he wanted to change. It seems like plenty of people showed concern and offered help. Maybe if they had caught it earlier, there would be a different outcome.

In the case of someone going to counselling, but only by force...if this person is feared to have dangerous tendancies...maybe that's when more extreme measures need to be taken. I don't know, I'm just thinking out loud.
 

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Janna, you're right to a certain extent about people that don't want help. The point is that you have to catch kids early. Maybe he bothered a family pet early on. Maybe he was a bully as a little kid. Maybe if someone was watching and caring, he could have been caught at a time when someone could have helped him. He didn't just *ppooof* into a school shooter.
 

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Discussion Starter · #7 ·
Gabby's Mom -- I was a clinical psychologist; retired in '97. Also taught as an adjunct assoc. prof at a local university for 30(?) years.

My guess is that Kansas still has commitment laws but there are now more protections for the individual than there used to be.

Unfortunately, there are also fewer places offering highly skilled long term treatment for the psychotic. Most inpatient facilities (except the one in Kansas for the criminally insane) are short-term "stabilization" facilities -- get them medicated and refer them out to a Mental Health Center (which may or may not have the staff that understands how to work with, say, a paranoid schizophrenic or a bi-polar, etc.).

I think (and correct me if I'm wrong, because I have absolutely no knowledge of this)...that perhaps the people that can be helped by counselling and being mentored are only the ones that have the will to change. What I'm reading about this kid...doesn't seem like any amount of counselling would have helped him at this point, because I don't think he wanted to change. It seems like plenty of people showed concern and offered help. Maybe if they had caught it earlier, there would be a different outcome.
Janna, in general, you're right. It's sort of like the joke, Q: "how many psychologists does it take to change a light bulb?" A: "Only one but the light bulb has to want to change."

But that simplifies things too much.

Putting a psychotic person on anti-psychotic medication usually makes them more capable of forming relationships with people in a few weeks or month. One looks for the staff person who can form a relationship with the person and then the therapeutic avenues available to increase the therapeutic leverage with the person -- perhaps a "current events group" led by a trained therapist? -- maybe music therapy with a music therapist supervised by a senior staff therapist with much experience working with that disorder? -- maybe an activity group (volleyball, ping pong, exercise, basketball, etc., led by an activity therapist supervised by a trained therapist)?

As Cho related to others in the last several years of his life, he wasn't capable of forming such relationships. While he desperately needed help he was incapable of accepting the help he needed. Some states prohibit giving medication without a patient's consent; maybe Virginia is one of them.

From what's been published about Cho, IMO he was schizophrenic with strong paranoid elements. Most paranoid schizophrenics are more intact and logical than he was so from this distance PLUS because the symptoms of the disorder appeared so very early in his life, I favor some type of schizophrenia with the paranoid element modifier.

The MH system failed Cho and, because it did, it also failed 33 other families, the VT community, and all of us.

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Further obervations:

What I said about how to form a relationship with a very distubed person (medication, stabilization, then look for the group activity that fits the person) comes from my experience at TSH where I supervised chaplains, activity & music therapists, junior staff psychologists, psychology interns, psychiatric residents, nurses, aides, in just such activities as did many other senior staff members. I (and many of them) were in turn supervised by the most senior, skilled clinicians at The Menninger Foundation and TSH.

Consider that Kansas is almost 500 miles wide and 200 tall. It has metropolitan areas (near KC, MO, & Wichita) but much area sparsely populated. It has about 34 Community MH Centers (CMHCs), some located in only one county with only one clinician, some located in consortiums of, say, seven counties with seven local offices staffed anywhere from one clinician to six, some located in metropolitan areas with 40+ therapists & many other helpers on their staffs.

The problem with long term hospitalization is that it removes the patient from his/her community and easy access to family and community support.

The problem with quick stabilization and rapid referral to a CMHC is -- what facilities and skills do they have for dealing with this problem? When a CMHC has only one clinician, how much can that one person do with the type of ideal group activities mentioned? When there is no supervision, how does that one clinician learn what to do, how to treat?

When I worked at TSH, we had some wards that provided treatment at the highest levels in the USA. While many of our supervisors also worked at The Menninger Foundation, some of our teams were better than their teams. We were a training facility for psychiatric residents, psychology interns, social worker field placements, adjunctive therapists, chaplains, etc. We attracted many of the best and brightest (when I saw that about 11 of 15 staff psycholgists had earned their Diplomates in clinical psychology, I thought that's where I want to go.)

BUT it takes a certain level of enthusiasm, desire to learn, and expert supervision to create an effective therapeutic atmosphere.

I remember (with great appreciation) the many times OUR team (psychiatrist, psychologist, social worker, nurse, aides, social work placements, psychology interns, chaplain trainees) discussed a case during working hours but then decided to meet again that evening for several hours to further discuss that case. The level of interest and excitement was SO high that it brought in ALL elements of our team -- not only our principal staff, but all others through the psychiatric aides. We'd usually have 12 or so people attending (on their own time, with no pay for attending).

What do you do for a one clinician MHC? What do you do to help a state hospital located in the boonies?

I do know what conditions lead to good treatment.

BUT, I have very LITTLE idea of how to disseminate the helpful elements of this to all.
 

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Bob, Thanks for the insightful and knowlegeable post. I believe this best can be explained by the statement:

the relation between the rights/protection of the individual and those of the society in which the individual lives will always be a case of "one at the expense of the other" -- the rights and protection of the individual comes at the expense of society and vice-versa.

All to often, in the name of safety and security, individual rights are chipped away. We screamed after 9/11 that all air passengers should be screened and double checked. Now we complain about being searched at the airport and that it is an invasion of privacy. We demanded better intelligence from the FBI and CIA .Now phones can be tapped at will.

Every tragedy has elements that if a particular rule or law was in place, maybe it could of been avoided. The VT tragedy must be looked at carefully and any decisions made, should bear in mind the preservation of freedom.
 
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Bob,

Thank you for that information and for saying what I wasn't sure how to say.

I am hearing a lot about how Cho should've been kicked out of school, how everyone should've seen this coming, how mentally ill people should be thisthatand the other.

I agree with those saying he was "in the system" and he had some major issues. The problem is that college mental health centers aren't set up for his type of problems! They're set up to help kids who are having problems adjusting, etc. They referred him on to a facility and then he was let go. They did what they were supposed to do. How many people on college campuses are "weird", "disturbed", etc. How many people ON THE STREET are this way? I run into people all the time that freak me out. Get on the web, you can read stuff or see stuff like his all the time. Should we arrest all of them and get them kicked out of their schools too?

How was VTech or anyone else supposed to kick him out, arrest him or anything else? Just like 9/11, hindsight is 20/20. Just like Columbine hindsight is 20/20. Campus emergency policies can and should be changed (Columbine and Colorado officials will help VTech with that I'm sure) and things will be reviewed...

But

"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety."
-Benjamin Franklin

I'm not willing to give up my rights or take away anyone elses based on the POSSIBILITY of insane actions. Putting in place plans to deal with problems and minimize the damage is a start and then trying to better our ability to see things like this coming before they happen is what we need to do - it starts with paying attention to our fellow man for petes sake. How about starting with knowing our own kids and our own neighbors maybe?
 
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