Reexamine Involuntary Treatment Laws

By Sally Satel
The American Enterprise Institute

"I contacted the police, contacted counseling, student affairs, the college to try to sound the alarm, and they felt that their hands were tied legally for various reasons ... as you probably know until someone actually threatens to do something, it can be incredibly difficult to make something happen ..." - Lucinda Roy, English Dept.

We don't know all the facts but the tragedy should prompt a serious re-examination of Virginia's involuntary treatment laws.

We don't know all the facts but the tragedy should prompt a serious reexamination of Virginia's involuntary treatment laws. According to state statute a person must be "an imminent danger to himself or others." But because Cho Seung Hui wasn't "imminently" violent, authorities' "hands were tied." How high must the bar be? Desperately troubled, Cho barely spoke or made eye contact; he started a dorm room fire and stalked women, according to the Chicago Tribune. He posted "im going to kill people at vtech," on a school Web forum, school officials said. Students shared "serious worry about whether he could be a school shooter" and Professor Roy, so concerned about him and his impact on classmates, tutored him privately. The 23 year old was the prime age for new-onset schizophrenia.

Granted, it is hard to predict violence but, taken together, these signs should have been sufficient to compel Mr. Cho to undergo intensive diagnostic assessment in a secure setting.

The Virginia "imminency" standard for commitment is too narrow. In Arkansas a lower threshold of "likely to cause harm to self or others" can trigger involuntary assessment, acute containment, and care. In Hawaii it includes "[individual] is obviously ill," and in Washington state it is "likelihood of serious harm." The Virginia legislature should consider revising its involuntary treatment law.

More details about legal aspects of involuntary care can be found at www.psychlaws.org.

Posted by Michael Corones |  April 18, 2007; 1:56 PM ET
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You obviously did not read the court documents. They found (16 months ago) that he was ill with depression but that a 'least restrictive environment' would meet the standard of suitable care and he was directed to go to counseling.

You simply can not lock people up if there is a non-confining alternative. That matter was settled in the US Supreme COurt over 30 years ago.

Given the if this, who knows, could be state of knowledge of psychology, that is an appropriate approach.

You do not get to sentence people to jail (even if it is a hospial disguised as a jail) on the grounds that treatment would be easier or they could do something but we don't know what.

It is called "cruel and unusual punishment" and prohibited by that curious little document called the Bill of Rights.

Posted by: AnnS | April 18, 2007 11:26 PM


The mentally ill that display antisocial behavior should be forced to take medication because they lack insight into their conditition. This is mostly an economic issue, as the state does not want to pay for the health care and involuntary treatment of these people. Our mental hospitals were dumped into the streets in the 1970s. Not just violent people, put the thousands of schizophrenic victims whose lives are shortened from living in the street. The Medecine works and can permit some, if not most, of these people to reintegrate.

Posted by: George | April 19, 2007 12:59 AM

Glad to know that folks are willing to "force" others to take medications contrary to well settled constitutional law. Please tell me who is going to be the arbiter of who is mentally ill and what medications that they will be forced to take? What kind of behavior will determine when such a drastic course of action will be set in motion? Will someone who is bi-polar be forced to take medication, someone who is accutely depressed? Both conditions can lead to sometimes delusional behavior. What medications will be forced upon these people? Lithium, Depakote, Haldol, even if it might not be clinically appropriate? Many mental illnesses are notoriously difficult to correctly diagnose. What happens if someone is misdiagnosed and forced to take improper or even dangerous medication that may exacerbate or intensify the illness or lead to other serious effects? Will those that have borderline personality disorder or the merely disruptive be forced to take such medications? As I recall, the Soviet Union used to confine dissidents to mental hopitals and drug them up on all kinds of medication. Their mental illness was defiance of the State.

Posted by: Bill H | April 19, 2007 01:22 AM

Millions of people suffer varying degrees of mental illness. When someone is hospitalized or constrained, they cannot continue their schooling, be part of their family, or work at their job. Certainly there are cases where hospitialization is necessary. Before we jump to the refrain "err on the side of caution", consider what this could mean. To prevent the 1 one in a million tragic event, are we willing to take away the freedoms and ruin millions of lives? Would not this be creating many smaller tragedies

Posted by: Jon | April 19, 2007 05:04 AM

The problem of how to deal with those who are dangerous to themselves or others because of mental illness has been around forever. It used to be dealt with by locking the unfortunates up in some facility, but this is subject to so much abuse and subjectivity in deciding who is actually ill, that our society more or less stopped the practice many years ago. Now we rely on medications - but, as is amply demonstrated by the numbers of mentally ill individuals on the streets, there is neither sufficient oversight to make sure medication is taken as prescribed nor is society willing to pay the cost of such for those who need it. Some of this is solvable if we are willing to pay for it, but there will always be those who fall through the cracks and constitute a menace that only becomes evident when it is too late. Perhaps we should place more emphasis on equipping everyone with a means of defense through training and a weapon available for defense. I don't know, but I do hope that we can come up with something better than that which allows the wholesale slaughter of the innocent.

Posted by: Jean | April 19, 2007 11:42 AM

Involuntary treatment requires a law with high standards of proof because involuntary confinement and treatment takes away all of the rights of an individual, even the right to decline mind-numbing drugs. We know that innocent people are sometimes convicted despite the "beyond reasonable doubt" standard of criminal law. Should a legal process that errs on the side of protecting the innocent from wrongful imprisonment be applied to someone accused of being an imminent danger to oneself or to others? But simply improving the mental fitness screening process for sale of rapid firing weapons with large magazine or instant clip replacement capability could provide better protection against future massacres.

There already is a law that requires a gun dealer to check the name of a potential gun buyer against a criminal history list. Also, gun dealers are prohibited from selling guns to mentally disturbed individuals. But there is not a list of people to whom rapid fire and quick reloading guns should not be sold because of mental instability, anger management problems, or violent antisocial tendencies.

Creation of such a list would be a delicate issue because of privacy concerns and taking away someone's right to a weapon (is it a right, as the latest Supreme Court decision indicates, or a privilege?) without due process. Because accusations are not necessarily valid, the law would need to include a way for someone on the list to appeal and a procedure for removal. In doing this, society would need to consider what the standard of proof should be. Does someone belong on the list only if it is believed beyond a reasonable doubt that the person might become berserk, or should the standard be a preponderance of evidence? To get off the list does the person need to prove beyond a shadow of a doubt that he or she is not now dangerous or never was dangerous? Before authorizing release from confinement, how certain would the mental health professional have to be that the individual would not harm others or himself? In any event, it seems logical that the standard of certainty for merely listing those who should be denied ownership of rapid firing and quick reloading guns should be less than the standard to force involuntary treatment.

A limited weapons restrictions database might be abused, used improperly for other purposes, and cause innocent people to suffer ostracism. A low legal standard of certainty would make this more of a concern.

An alternative to the list for accomplishing the same screening objective would be to require purchasers to provide affidavits from people who affirm they know the individual and have no reason to suspect he or she should not own such weapons. To keep this system honest, the affirmers might have to legally defend their affirmations should the individual at some later date go berserk. This approach would, I think, avoid many of the privacy and civil liberty issues of a central database.

Posted by: BTPost | April 29, 2007 02:49 PM

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