When, and Whom, to Commit

Sunday, September 16, 2007

THE BLOODBATH at Virginia Tech has inaugurated a season of soul-searching and policy review by mental health officials, university administrators and lawmakers, among others. In examining how so devastating a tragedy might have been avoided or a similar one averted in the future, they are delving into a range of tough questions, many of which seek to strike the right balance between public safety and the protections of privacy and individual liberty. Republicans in the Virginia General Assembly have unveiled what appears to be a sensible plan to begin tightening the system. At the heart of their proposal is a shift in the state's standard for involuntary commitment, which would allow authorities to more easily take an individual who is judged to present a danger and confine him to the care of mental health professionals.

Virginia currently requires that authorities determine that an individual poses an "imminent danger" to self or others, or be unable to care for himself, before they can order involuntary detention. That high hurdle, once embraced by a majority of states, has kept many unstable and dangerous people from receiving the care they need. In the case of Seung Hui Cho, the Virginia Tech gunman, officials who examined him in late 2005 after he had made a suicide threat could not agree whether he met the standard. Ultimately, a special justice decided that outpatient treatment was adequate for Mr. Cho -- who then never received it.

The Republican proposal would allow for the detention of individuals judged to be a threat to themselves or others even if the danger were not imminent at the time of a commitment hearing. Although legislative language has not yet been drafted, the shift would appear to put Virginia in line with other states that in recent years have also moved away from the "imminent danger" standard.

Along with that fundamental reform, GOP lawmakers are proposing two other sensible changes. One would require a representative of the local Community Services Board -- in effect, the state's case officer for mentally ill individuals -- to attend all client commitment hearings. That would provide a measure of accountability and continuity that went missing in the case of Mr. Cho, whose board representative urged involuntary detention but was not present at his commitment hearing. A separate reform would expand the number of psychiatric emergency rooms, known as "crisis stabilization units," around the state. All of these initiatives will cost money, particularly the adoption of a new standard for involuntary commitment, which would result in more inpatient stays. Traditionally, many Virginia Republicans have balked at incurring new expenses for social services. But as Mr. Cho's rampage so grimly demonstrated, the price of inadequate treatment is unacceptable.


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