Star One Smart Blog's

Two days ago, April 17, Cho Seung-Hui went from being just a "Question Mark Kid" to another, the most recent, deadly mass killer in the US. We're finding out that people knew he was 'crazy', talked about his problems amongst themselves at VT, read his writings, and that Cho even had some level of 'commitment' in Radford. Lots of bzzz, bzzzz, bzzzz, but you know what?

Completely Ineffective. It didn't work. People died, because of...what?

We see the complete failure of our mental-health 'saftey net'.

"A court found that Virginia Tech killer Seung-Hui Cho was "mentally ill" and potentially dangerous. Then it let him go.

"In December 2005 -- more than a year before Monday's mass shootings -- a district court in Montgomery County, Va., ruled that Cho presented "an imminent danger to self or others." That was the necessary criterion for a detention order, so that Cho, who had been accused of stalking by two female schoolmates, could be evaluated by a state doctor and ordered to undergo outpatient care."

Outpatient care. That's known as 'managed care', and means, still on the streets. There was a failure of our mental health safety net. Period.

Mental health evaluation and treatment is expensive. One can't get 'cured' of problems overnight; almost all treatments I've heard of take years of therapy, and medicines, to effect a cure. Obvioulsy, from the results, Cho was not in remission for his mental health issues. From Psychiatry Online...

"....insurance is designed to pay for the treatment of sickness or injury, but not for services for people who are "suffering from life." They argued that treatment is never medically necessary for shyness or other personal enhancement, loneliness and irascibility and other temperamental characterological issues, or lack of personal satisfaction.

and

"Insurance underwriters have expressed fears that if greater mental health and substance abuse benefits are available, people will increase their use of these services for problems in living rather than for psychiatric disorders, thereby creating moral hazard.

[emboldenings mine]

Well, we had some extreme 'moral hazard' happen, and now some changes are forced. Whether cost was a factor in Cho's inabiltiy to stay in therapy, or whether the Clinic couldn't or wouldn't justify seeing him frequently enough due to understaffing, or no money from Cho, the fact remains that inadequate care was provided, as proved by the results of Tuesday's tragedy. More...

"The most adverse cost impact of implementing the current concept of medical necessity comes from its lack of recognition of the need for continuing treatment even when signs and symptoms of a mental or substance use disorder are not present. This lack is particularly true for long-term conditions that may be in remission but for which ongoing treatment is necessary to avoid more intensive levels of care in the future. Certain personality disorders and severe and persistent mental illness are examples."

So, what obstacles do we have to overcome, to get some proper care for seriously mentally ill people? From an Op-Ed, (h/t Dr. Helen) in the WSJ, entitled "Why Deinstitutionalization Turned Deadly", we see some of the usual suspects:

Lawsuits brought by the American Civil Liberties Union and Washington-based Bazelon Center for Mental Health Law have changed most states’ criteria for outpatient commitment. Individuals must be classified as an imminent danger to themselves or others before they can be involuntarily treated, either in the hospital or in the community; this criterion is strictly applied. Most psychotic individuals, who are merely making threats against others or living on the streets and eating out of garbage cans, are not deemed legally sick enough to qualify for outpatient commitment.

Well, not the first time the ACLU has shown itself counter-productive to intelligent thinking. We've seen 'Mental Institutions' practically disappear, on the heels of lawsuits, so where do these people who need help go? To the State? Well, no...

At the same time as civil liberties lawyers have been making it virtually impossible to treat severely mentally ill individuals involuntarily until they commit some horrific act, state mental health officials have been increasingly abdicating their responsibility for these individuals. More than 90 % of state psychiatric hospital beds that existed in 1960 have been eliminated.

Now, at this time, after the tradgedy, we have to do something. Again, from the article above (written in 1998, mind you) we find possible solutions:

If we hope to stem this tide of unnecessary violence and preventable tragedies, we will have to address squarely the issue of involuntary treatment. Outpatient commitments, conservatorships, and conditional hospital releases should be used much more widely to ensure that discharged patients comply with the requirement that they take their medication.

So be it. Let's get busy, shall we, and make some changes, without and before the US Congress starts whipping it's usual Straw Man.















Re-Open the doors, boys...

---

UPDATED 4/20/06 6:00AM

moved to a new post...