MENTAL HEALTH : An Imminent Danger
Commitment Rule Is Key To Changing The System
Wednesday, November 28, 2007
The Fairfax County teenager was candid with the social worker: When he was in jail two weeks earlier, he'd been hallucinating and thought people were turning into zombies.
The 18-year-old, who also had escaped from a mental clinic, said that he believed in aliens from outer space but that he didn't think they were probing his mind. And he was joking and cooperative, the social worker wrote in an internal report. He planned to go to college and look for a job.
So, the social worker decided, the young man was not an "imminent danger to himself or others," and he was released.
Three days later, Michael Kennedy gathered seven guns from his home in Centreville, hijacked a van, drove to a nearby county police station and fatally shot two veteran officers before police killed him.
As Virginia wrestles with how to fix its mental health system after the massacre at Virginia Tech in April, one of the most crucial issues facing legislators and Gov. Timothy M. Kaine (D) comes down to those two words: "imminent danger." Judges and magistrates cannot order people into a treatment facility unless they meet this standard. Virginia is one of only five states that have such a high bar for commitment. Maryland abandoned the standard after tragedies there in 2002, and the District has a lower bar.
But when a psychologist examined Seung Hui Cho in 2005, it was determined that Cho did not meet the imminent danger standard. So he was never committed, and he never received treatment. On April 16, Cho killed 32 people and himself at Tech, bringing unprecedented scrutiny to the state's fractured mental health system.
A special subcommittee of the Courts of Justice Committee in the House of Delegates will begin assessing and drafting legislation on the standard. Kaine and lawmakers in both parties have said they expect the issue to be a priority for the General Assembly in January. But as the Kennedy case shows, the high standard was an issue well before the Tech massacre. The state Supreme Court convened a mental health commission last year, with a task force focused specifically on the imminent danger standard. The commission's report is due soon.
The problem is that imminent danger is "a vague term that's inconsistently applied and overly restrictive," said Bruce J. Cohen, a psychiatrist at the University of Virginia who is on the Supreme Court task force. "Most states have gotten rid of it."
Virginia law does not define exactly what "imminent danger" means, and statistics supplied by local jurisdictions indicate that the standard is applied differently from county to county in the approximately 14,000 cases heard annually statewide. That means that a person might be committed in one county but freed in another.
"Make it easier to get help for mentally ill people before they hurt themselves or others," said a Reston man whose son has been in and out of the mental health system for years and spoke on condition of anonymity to protect his privacy. "We just need a lower threshold to get help for people."
Virginia law says that for a person to be involuntarily committed to a mental hospital, he must present "an imminent danger to himself or others as a result of mental illness" or be "so seriously mentally ill as to be substantially unable to care for himself." The standard is used in civil commitment hearings, usually held in hospitals, at which a family member or mental health professional asks a special justice to order someone into psychiatric treatment against his will.
Families and experts say the rulings in those hearings set precedents throughout the counties in which they're held, creating a standard that emergency room doctors, social workers, psychologists and others try to anticipate. In Fairfax, families say the special justices are particularly rigorous in applying the imminent danger standard, and statistics show they dismiss more than half the cases they hear, a far higher rate than in much of the rest of Virginia.