c. 2007 Religion & Ethics NewsWeekly

(UNDATED) The April shooting at Virginia Tech University was the deadliest in modern American history _ 33 people, including the shooter, were killed.

And there are still more questions than answers about what went so wrong.

How was it, for example, that Seung-Hui Cho slipped through the mental health system even though he was judged “an imminent danger to himself or others as a result of mental illness”?

On a broader scale, Judges, psychiatrists and mental health activists say they’re still struggling with the moral dilemma of exactly how and when to commit people to a mental hospital.

After the shooting, Virginia’s Commission on Mental Health Law Reform and its task force on commitment went to work with a sense of urgency, struggling over Virginia’s standards for committing someone. The standards require finding a mental patient “imminently” dangerous before he or she can be involuntarily committed.

Task force member Peter Earley asked his colleagues at a recent meeting, “When do we force someone against their will and say, `It’s in society’s best interest to step in and commit you’?”

The question is deeply personal to Earley, an author who has written a number of books on crime and punishment as well as the 2007 Pulitzer Prize finalist “Crazy: A Father’s Search Through America’s Mental Health Madness.” Earley’s son, Mike, has bipolar disorder.

One day Earley got a call from Mike, asking him how he would feel “if someone you loved killed himself.” Peter raced to the emergency room, where he waited for four hours before flagging down a doctor.

But Earley said the doctor told him that Virginia law “is very specific. Unless a person is in imminent danger either to himself or someone else, we can’t intervene.”

Later, Mike broke into a neighbor’s house. And when police told Pete Earley his son would be sent to jail rather than a mental hospital, he said he lied and told them his son had threatened to kill him.

“And that was good enough to get him into the hospital and 48 hours later he voluntarily committed himself,” Earley said.

At Virginia Tech, Cho was ordered by a judge to get involuntary outpatient treatment. But he didn’t show up, and mental health officials didn’t follow through.

Critics argue that in many states there is no follow-through because of budget cuts.

Historically, mental patients were committed to large institutions like St. Elizabeth’s in Washington, D.C. Once, St. Elizabeth’s treated 7,000 patients. Today, that number has shrunk to just over 300 because patients have been moved out. The idea was that they would be treated by community-based programs.

Emptying out the institutions was the government’s intent, said Dr. Robert Phillips, a psychiatrist and chief medical director of Forensic Consultation Associates, which specializes in psychiatric consultations for civil and criminal litigation.

Phillips said that when the institutions were emptied, legislators spent the money saved on other programs rather than on community

Government officials “didn’t follow through with the necessary resources that allowed you to deliver the services to the people who were extruded from the institution,” he said.

Earley estimated there are 300,000 people with bipolar disorder, schizophrenia and major depression in the nation’s jails and prisons, another 500,000 are on probation, and 700,000 go through the justice system every year.

“And part of the reason is because they are people like my son who have no criminal intent but because you can’t get them help, they end up getting locked up,” he said.

Based on his experience, Phillips said predicting those with mental illness who will likely be dangerous is a very inexact science.

Judge Joan Goldfrank, a magistrate for the District of Columbia Superior Court, works with two doctors and interviews patients to decide if they should be committed. She says it is difficult to balance the civil liberties of individuals against the safety of the public.

“Certainly, taking away somebody’s liberty is a significant power to have over someone,” she said. “I’m playing in my head, `Did we do the right thing?’ But I also do not err on the side of committing somebody if I feel that there really isn’t the evidence to support it.”

Unlike Virginia’s “imminent danger” standard, Washington and a majority of states can commit someone if it is determined that he or she is a danger to themselves or others. It doesn’t have to be imminent.

But what is most urgent, Phillips said, is that Congress and states allocate more money for mental health care.

“You know, in Los Angeles, in any given day, there are more people in the county lockup that there are in psychiatric hospitals in the U.S. combined,” he said. “That should tell you something.”

The investigations into the tragedy at Virginia Tech are continuing, but it could be an uphill battle to win more money to treat people like Cho.

(A version of this story first appeared on the PBS program “Religion & Ethics NewsWeekly.” This article may be reprinted by RNS clients. Please use the Religion & Ethics Newsweekly byline.)

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