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Chapter IV

MENTAL HEALTH HISTORY OF SEUNG HUI CHO

This chapter is divided into two parts: Part A, the mental health history
of Cho, and Part B, a discussion of Virginia’s mental health laws.

Part A – Mental Health History of Seung Hui Cho

Virginia Tech, and various medical offices and

O ne of the major charges Governor Kaine


gave to the panel was to develop a profile
of Cho and his mental health history. In this •
mental health treatment centers.
Interviews with high school staff and adminis-
chapter, developmental periods of Cho’s life trators where Cho attended school, faculty
are discussed, followed by an assessment and and staff at Virginia Tech, and several of
recommendations to address policy gaps or Cho’s suitemates, roommates, and resident
system flaws. The chapter details his involun- advisors in the dormitories.
tary commitment for mental health treatment • Interviews with staff at the Center for Multi-
while at Virginia Tech. It also examines the cultural Human Services, the Cook Counsel-
particular warning signs during Cho’s junior ing Center, the Carilion Health System, spe-
year at Virginia Tech and the university’s cial justices, and Virginia Tech police.
ability to identify and respond appropriately • The tape and written records of Cho’s hearing
to students who may present a danger to before special justice Barnett.
themselves and others.
• The report of the Inspector General for Mental
Information was gleaned from many sources. Health, Mental Retardation and Substance
One of the most significant was a 3-hour Abuse Services, Investigation of April 16, 2007
interview with Cho’s parents and sister. The Critical Incident at Virginia Tech.
family stated that they were willing to help in
any way with the panel’s work, and felt inca- EARLY YEARS
pable of redressing the loss for other families.
They expressed heartfelt remorse, and they
apologized to the families whose spouse, son,
C ho was born in Korea on January 18, 1984,
the second child of Sung-Tae Cho and Hyang
Im Cho. Both parents were raised in two-parent
or daughter was murdered or injured. The
families that included the paternal grandmother;
Cho’s have said that they will mourn, until
there was extended family support. The families
the day they die, the deaths and injuries of
did not encounter the level of deprivation that
those who suffered at the hands of their son.
many did in post-war Korea. The Chos recall that
Cho’s sister, Sun, interpreted the answers to a paternal uncle in Korea committed suicide.
every question posed to Mr. and Mrs. Cho. At Their first child, daughter Sun Kyung, was born 3
the end of the interview, they had portrayed years before Seung Hui.
the person they knew as a son and brother,
When he was 9 months old, Cho developed
someone who was startlingly different from
whooping cough, then pneumonia, and was
the one who carried out premeditated murder.
hospitalized. Doctors told the Chos that their son
Other sources of information included: had a hole in his heart (some records say “heart
murmur”). Two years later, doctors conducted
• Hundreds of pages of transcripts and cardiac tests to better examine the inside of his
records from Westfield High School, heart that included a procedure (probably an

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

echocardiograph or a cardiac catherization). Sun and her parents recall that Cho seemed to be
This caused the 3-year-old emotional trauma. doing better. He was enrolled in a Tae Kwon Do
From that point on, Cho did not like to be program for awhile, watched TV, and played video
touched. He generally was perceived as games like Sonic the Hedgehog. None of the video
medically frail. According to his mother, he games were war games or had violent themes. He
cried a lot and was constantly sick. liked basketball and had a collection of figurines
and remote controlled cars. Years later when he
In Korea, Cho had a few friends that he would
was in high school, Cho was asked to write about
play with and who would come over to the
his hobbies and interests. He wrote:
house. He was extremely quiet but had a
sweet nature. In Korea, quietness and calm- I like to listen to talk shows and alternative
ness are desired attributes—characteristics stations, and I like action movies…My favor-
ite movie is X-Men, favorite actor is Nicolas
equated with scholarliness; even so, his intro-
Cage, favorite book is Night Over Water, fa-
verted personality was so extreme that his vorite band is U2, favorite sport is basketball,
family was very concerned. favorite team is Portland Trailblazers, favor-
ite food is pizza, and favorite color is green.
In 1992, the family moved to the United
States to pursue educational opportunities for Transportation to and from extracurricular activi-
their children. They were encouraged by Mr. ties was a problem because both parents worked
Cho’s sister who had immigrated before them. long hours trying to save money to buy a town-
Mrs. Cho began working outside the home for house, which they accomplished a few years later.
the first time in order to make ends meet. The The parents recalled that Cho had to wait for
transition was difficult: none of the family transport back and forth all the time.
spoke English. Both children felt isolated. The
The parents reported no disciplinary problems
parents began a long period of hard labor and
with their son. He was quiet and gentle and did
extended work hours at dry cleaning busi-
not exhibit tantrums or angry outbursts. The fam-
nesses. English was not required to do their
ily never owned weapons or had any in the house.
work, so both there and at home they spoke
At one point after Cho was in college, his mother
Korean.
found a pocket knife in one of his drawers, and
Sun stated that her brother seemed more she expressed her disapproval. He had few duties
withdrawn and isolated in the United States or responsibilities at home, except to clean his
than he had been in Korea. She recalled that room. He never had a job during summers or over
at times they were “made fun of,” but she took school breaks, either in high school or in college.
it in stride because she thought “this was just
The biggest issue between Cho and his family was
a given.” In about 2 years, the children began
his poor communication, which was frustrating
to understand, read, and write English at
and worrisome to them. Over the years, Cho spoke
school. Korean was spoken at home, but Cho
very little to his parents and avoided eye contact.
did not write or read Korean.
According to one record the panel reviewed, Mrs.
For the first 6 months in the United States, Cho would get so frustrated she would shake him
the Chos lived with family members in Mary- sometimes. He would talk to his sister a little, but
land. They moved to a townhouse for 1 year, avoided discussing his feelings and reactions to
after which they relocated to Virginia, living things or sharing everyday thoughts on life,
in an apartment for 3 years. The move to Vir- school, and events. If called upon to speak when a
ginia occurred in the middle of third grade for visitor came to the home, he would develop sweaty
Cho. He was 9 years old. Cho’s only known palms, become pale, freeze, and sometimes cry.
friendship was with a boy next door with Frequently, he would only nod yes or no.
whom he went swimming.

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

Mrs. Cho made a big effort to help Cho become • His parents worked very long hours and had
better adjusted, and she would talk to him, financial difficulties. They worried about the
urging him to open up, to “have more cour- effect of this on their children because they
age.” The parents urged him to get involved in had less than optimum time to devote to par-
activities and sports. They worried that he enting.
was isolating himself and was lonely. Other • Medical records did not indicate a diagnosis of
family members asked why he would not talk. mental illness prior to coming to the United
He reportedly resented this pressure. Mr. Cho, States.
having a quiet nature himself, was slightly
more accepting of his son’s introspective and ELEMENTARY SCHOOL IN VIRGINIA
withdrawn personality, but he was stern on
matters of respect. Cho and his father would
argue about this. According to one of the re- C ho was enrolled in the English as a Second
Language (ESL) program in Virginia as soon
as he arrived in the middle of third grade. The
cords reviewed, Cho’s father would not praise
his son. Where Cho’s later writings included a family at this time was living in a small apart-
father-son relationship, the character of the ment. School teachers indicated that Cho would
father was always negative. Cho never talked not “interact socially, communicate verbally, or
about school and never shared much. His participate in group activities.” One teacher
mother and sister would ask how he was doing reported that he did play with one student during
in school, trying to explore the possibility of recess.
“bullying.” His sister knew that when he
Cho was referred to the school’s educational
walked down school hallways a few students
screening committee because teachers believed his
sometimes would yell taunts at him. He did
communication problems stemmed more from
not talk about feelings or school at all. He
emotional issues than from language barriers.
would respond “okay” to all questions about
When Cho was in sixth grade, his parents bought
his well being.
a townhouse next to the school so he could easily
Cho, as a special needs child, generated a high commute to his classes. The school requested a
level of stress within the family. Adaptation to parent–teacher conference because Cho was not
cope with this stress can produce both positive answering any questions in class. Mrs. Cho took
and negative results. The family dynamic an interpreter with her to the parent-teacher con-
which evolved in the Chos’ to cope with this ference. She resolved to “find” friends for him and
stress was that of “rescue” behavior and more encouraged both their children to go to the church
coddling of Cho who seemed unreachable emo- she attended. Because the congregation was
tionally. There was some friction between Cho small, however, there were few children, so both
and his sister, however, nothing that appeared Cho and his sister lost interest and stopped going
as other than normal sibling rivalry. In fact, to church.
Sun was the one to whom Cho spoke the most.
One of Mrs. Cho’s friends urged her to look into
Key Findings of Early Years another church that reportedly had a minister
who “could help people with problems like Cho’s.”
• Cho’s early development was character- She occasionally attended that church over a 6-
ized by physical illness and inordinate month period, but decided against reaching out to
shyness. that pastor to work with her son. Several news-
• Even as a young boy, Cho preferred not to paper articles that appeared after the shooting
speak, a situation that worried and frus- reported that the pastor from that church had
trated his parents. worked directly with Cho. According to Mrs. Cho,
• He was ostracized by some peers, though those reports are untrue. Mrs. Cho did register
he did not discuss this with his family. her son for a 1-week summer basketball camp

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

sponsored by that church, but she never addressing the emotional pain and psychological
sought its help on personal matters. problems of clients. Typically, this form of therapy
is used with younger children who do not have
Mrs. Cho tried to be extra nurturing to Cho. sufficient language or cognitive skills to utilize
He did not reject her attempts at socialization
traditional “talk” therapy. Because Cho would not
per se, but he disliked talking. Finally, Cho’s converse and uttered only a couple words in
parents decided to “let him be the way he is” response to questions, art therapy was one way to
and not force him to interact and talk with
reach him. The specialist offered clay modeling,
others. He never spoke of imaginary friends. painting, drawing, and a sand table at each ses-
He did not seem to be involved in a fantasy sion. Cho would choose one of the options. As he
world or to be preoccupied by themes in his
worked, the therapist could ascertain how he was
play or work that caused concern. He never feeling and what his creations might represent
talked of a “twin brother.” The parents’ char- about his inner world. Then she talked to him
acterization of him was a “very gentle, very
about what his work indicated and hoped to help
tender,” and “good person.” him progress in being more socially functional. He
modeled houses out of clay, houses that had no
MIDDLE SCHOOL YEARS windows or doors.

T he summer before Cho started seventh


grade, his parents followed up on a rec-
ommendation from the elementary school that
Cho’s therapist noted that while explaining the
meaning of Cho’s artwork to him, his eyes some-
times filled with tears. She never saw anything
they seek therapy for Cho. In July 1997, the
that he wrote. Eventually, Cho began to make eye
Cho’s took their son to the Center for Multi-
contact. She saw this as a start toward becoming
cultural Human Services (CMHS), a mental
healthier.
health services facility that offers mental
health treatment and psychological evalua- Cho also had a psychiatrist who participated in
tions and testing to low-income, English- the first meeting with Cho and his family and
limited immigrant and refugee individuals. periodically over the next few years. He was diag-
They told the specialists of their concern about nosed as having [severe] “social anxiety disorder.”
Cho’s social isolation and unwillingness to dis- “It was painful to see,” recalled one of the psychia-
cuss his thoughts or feelings. trists involved with Cho’s case. The parents were
told that many of Cho’s problems were rooted in
Mr. and Mrs. Cho overcame several obstacles
acculturation challenges—not fitting in and diffi-
to get their son the help he needed. In order
culty with friends. Personnel at the center also
for Cho to make his weekly appointments at
noted in his chart that he had experienced medi-
the center, they had to take turns leaving
cal problems and that medical tests as an infant
work early to drive him there. There were cul-
and as a preschooler had caused emotional
tural barriers as well. In the family’s native
trauma. Records sent to Cho’s school at the time
country, mental or emotional problems were
(following a release signed by his parents) and the
signs of shame and guilt. The stigmatization
tests administered by mental health professionals
of mental health problems remains a serious
evaluated Cho to be a much younger person than
roadblock in seeking treatment in the United
his actual age, which indicated social immaturity,
States too, but in Korea the issue is even more
lack of verbal skills, but not retardation. His
relevant. Getting help for such concerns is
tested IQ was above average.
only reluctantly acknowledged as necessary.
Cho continued to isolate himself in middle school.
After starting with a Korean counselor with
He had no reported behavioral problems and did
whom there was a poor fit, Cho began working
not get into any fights. Then, in March 1999,
with another specialist who had special train-
when Cho was in the spring semester of eighth
ing in art therapy as a way of diagnosing and

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

grade, his art therapist observed a change in was in the process of doing that at GWU Hospital
his behavior. He began depicting tunnels and when he first met Cho.
caves in his art. In and of themselves, those
symbols were not cause for alarm, but Cho Mr. and Mrs. Cho explained to the psychiatrist
that they were facing a family crisis since their
also suddenly became more withdrawn and
showed symptoms of depression. In that con- daughter would be leaving home in the fall to
text, the therapist felt that the tunnels and attend college and she was the family member
with whom Cho communicated, as limited as that
caves were red flags. She was concerned and
asked him whether he had any suicidal or communication was. They feared that once their
homicidal thoughts. He denied having them, daughter was no longer home, he would not com-
municate at all. The psychiatrist also was
but she drew up a contract with him anyway,
spelling out that he would do no harm to him- informed of the disturbing paper Cho had written.
self or to others, and she told him to commu- The doctor diagnosed Cho with “selective mutism”
nicate with his parents or someone at school if and “major depression: single episode.” He pre-
he did experience any ideas about violence. scribed the antidepressant Paroxetine 20 mg,
That is just what he did, in the form of a which Cho took from June 1999 to July 2000. Cho
paper he wrote in class. did quite well on this regimen; he seemed to be in
a good mood, looked brighter, and smiled more.
The following month, April 1999, the murders
at Columbine High School occurred. Shortly The doctor stopped the medication because Cho
thereafter, Cho wrote a disturbing paper in improved and no longer needed the antidepres-
English class that drew quick reaction from sant.
his teacher. Cho’s written words expressed Selective mutism is a type of an anxiety disorder
generalized thoughts of suicide and homicide, that is characterized by a consistent failure to
indicating that “he wanted to repeat Colum- speak in specific social situations where there is
bine,” according to someone familiar with the an expectation of speaking. The unwillingness to
situation. No one in particular was named or speak is not secondary to speech/communication
targeted in the words he wrote. The school problems, but, rather, is based on painful shyness.
contacted Cho’s sister since she spoke English Children with selective mutism are usually inhib-
and explained what had happened. The family ited, withdrawn, and anxious with an obsessive
fear of hearing their own voice. Sometimes they
was urged to have Cho evaluated by a psy-
show passive-aggressive, stubborn and controlling
chiatrist. The sister relayed this information
traits. The association between this disorder and
to her parents who asked her to accompany autism is unclear.
Cho to his next therapy appointment and
report the incident, which she did. The thera- Major depression refers to a predominant mood of
pist then contacted the psychiatrist for an sadness or irritability that lasts for a significant
evaluation. period of time accompanied by sleep and appetite
disturbances, concentration problems, suicidal
Cho was evaluated in June 1999 by a psychia-
ideations and pervasive lack of pleasure and
trist at the Center for Multicultural Human energy. Major depression typically interferes with
Services. There, psychiatric interns from The social, occupational and educational functioning.
George Washington University Hospital pro- Effective treatments for depression and selective
vide treatment one day a week supervised by mutism include psychotherapy and anti depres-
other doctors at GWU. Cho was fortunate sants/anti-anxiety agents such as Selective Sero-
because the intern who was his psychiatrist tonin Reuptake Inhibitors (SSRI’s).
was actually an experienced child psychiatrist
and family counselor who had practiced in It should be noted that when the subject of Cho’s
South America prior to coming to the United eighth grade paper and subsequent evaluation
States. He had to recertify in this country and was discussed with Mr. and Mrs. Cho and Cho’s

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

sister during the interview, they appeared mainstreamed in classrooms. Provisions are made
shocked to learn that he had written about for special services or accommodations after a core
violence toward others. They said they knew evaluation involving a battery of tests is given to
he had hinted at ideas about suicide, but not diagnose the problems and to guide the school in
about homicide. preparing an Individualized Education Plan
(IEP). The high school conducted a special as-
School records indicate that an interpreter sessment to rule out autism as an underlying fac-
was provided (sometimes this was Cho’s sis-
tor. Cho also was evaluated in the following
ter) during meetings that involved the par-
domains:
ents, as is the policy and required by law.
Psychological
HIGH SCHOOL YEARS Sociocultural
Educational

I n fall of 1999, Cho began high school at


Centreville High School. The following year
a new school, Westfield High School, opened to
Speech/Language
Hearing Screening
Medical
accommodate the population growth in that
Vision
part of Fairfax County. Cho was assigned
there for his remaining 3 years. About 1 As part of the assessment process, school person-
month after classes began at Westfield, one of nel met with Cho’s parents to find out more about
Cho’s teachers reported to the guidance office his history and to explain the assessment process.
that Cho’s speech was barely audible and he Mrs. Cho expressed concern about how her son
did not respond in complete sentences. The would fare later in college given the transition
teacher wrote that he was not verbally inter- required and his poor social skills. She noted that
active at all and was shy and shut down. her son was receiving counseling and gave per-
There was practically no communication with mission for the school to contact her son’s thera-
teachers or peers. Those failings aside, teach- pist. The therapist, in turn, was encouraged by
ers also praised Cho for his qualities as a stu- the fact that the school would be tracking Cho’s
dent. He achieved high grades, was always on progress. The committee determined that Cho was
time for class, and was diligent in submitting eligible for the Special Education Program for
well-done homework assignments. Other than Emotional Disabilities and Speech and Language.
failing to speak, he did not exhibit any other Mr. and Mrs. Cho were receptive to receiving help
unusual behaviors and did not cause prob- for him and so was his older sister who was in col-
lems. When the teacher asked Cho if he would lege and with whom he had a good relationship.
like help with communicating, he nodded yes. The parents and sister continued to be in contact
with the school; Sun usually served as interpreter.
The guidance counselors asked Cho whether
he had ever received mental health or special Special accommodations were made to help Cho
education assistance in middle school or in his succeed in class without frustration or intimida-
freshman year (at the previous high school), tion. The school developed an IEP, as required by
and he reportedly indicated (untruthfully) law, that was effective in January 2001. The IEP
that he had not. listed two curriculum and classroom accommoda-
tions and modifications: modification for oral
Cho’s situation was brought before Westfield’s
presentations, as needed, and modified grading
Screening Committee on October 25, 2000, for
scale for oral or group participation. In-school lan-
evaluation to determine if he required special
guage therapy was recommended as well, but Cho
education accommodations. Federal law
only received that service once a month for 50
requires that schools receiving federal funding
minutes. His art therapist, who reached out to a
enable children with disabilities to learn in
few teachers and others at the school with
the least restrictive environment and to be

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

questions or concerns, said she asked why the school counselor could not say whether bullying
language therapy was so limited. The school might have occurred before or after school, as
responded that it was reluctant to pull him suggested by other unconfirmed sources.
out of class for this special service because
It would be reasonable, however, to assume that
this would interrupt his academic work or
negatively impact his grades. Besides, the Cho was a victim of some bullying, though to what
primary diagnosis was selective mutism, not extent and how much above the norm is not
known. His sister said that both of them were sub-
problems with the mechanics of speaking or
jected to a certain level of harassment when they
an inability to function in English.
first came to the United States and throughout
Cho was encouraged to join a club and to stay their school years, but she indicated that it was
after school for help from teachers. He was neither particularly threatening nor ongoing.
permitted to eat lunch alone and to provide
verbal responses in private sessions with In the eleventh grade, Cho’s weekly sessions at
teachers rather than in front of the whole the mental health center came to an end because
there was a gradual, if slight, improvement over
class where his manner of speaking and
the years and he resisted continuing, according to
accent sometimes drew derision from peers.
his parents and therapist “There is nothing wrong
With this arrangement, Cho’s grades were with me. Why do I have to go?” he complained to
excellent. He had advanced placement and his parents. Mr. and Mrs. Cho were not happy
honors classes. However, his voice was liter- that their son chose to discontinue treatment, but
ally inaudible in class, and he would only he was turning 18 the following month and legally
whisper if pushed (an observation consistent he could make that decision.
with his behavior later in college). In written
responses, at times, his thinking appeared Cho took upper level science and math courses
confused and his sentence structure was not and spent 3 to 4 hours a day on homework. He
earned high marks and finished high school with
fluent. Indeed, his guidance counselor raised
the question to the panel: “Why did he change a grade point average of 3.52 in an honors pro-
his major to English at Tech?” Why did this gram. That GPA, along with his SAT scores (540
for verbal and 620 for math registered in the 2002
student, whose forte appeared to be science
testing year) were the basis for his acceptance at
and math, switch to humanities?
Virginia Tech. What the admission’s staff at Vir-
After the Virginia Tech murders, some news- ginia Tech did not see were the special accommo-
papers reported that Cho was the subject of dations that propped up Cho and his grades.
bullying. The panel could not confirm whether Those scores reflected Cho’s knowledge and intel-
or not he was bullied or threatened. His fam- ligence, but they did not reflect another compo-
ily said that he never mentioned being the nent of grades: class participation. Since that
target of threats or intimidating messages, aspect of grading was substantially modified for
but then neither did he routinely discuss any Cho due to the legally mandated accommodations
details about school or the events of his day. for his emotional disability, his grades appeared
His guidance counselor had no records of bul- higher than they otherwise would have been.
lying or harassment complaints.
When his guidance counselor talked to Cho and
Nearly all students experience some level of his family about college, she strongly recom-
bullying in schools today. Much of this behav- mended they send him to a small school close to
ior occurs behind the scenes or off school home where he could more easily make the transi-
grounds—and often electronically, through tion to college life. She cautioned that Virginia
instant messaging, communications on Tech was too large. However, Cho appeared very
MySpace and, to a lesser extent, on Facebook, self-directed and independent in his decision. He
a website used by older teenagers. Cho’s high

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

chose Virginia Tech, which had been his goal lems. Then, there is a subheading labeled “Special
for some time. He applied and was accepted. Services Files” where six additional boxes are pre-
sented: Contract Services, ESL, 504 Plan, Gifted
Virginia Tech does not require an essay or let- and Talented, Homebound, and Special Educa-
ters of recommendation in the freshman
tion. Only the ESL box is checked, even though
application package and does not conduct per- Cho had special education services. The special
sonal interviews. Acceptance decisions at Vir-
education services box was not checked.
ginia Tech are based primarily on grades and
SAT scores, though demographics, interests, As the panel reviewed Cho’s mental health
and some intangibles are also considered. An records and conducted interviews with persons
essay about oneself is optional. Cho included a who had provided psychiatric and counseling ser-
short writing about rock climbing in his appli- vices to Cho throughout his public school career, it
cation, which was written in the first person became evident that critical records from one pub-
and spoke about human potential that often lic institution are not necessarily transferred to
cannot be achieved because of self-doubt. the next as a person matures and enters into new
stages of development. What are the rules regard-
Before Cho left high school, the guidance ing the release of special education records
counselor made sure that Cho had the name
between, for example, high schools and colleges?
and contact information of a school district
resource who Cho could call if he encountered It is common practice to require students entering
problems at college. As is now known, Cho a new school, college, or university to present
never sought that help while at Virginia Tech. records of immunization. Why not records of seri-
ous emotional or mental problem too? For that
As Cho looked to the fall of 2003, he was pre-
matter, why not records of all communicable dis-
paring to leave home for the first time and
eases?
enter an environment where he knew no one.
He was not on any medication for anxiety or The answer is obvious: personal privacy. And
depression, had stopped counseling, and no while the panel respects this answer, it is impor-
longer had special accommodations for his tant to examine the extent to which such informa-
selective mutism. Neither Cho nor his high tion is altogether banned or could be released at
school revealed that he had been receiving the institution’s discretion. No one wants to stig-
special education services as an emotionally matize a person or deny her or him opportunities
disabled student, so no one at the university because of mental or physical disability. Still,
ever became aware of these pre-existing condi- there are issues of public safety. That is why
tions. immunization records must be submitted to each
new institution. But there are other significant
There is a standard cover page that accompa- threats facing students beyond measles, mumps,
nied Cho’s transcripts to Virginia Tech called
or polio.
“Pupil Permanent Record, Category 1”. The
page lists all the types of student records, The panel asked its legal counsel to review the
whether they include information from ele- laws pertaining to special education records and
mentary, middle, or high school, and how long the release of that information, specifically as
they are to be retained. The lower right corner addressed in FERPA and the Americans with Dis-
of the page has a section marked “The Student abilities Act (ADA). Although FERPA generally
Scholastic Record” under which are boxes to allows secondary schools to disclose educational
be checked as they apply. The first six boxes records (including special education records) to a
are Clinic, Cumulative, Discipline, Due Proc- university, federal disability law prohibits univer-
ess, Law Enforcement, and Legal. Only the sities from making what is known as a ‘preadmis-
first two were checked, indicating Cho had no sion inquiry” about an applicant’s disability
records pertaining to discipline or legal prob- status. After admission, however, universities

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CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

may make inquiries on a confidential basis as well remain relevant. Maybe there really should
to disabilities that may require accommoda- be some form of "permanent record."
tion.
Key Findings of Cho’s School Years
It should be noted that the Department of
• Both the family and the schools recognized
Education’s March 2007 “Transition of Stu-
that Cho’s problem was not merely introver-
dents with Disabilities to Post Secondary Edu-
sion and that Cho needed therapy to help with
cation: A Guide for High School Educators”
extreme social anxiety, as well as accultura-
clarifies that a high school student has no
tion and communication.
obligation to inform an institution of post sec-
ondary education that he or she has a disabil- • A depressive phase in the second half of
ity; however, if the student wants an academic eighth grade led to full blown depression and
adjustment, the student must identify himself thoughts of suicide and homicide precipitated
or herself as having a disability. Cho did not by the Columbine shooting. Cho received
seek any accommodations from Virginia Tech. timely psychiatric assessment and interven-
The disclosure of a disability is always volun- tion (prescription of Paroxetine and continued
tary. therapy). This episode abated within a year,
and medications were discontinued.
It is a more subtle question whether Fairfax
• Transportation problems interfered with Cho’s
County Public Schools would have had to
remove any indication of special education involvement with sports and extracurricular
status or accommodation from Cho’s tran- activities, which may have increased his isola-
script or grade reports as part of his college tion.
application. • Intervention for a child suffering from mental
Because this issue is of such great importance illness reduces the burden of illness as well as
and because much more study is needed, the the risk for severe outcomes such as violence
panel does not make a recommendation here. and suicide, as it did for Cho during his pre-
But the panel hopes that this issue begins to college years.
be debated fully in the public realm. Perhaps
• During his high school years, Cho was identi-
students should be required to submit records
fied as having special educational needs. His
of emotional or mental disturbance and any
communicable diseases after they have been identification as a special education student
admitted but before they enroll at a college or within the first 9 weeks of enrollment in a
university, with assurance that the records new high school and the accommodations ac-
will not be accessed unless the institution’s corded him as part of his Individualized Edu-
threat assessment team (by whatever name it cational Plan led to a high degree of academic
is known) judges a student to pose a potential success. Indeed, his high school guidance
threat to self or others. counselor felt that his high school career was
Or perhaps an institution whose threat a success. With regard to his social skills,
assessment team determines that a student is however, his progress was minimal at best.
a danger to self or others should promptly con- • Clearly, Cho appeared to be at high risk, as
tact the student’s family or high school, inform withdrawn and inhibited behavior confers
them of the assessment, and inquire as to a risk. This risk seemed mitigated by the inter-
previous history of emotional or mental
ventions and accommodations put in place by
disturbance.
the school. This risk also was reduced by in-
This much is clear: information critical to pub- volved and concerned parents who were par-
lic safety should not stay behind as a person ticular in following through with weekly ther-
moves from school to school. Students may apy. This risk was further mitigated by effec-
start fresh in college, but their history may tive therapy that allowed expression (through

39
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

art therapy) of underlying feelings of thing, including money. Mr. and Mrs. Cho said
inadequacy. These factors as well as an that he never asked for extra money and would
above-average performance in school (but- not accept any. He was very mindful of the fam-
tressed by accommodations) lessened his ily’s financial situation and lived frugally. He
frustration and anger. would not buy things even though his parents
• The school that Cho attended played an encouraged him occasionally to purchase new
important part in reducing the possibility clothes or other items. They reported that he did
of severe regression in his functioning. not appear envious or angry about anything.
The school worked closely with Cho’s par- During his freshman year, Cho took courses in
ents and sister. There was coordination biology, math, communications, political science,
between the school and the therapist and business information systems, and introduction to
the psychiatrist who were treating Cho. poetry. His grades overall were good, and he
These positive influences ended when Cho ended the year with a GPA of 3.00.
graduated from high school. His multi-
faceted support system then disappeared Cho’s sophomore year (2004–2005) brought some
leaving a huge void. changes. Cho made arrangements to share the
rent on a condominium with a senior at Virginia
COLLEGE YEARS Tech who worked long hours and was rarely
home. His courses that fall leaned more heavily

I n August of 2003, Cho began classes at


Virginia Tech as a Business Information
Technology major. Mr. and Mrs. Cho were
toward science and math. His grades slipped that
term. At the same time, he became enthusiastic
about writing and decided he would switch his
concerned about his move away from home major to English beginning the fall semester of
and the stress of the new environment, espe- 2005. It is unclear why he made this choice as he
cially when they learned he was unhappy with disliked using words in school or at home. More-
his roommate. His parents visited him every over, English had not been one of his strongest
weekend on Sundays during that first semes- subjects in high school.
ter, which was a major time commitment since
they both worked the other 6 days of the week. The answer may be found in an exchange of
They noted that the dorm room trash can was e-mails that Cho had with then-Chair of the Eng-
full of beer cans (allegedly, from the interview lish Department, Dr. Lucinda Roy. Cho had taken
with Cho’s parents, the roommate was drink- one of her poetry classes, a large group, entry-
ing) and the room was quite dirty. Cho, in con- level course the previous semester. On Saturday,
trast, had kept his room neat at home and had November 6, 2004, he wrote “I was in your poetry
good hygiene. He requested a room change—a class last semester, and I remember you talking
move that his parents and sister saw as a about the books you published. I’m looking for a
positive sign that he was being proactive and publisher to submit my novel…I was just wonder-
taking care of his own affairs. It seemed as ing if you know of a lot of publishers or agents or
though college was working out for him if you have a good connection with them.” He went
because he seemed excited about it. on, “My novel is relative[ly] short…sort of like
Tom Sawyer except that it’s really silly and
Cho settled in, got his room changed by the pathetic depending on how you look at it.…” Dr.
beginning of the second semester, and seemed Roy’s first e-mail back said: “Could you send me
to be adjusting. Parental visits became less your name? You forgot to sign your note.” “Seung
frequent. According to a routine they estab- Cho,” he wrote. Dr. Roy then recommended two
lished, every Sunday night he spoke with his resource books and gave him tips on finding liter-
parents by telephone who always asked how ary agents. She also advised, “If you haven’t yet
he was doing and whether he needed any-

40
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

taken a creative writing (fiction) course…you from a New York publishing house on Cho’s desk
should consider doing so.” at home. He had submitted a topic for a book
describing the book’s outline. She encouraged him
University personnel explained to the panel to continue to write and learn saying that all
that Virginia Tech’s process for changing
writers have to work at their craft for a long time
majors relies on “advisors” who serve to help before they are published and that he was just at
ensure that students are taking the right
the beginning and not to lose heart.
number of credits and courses to meet the
requirements of their major and to graduate. While living in the off-campus condominium, Cho
They do not generally offer counsel on became convinced that he had mite bites (based
whether a student is making a wise move or on searches he did on the Internet). He went to a
examine the reasons behind their class local doctor who diagnosed it as severe acne and
choices. In any given year at Virginia Tech, put him on medication. Other than followup
many students change majors. Over 40 per- appointments for his acne at home and at the
cent of the student body changes their major Shiffert Medical Center at Virginia Tech (he con-
after the first year or two. Thus this change is tinued to believe mites were the problem), he did
not abnormal and not a red flag. not have regular appointments with general prac-
titioners, specialists, psychiatrists, or counselors
Cho seemed to enjoy the idea of writing, espe-
in his hometown during his entire college tenure.
cially poetry. His sister noticed that he would His family reported that he came home for all his
bring home stacks of books on literature and breaks and would spend the time writing, reading,
poetry and books on how to become a writer.
playing basketball, and riding his bike—alone.
Writing seemed to have become a passion, and
his family was thrilled that he found some- Storm Clouds Gathering, Fall 2005 – The fall
thing he could be truly excited about. He semester of Cho’s junior year (2005) was a pivotal
would spend hours at his computer writing, time. From that point forward, Cho would become
but when his sister asked to see his work, he known to a growing number of students and fac-
would refuse. On one rare occasion, she did ulty not only for his extremely withdrawn person-
get to read a story he wrote about a boy and ality and complete lack of interest in responding
his imaginary friend, which she thought was to others in and out of the classroom, but for hos-
somewhat strange, but nothing too odd. tile, even violent writings along with threatening
behavior.
Cho’s parents never read his compositions,
both because he did not offer to show them He registered for French and four English
and because they did not read English, at courses, one of which was Creative Writing:
least not well. Poetry, taught by Nikki Giovanni. It would seem
he selected this course on the basis of Dr. Roy’s
Cho took three English courses in the spring
advice to him the previous fall. His sister began
of 2005, plus an economics course, and an noticing some subtle changes: he was not writing
introductory psychology course. He did not do as much in his junior year and he seemed more
particularly well, especially in the literature
withdrawn. The family wondered whether he was
courses. One of his English professors gave getting anxious about the future and what he
him a D-, another, a C+. He earned a B+ in would do after graduation. His father wanted him
Introduction to Critical Reading, but also
to go to graduate school, but Cho indicated he did
withdrew from the economics class, thus earn- not want to continue with academics after he
ing only 12 credits and registering a 2.32 for graduated. His parents then offered to help him
the semester.
find a job after graduation, but he refused.
Late that sophomore year, in his presence,
Cho had moved back to the dormitories that
Cho’s sister chanced upon a rejection letter semester. He had a roommate and two suitemates

41
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

who lived in another room connected by a bottle on his desk. He and the others in the suite
bathroom—a typical layout in the residence looked it up online and found that it was a
halls. The panel interviewed his roommate medication for “skin fungus.”
and one suitemate who related some events
Cho’s actions in the poetry class taught by Nikki
from that year. They described Cho in the
same way as he is described throughout this Giovanni that semester are widely known and
report: very quiet, short responses to ques- documented. For the first 6 weeks of class, the
professor put up with Cho’s lack of cooperation
tions, and rarely initiating any communica-
tion. At the beginning of the school year, the and disruptive behavior. He wore reflector glasses
roommate and the other suitemates took Cho and a hat pulled down to obscure his face.
Dr. Giovanni reported to the panel that she would
to several parties. He would always end up
sitting in the corner by himself. One time they have to take time away from teaching at the
all went back to a female student’s room. Cho beginning of each class to ask him to please take
off his hat and please take off his glasses. She
took out a knife (“lock blade, not real large”)
and started stabbing the carpet. They stopped would have to stand beside his desk until he
complied. Then he started wearing a scarf
taking him out with them after that incident.
wrapped around his head, “Bedouin-style”
The three suitemates would invite Cho to eat according to Professor Giovanni. She felt that he
with them at the beginning of the year, but he was trying to bully her.
would never talk so they stopped asking. They
observed him eating alone in the dining hall Cho also was uncooperative in presenting and
changing the pieces that he wrote. He would read
or lounge. The roommate asked Cho who he
hung out with and Cho said “nobody.” He from his desk in a voice that could not be heard.
would see him sometimes at the gym playing When Dr. Giovanni would ask him to make
changes, he would present the same thing the fol-
basketball by himself or working out.
lowing week. One of the papers he read aloud was
Cho’s roommate never saw him play video very dark, with violent emotions. The paper was
games. He would get movies from the library titled “So-Called Advanced Creative Writing –
and watch them on his laptop. The roommate Poetry.” He was angry because the class had spent
never saw what they were, but they always time talking about eating animals instead of
seemed dark. Cho would listen to and down- about poetry, so his composition, which he would
load heavy metal music. Someone wrote heavy later characterize as a satire, spoke of an “animal
metal lyrics on the walls of their suite in the massacre butcher shop.”
fall, and then in the halls in the spring. Sev-
eral of the students believed Cho was respon- In the paper, Cho accused the other students in
the class of eating animals, “I don’t know which
sible because the words were similar to the
uncouth, low-life planet you come from but you
lyrics Cho posted on Facebook.
disgust me. In fact, you all disgust me.” He made
Several times when the suitemates came in up gruesome quotes from the classmates, then
the room, it smelled as though Cho had been wrote, “You low-life barbarians make me sick to
burning something. One time they found the stomach that I wanna barf over my new shoes.
burnt pages under a sofa cushion. Cho would If you despicable human beings who are all dis-
go to different lounges and call one of the graces to [the] human race keep this up, before
suitemates on the phone. He would identify you know it you will turn into cannibals—eating
himself as “question mark”—Cho’s twin little babies, your friends,. I hope y’all burn in hell
brother—and ask to speak with Seung. He for mass murdering and eating all those little
also posted messages to his roommate’s animals.”
Facebook page, identifying himself as Cho’s
twin. The roommate saw a prescription drug Dr. Giovanni began noticing that fewer students
were attending class, which had never been a

42
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

problem for her before. She asked a student Dean Brown also said, “I talked with a coun-
what was going on and he said, “It’s the selor…and shared the content of the ‘poem’… and
boy…everyone’s afraid of him.” That was she did not pick up on a specific threat. She sug-
when she learned that Cho also had been gested a referral to Cook during your meeting. I
using his cell phone to take pictures of stu- also spoke with Frances Keene, Judicial Affairs
dents without permission. director and she agrees with your plan.” He con-
tinued, “I would make it clear to him that any
Dr. Giovanni talked to Cho, telling him, “I
similar behavior in the future will be referred.”
don’t think I’m the teacher for you,” and
offered to get him into another class. He said Frances Keene noted in her response to Dean
that he did not want to transfer, which sur- Brown and Dr. Roy that she was available if Cho
prised her. She contacted the head of the Eng- had any further questions about how using his
lish Department, Dr. Roy, about Cho and cell phone in class to take photographs could con-
warned that if he were not removed from her stitute disorderly conduct. She also wrote, “I agree
class, she would resign. He was not just a dif- that the content is inappropriate and alarming
ficult student, she related, he was not working but doesn’t contain a threat to anyone’s immedi-
at all. Dr. Giovanni was offered security, but ate safety (thus, not actionable under the abusive
declined saying she did not want him back in conduct – threats section of the UPSL).”
class, period. She saw him once on campus
During an interview with the panel, Ms. Keene
after that and he just stared at the ground.
related that she would have needed something in
Dr. Roy explained to the panel what her writing to initiate an investigation into the disor-
actions were once Dr. Giovanni made her derly conduct violation, and reported that she
aware of Cho’s upsetting behavior. She never received anything. The formal request
remembered Cho from the previous semester would have come from the English Department.
when he took that poetry class she taught (she
Ms. Keene recalled that the concern about Cho
had given him a B- in the course). Dr. Roy
contacted the Dean of Student Affairs, Tom was brought before the university’s “Care Team,”
Brown, the Cook Counseling Center, and the of which she is a member, at their regular meet-
ing. The Care Team is comprised of the dean of
College of Liberal Arts with regard to the
objectionable writing that Dr. Giovanni Student Affairs, the director of Residence Life, the
showed Dr. Roy. She asked to have it evalu- head of Judicial Affairs, Student Health, and legal
counsel. Other agencies from the university are
ated from a psychological point of view and
inquired about whether the picture-taking occasionally asked to participate; including the
might have been against the code of student Women’s Center, fraternities and sororities, the
Disability Center, and campus police, though
conduct.
these agencies are not standing members of the
Dean Brown sent an e-mail message to Dr. Team.
Roy and advised “there is no specific policy
related to cell phones in class. But, in Section At the Care Team meeting, members were advised
of the situation with Cho and that Dr. Roy and Dr.
2 of the University Policy for Student Life,
item #6 speaks to disruption. This is the ‘dis- Giovanni wanted to proceed with a class change to
orderly conduct’ section which reads: ‘Behav- address the matter. The perception was that the
situation was taken care of and Cho was not dis-
ior that disrupts or interferes with the orderly
function of the university, disturbs the peace, cussed again by the Care Team. The team made
or interferes with the performance of the no referrals of Cho to the Cook Counseling Center.
The Care Team did nothing. There were no refer-
duties of university personnel.’ Clearly, the
disruption he caused falls under this policy if rals to the Care Team later that fall semester
when Resident Life, and later, VTPD became
adjudicated.”

43
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

aware of Cho’s unwanted communications to he was “just joking” about the writing in
female students and threatening behavior. Giovanni’s class, but agreed that it might have
been perceived differently. Dr. Roy asked him if
Frances Keene said that she received no com- he was offended by the class discussion on eating
munications from the female students who
animals and he said, “I wasn’t offended. I was just
had registered complaints about Cho and that making fun of it…thought it was funny, thought
she learned of those incidents only through I’d make fun of it.” He was asked if he was a vege-
campus police incident reports. However, the
tarian or had religious beliefs about eating meat
assistant director of Judicial Affairs, Rohsaan
or animals; he answered no to both questions.
Settle, received an e-mail communication on
December 6 advising her of Cho’s “odd behav- Ms. Ruggiero’s transcript mentions that Dr. Roy
ior” and “stalking.” Ms. Keene indicated that “proposes alternative of working independently
it is her office’s policy to contact students who with herself and Fred D’Aguiar.” The transcript
have been threatened and advise them of their also notes that Cho “doesn’t want to lose cred-
rights, but one of the students stated that she its…if not ‘kicked out’ will stay” [I (Ruggiero)
was never contacted by Judicial Affairs, and noted some emotion on the words ‘kicked out,’ a
there is no documentation that the others small spark of anger or resentment]. The tran-
were contacted. Ms. Keene indicated that she script goes on to document that “Lucinda asked if
would have discussed these incidents with the he would remove his sunglasses.” Cho takes a long
Care Team at the time the incidents occurred time to respond, but he does remove them. “It is a
had she known about them. very distressing sight, since his face seems very
naked and blank without them. It’s a great relief
Dr. Roy e-mailed Cho and asked him to con- to be able to read his face, though there isn’t much
tact her for a meeting. He responded with an there.” Dr. Roy asks if taking off the sunglasses
angry, two-page letter in which he harshly
has been terrible for him…and says “he doesn’t
criticized Dr. Giovanni and her teaching, say- seem like himself, like the student she knew in
ing she would cancel class and would not the Intro to Poetry class, and she asks if anything
really instruct, but just have students read
terrible or bad has happened to him.” Eventually
what they wrote and discuss the writings. He
Cho answers “No.”
agreed to meet with Dr. Roy and said “I know
it’s all my fault because of my personal- Twice during the meeting with Cho, Dr. Roy
ity…Being quiet, one would think, would repel asked him if he would talk to a counselor. She told
attention but I seem to get more attention him she had the name of someone, and asked
than I want (I can just tell by the way people again if he would consider going. He did not
stare at me).” He said he imagined she was answer for a while, and then said vaguely, “sure.”
going to “yell at me.”
In her interview with the panel, Dr. Roy stated
Dr. Roy asked a colleague, Cheryl Ruggiero, to that the university’s policy made the situation
be present for the meeting with Cho. Ms. difficult. She was obligated to offer Cho an alter-
Ruggiero took notes, the transcription of native that was equivalent to the instruction he
which provided an exceptionally detailed would receive in Giovanni’s class. Thus, she
account of that session with Cho as did offered to tutor him privately. He later agreed.
e-mails from Dr. Roy to appropriate admini- She told Cho that he would have to meet four
stration officials after the meeting. more times and do some writing. As he left the
meeting, Dr. Roy gave him a copy of her book. He
Cho arrived wearing dark sunglasses. He
took it and “appeared to be crying,” she related.
seemed depressed, lonely, and very troubled.
Dr. Roy assured him she was not going to yell Throughout the deliberations about Cho’s writing
at him, but discussed the seriousness of what and behavior and the available options, Dr. Roy
he wrote and his other actions. He replied that communicated widely with all relevant university

44
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

officers and provided updates on meetings and For the remainder of the semester, Dr. Roy
decisions. On October 19, 2005, Dr. Roy focused on William Butler Yeats and Emily Dick-
e-mailed Zenobia Hikes, Tom Brown, George inson to help him develop empathy toward others
Jackson, and Robert Miller with a report on and redirect his writing away from violent
her meeting with Cho. themes. They worked on a poem together where
she went over technical skills. She saw no overt
Cheryl and I met with the student we
spoke about today. We spoke about 30 threats in the writings he did for her. He was stiff,
minutes. He was very quiet and it took sad, and seemed deliberately inarticulate, but
him long time to respond to question; but gradually he opened up and wrote well. She
I think he may be willing to work with repeatedly offered to take him to counseling. She
me and with Professor Fred D’Aguiar eventually gave him an “A” for a grade.
rather than continuing in Nikki's
course…h e didn't seem to think that his Cho did not go home for Thanksgiving, according
poem should have alarmed anyone…
to his roommate and resident advisor, though he
[But] he also said he understood why
people assumed from the piece that he thought that Cho may have gone home for a few
was angry with them. I strongly recom- days at Christmas. When Cho’s parents were
mended that he see a counselor, and he asked about this they indicated that he came
didn't commit to that one way or the home at every break, but that sometimes he
other. …Both Cheryl and I are genuinely would have to wait a day or so until their day off
concerned about him because he ap-
work so they could come pick him up at school.
peared to be very depressed—though of
course only a professional could verify
According a VTPD incident report, on Sunday,
that.
November 27, the police, following a complaint
One month later, Dr. Roy wrote to Associate from a female student who lived on the fourth
Dean Mary Ann Lewis, Liberal Arts & Human floor of West Ambler Johnston, came to Cho’s
Sciences, who in turn shared it with the dean room to talk to him. The roommate went to the
of Student Affairs and Ellen Plummer, lounge and then returned after the police left. Cho
Assistant Provost and Director of the Women’s said “want to know why the police were here?” He
Center. She wrote then related that “he had been text messaging a
female student and thought it was a game”. He
He is now meeting regularly with me and
went to her room wearing sunglasses and a hat
with Fred D’Aguiar rather than with
Nikki. This has gone reasonably well, pulled down and said “I’m question mark.” He
though all of his submissions so far have said that “the student freaked out,” and the resi-
been about shooting or harming people dent advisor came out and called the police.
because he’s angered by their authority According to the police record, the officer warned
or by their behavior. We’re hoping he’ll
Cho not to bother the female student anymore,
be able to write inside a different kind of
narrative in the future, and we’re and told him they would refer the case to Judicial
encouraging him to do so…I have to ad- Affairs.
mit that I’m still very worried about this
student. He still insists on wearing The resident advisor told the panel about Cho,
highly reflective sunglasses and some “He was strange and got stranger.” She said that
responses take several minutes to elicit. Cho’s roommate and one of the other suitemates
(I’m learning patience!) But I am also found a very large knife in Cho’s desk and dis-
impressed by his writing skills, and by
carded it.
what he knows about poetry when he
opens up a little. I know he is very angry, On Wednesday, November 30, at 9:45 am, Cho
however, and I am encouraging him to
called Cook Counseling Center and spoke with
see a counselor––something he’s resisted
so far. Please let me and Fred know if Maisha Smith, a licensed professional counselor.
you see a problem with this approach. This is the first record of Cho’s acting upon pro-
fessors’ advice to seek counseling, and it followed

45
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

the interaction he had had with campus police CHO’S HOSPITALIZATION AND
three days before. She conducted a telephone COMMITMENT PROCEEDINGS
triage to collect the necessary data to evaluate
the level of intervention required. Ms. Smith (The law pertaining to these proceedings is discussed in
has no independent recollection of Cho and Part B of this chapter.)

O
her notes from the triage are missing from n December 12, 2005, the Virginia Tech Po-
Cho’s file. A note attached to the electronic lice Department (VTPD) received a complaint
appointment indicates that Cho specifically from a female sophomore residing in the East
requested an appointment with Cathye Betzel, Campbell residence hall regarding Cho. She knew
a licensed clinical psychologist, and indicated Cho through his roommate and suitemate. The
that his professor had spoken with Dr. Betzel. students had attended parties together at the
The appointment was scheduled for December beginning of the semester and it was at this young
12 at 2:00 pm, but Cho failed to keep the woman’s room that Cho had produced a knife and
appointment. However, he did call Cook stabbed the carpet. While the student no longer
Counseling after 4:00 pm that same afternoon saw Cho socially, she had received instant mes-
and was again scheduled for telephone triage. sages and postings to her Facebook page through-
According to the Cook scheduling program out the semester that she believed were from him.
documents, Cho was again triaged by tele- The messages were not threatening, but, rather,
phone at 4:45 on December 12. This triage self-deprecating. She would write back in a posi-
was conducted by Dr. Betzel who has no recol- tive tone and inquire if she were responding to
lection of the specific content of the “brief tri- Cho. The reply would be “I do not know who I
age appointment.” Written documentation am.” In early December, she found a quote from
that would have typically been completed at Romeo and Juliet written on the white erase
that time is missing. The “ticket” completed to board outside her dorm room. It read:
indicate the type of contact indicates that the By a name
telephone appointment was kept, that no I know not how to tell thee who I am
diagnosis was made (consistent with Cook’s My name, dear saint is hateful to myself
procedure to not make a diagnosis until a Because it is an enemy to thee
Had I it written, I would tear the word
clinical intake interview is completed) and
that no referral was made for follow-up ser- The young woman shared with her father her con-
vices either at Cook or elsewhere. Dr. Betzel cerns about the communications that she believed
did recall at the time of her interview with the were from Cho. The father spoke with his friend,
panel that she had a conversation with Dr. the chief of police for Christiansburg, who advised
Roy concerning a student whose name she did that the campus police should be informed.
not recall, however the details were so similar
that she believes it was Cho. She recalls that The following day, December 13, a campus police
Dr. Roy was concerned about disturbing writ- officer met with Cho and instructed him to have
ings submitted by Cho in class, and that Dr. no further contact with the young woman. She did
Roy detailed her plans to meet with the stu- not file criminal charges. No one spoke with her
dent individually. The date of Dr. Betzel’s con- regarding her right to file a complaint with Judi-
sultation with Dr. Roy is unknown and any cial Affairs. Records document that there were
written documentation that would typically multiple e-mail communications regarding the
have been associated with the consultation is incident among Virginia Tech residential staff, the
missing from Cho’s file. residence life administrator on call, and the presi-
dent’s & upper quad area coordinator, the director
of Residence Life, and the assistant director of
Judicial Affairs. The matter was not, however,

46
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

brought before the Virginia Tech multi- inquired about this, and checking the box for fire-
disciplinary Care Team. arm access may have been an error.) He was on no
medication at the time of admission, but Ativan
Following the visit from the police, Cho sent was prescribed for anxiety, as needed. One milli-
an instant message to one of his suitemates
gram of Ativan was administered at 11:40 p.m.
stating “I might as well kill myself.” The (The records do not show that he ever received
suitemate reported the communication to the another dose.) Cho passed an uneventful night
VTPD.
according to the nursing notes.
Police officers returned around 7:00 p.m. that
On the morning of December 14, at approximately
same day to interview Cho again in his dorm 6:30 a.m., the Clinical Support Representative for
room. The suitemate was not present, but they St. Albans met with Cho to give him information
spoke to Cho’s roommate out of his presence.
about the mental health hearing. Around 7:00
The officers took Cho to VTPD for assessment, a.m., the representative escorted Cho to meet with
and a pre-screen evaluation was conducted a licensed clinical psychologist, who conducted an
there at 8:15 p.m. by a licensed clinical social
independent evaluation of Cho pursuant to
worker for New River Valley Community
Virginia law.
Services Board (CSB). The pre-screener inter-
viewed Cho and the police officer, and then The independent evaluator reported to the panel
spoke with both Cho’s roommate and a suite- that he reviewed the prescreening report, but that
mate by phone. She recorded her findings on a due to the early hour, there were no hospital
five-page Uniform Pre-Admission Screening records available for his review. He did not speak
Form, checking the findings boxes indicating with the designated attending psychiatrist who
that Cho was mentally ill, was an imminent had not yet seen Cho. The evaluator has no spe-
danger to self or others, and was not willing to cific recollection, but believes that the independ-
be treated voluntarily. She recommended ent evaluation took approximately 15 minutes.
involuntary hospitalization and indicated that
the CSB could assist with treatment and dis- The evaluator completed the evaluation form cer-
charge planning. She located a psychiatric tifying his findings that Cho “is mentally ill; that
he does not present an imminent danger to
bed, as required by state law at St. Albans
Behavioral Health Center of the Carilion New (himself/others), or is not substantially unable to
River Valley Medical Center (St. Albans) and care for himself, as a result of mental illness; and
that he does not require involuntary hospitaliza-
contacted the magistrate by phone to request
that a temporary detention order (TDO) be tion.” The independent evaluator did not attend
the commitment hearing; however, both counsel
issued.
for Cho and the special justice signed off on the
The magistrate considered the pre-screen form certifying his findings.
findings and issued a TDO at 10:12 p.m.
Police officers transported Cho to St. Albans Shortly before the commitment hearing, the at-
where he was admitted at 11:00 p.m. Cho did tending psychiatrist at St. Albans evaluated Cho.
When he was interviewed by the panel, the psy-
not speak at all with the officer during the trip
to the hospital. He was noted to be cooperative chiatrist did not recall anything remarkable about
with the admitting process. The diagnosis on Cho, other than that he was extremely quiet. The
psychiatrist did not discern dangerousness in Cho,
the admission orders was “Mood Disorder,
NOS” [non specific]. On the Carilion Health and, as noted, his assessment did not differ from
Services screening form for the potential for that of the independent evaluator—that Cho was
not a danger to himself or others. He suggested
violence, it was marked that Cho denied any
prior history of violent behavior, but that he that Cho be treated on an outpatient basis with
did have access to a firearm. (The panel counseling. No medications were prescribed, and
no primary diagnosis was made.

47
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

The psychiatrist’s conclusion was based in after 11:00 a.m. on December 14. Neither Cho’s
part on Cho’s denying any drug or alcohol suitemate nor his roommate nor the detaining
problems or any previous mental health police officer nor the pre-screener nor the inde-
treatment. The psychiatrist acknowledged pendent evaluator nor the attending psychiatrist
that he did not gather any collateral informa- attended the hearing. The prescreening report
tion or information to refute the data obtained was read into the record by Cho’s attorney. The
by the pre-screener on the basis of which the special justice reviewed the independent evalua-
commitment was obtained. He indicated that tion form completed by the independent evaluator
this is standard practice and that privacy laws and the treating psychiatrist’s recommendation.
impede the gathering of collateral informa- He heard evidence from Cho. The special justice
tion. (Chapter V discusses these information ruled that Cho “presents an imminent danger to
privacy laws in detail.) The psychiatrist also himself as a result of mental illness” and ordered
said that the time it takes to gather collateral “O-P” (outpatient treatment) “—to follow all rec-
information is prohibitive in terms of existing ommended treatments.”
resources.
The clinical support representative (CSR) con-
Freer access to clinical information among tacted Cook Counseling Center at Virginia Tech to
agencies is imperative so that a rational plan make an appointment for Cho. The Cook Counsel-
for treatment can be developed. As for the ing Center required that Cho be put on the phone
relationship between the independent evalua- (a practice begun shortly before this hearing
tor and the staff psychiatrist, they rarely see according to the CSR) to make the appointment,
each other and they function independently. which he did. The appointment was scheduled for
The role of the independent evaluator is to 3:00 p.m. that afternoon, December 14. The CSR
provide information to the court and the job of does not recall whether this phone call was made
the attending psychiatrist is to provide clinical prior to or following the hearing.
care for the patient.
The clinical support representative recalls making
As for counseling services at Virginia Tech his customary phone call to New River Valley CSB
and the other area universities from which St. to advise them of the outcome of the morning’s
Albans Hospital receives patients, according hearings. It was not the hospital’s practice at that
to the psychiatrist they are all stretched for time to send copies of the orders from the com-
mental health resources. The lack of outpa- mitment hearings.
tient providers who can develop a post-
discharge treatment plan of substance is a Due to the rapidly approaching outpatient
major flaw in the current system. The lack of appointment for Cho, the CSR urged the treating
psychiatrist to expedite the dictation and tran-
services is common in both the public and the
scription of his discharge summary. It was tran-
private outpatient sectors.
scribed shortly before noon and the physical
The psychiatrist noted his recommendation evaluation findings and recommendation about an
for outpatient counseling on the Initial Con- hour later. The clinical support representative
sent Form for TDO Admissions. The clinical recalls faxing the records to Cook Counseling Cen-
support representative then escorted Cho and ter, but he did not place a copy of the transmittal
other TDO patients to meet with their attor- confirmation in the hospital records. Cook Coun-
ney prior to their hearings. There were four seling Center, however, has no record of having
hearings that morning, and the attorney has received any hospital records until January 2006.
no specific recollection of Cho. The physical evaluation report indicated that Cho
was to be treated by the psychiatrist at St. Albans
A special justice designated by the Circuit “and hopefully have some intervention in therapy
Court of Montgomery County presided over for treatment of his mood disorder.” The discharge
the commitment hearing for Cho held shortly

48
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

summary, which was not part of the records ers and eventually, campus police. They were
received by the panel from Cook Counseling unaware that their son had been committed for a
Center, indicated “followup and aftercare to be time to St. Albans Hospital or that he had
arranged with counseling center at Virginia appeared in court before a special justice. This is
Tech. Medications none.” corroborated by documents and interviews relat-
ing that Cho refused to notify his parents when
Cho was discharged from St. Albans at 2:00 campus police responded to his threat of suicide.
p.m. on December 14. No one the panel inter-
The university did not inform the parents either.
viewed could say how Cho got back to campus.
However, the electronic scheduling program at According to Virginia Tech records, there was a
the Cook Counseling Center indicates that “home town” doctor or counselor who Cho could
Cho kept his appointment that day at 3:00 see when he was home. The panel did not discover
p.m. He was triaged again, this time face-to- what led to this assumption. However, it is known
face, but no diagnosis was given. The triage that the university did not contact the family to
report is missing (as well as those from his ascertain the veracity of home town followup for
two prior phone triages), and the counselor counseling and medication management.
who performed the triage has no independent
recollection of Cho. It is her standard practice When Cho’s parents were asked what they would
have done if they had heard from the college about
to complete appropriate forms and write a
note to document critical information, recom- the professors’, roommates, and female students’
complaints, their response was, “We would have
mendations, and plans for followup.
taken him home and made him miss a semester to
It is unclear why Cho would have been triaged get this looked at …but we just did not know…
for a third time rather than receiving a treat- about anything being wrong.” From their history
ment session at his afternoon appointment during the high school years, we do know that
following release from St. Albans. The Colle- they were dedicated to getting him to therapy
giate Times had run an article at the begin- consistently and also consented to psychopharma-
ning of the fall semester expressing “concern cology when the need arose.
about the diminished services provided by the
More Problems, Spring 2006 – The trend of dis-
counseling center” and the temporary loss of
turbing themes continued to be apparent in many
its only psychiatrist.
of Cho’s writings, along with his selective mutism.
It was the policy of the Cook Counseling Cen-
ter to allow patients to decide whether to Robert Hicok had Cho in his Fiction Workshop
class that semester. Hicok described his class as a
make a followup appointment. According to
the existing Cook Counseling Center records, mid-level fiction course with about 20 students.
none was ever scheduled by Cho. Because He told the panel that there was no participation
from Cho and that Cho’s stories and work were
Cook Counseling Center had accepted Cho as
a voluntary patient, no notice was given to the violent. He said Cho was a very cogent writer, but
CSB, the court, St. Albans, or Virginia Tech his creativity was not that good. Cho was open to
suggestions and he made some edits, but he was
officials that Cho never returned to Cook
“not very unique” in his writing. The combination
Counseling Center.
of the content of Cho’s stories and his not talking
AFTER HOSPITALIZATION raised red flags for Hicok. He consulted with Dr.
Roy, but then decided to keep Cho in the class and

C ho’s family did not realize what was hap-


pening with him at Blacksburg that fall
2005 semester: his dark writings, stalking,
just deal with him. Hicok scheduled two meetings
with Cho, but he did not show up, and Hicok
never saw Cho again after the semester ended.
and other odd and unsettling behavior that Cho received a D+ in this class.
worried roommates, resident advisors, teach-

49
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

Professor Hicok shared none of Cho’s writings dents would allow him to get credit for group pro-
with the panel. However, based on a question jects without having worked on them. Bean noted
to a panel member by a reporter, further in- that Cho derived satisfaction from learning “how
quiry was made as this report was about to go to play the game—do as little as he needed to do
to press. Several writings by Cho in Hicok’s to get by.” This profile of Cho stands in contrast to
class were produced, one of which is of par- the profile of a pitiable, emotionally disabled
ticular significance. It tells the story of a young man, but it may in fact represent a true
morning in the life of Bud “who gets out of bed picture of the other side of Cho—the one that
unusually early…puts on his black jeans, a murdered 32 people.
strappy black vest with many pockets, a black
Bean allowed that Cho was very intelligent. He
hat, a large dark sunglasses [sic] and a flimsy
jacket….” At school he observes “students could write with technical proficiency and could
strut inside smiling, laughing, embracing each read well. However, his creative writing skills
were limited and his command of the English lan-
other….A few eyes glance at Bud but without
the glint of recognition. I hate this! I hate all guage was “very impoverished.” He had trouble
these frauds! I hate my life….This is it….This with verb tenses and use of articles. On two or
three occasions early in the semester, Bean had
is when you damn people die with me.…” He
enters the nearly empty halls “and goes to an spoken to Cho after class regarding the fact that
arbitrary classroom….” Inside “(e)veryone is he was not participating orally nor working col-
laboratively on group assignments. By late March
smiling and laughing as if they’re in heaven-
on-earth, something magical and enchanting or early April, the class was given a writing
about all the people’s intrinsic nature that assignment to do a technical essay about a subject
within their major. Cho suggested George Wash-
Bud will never experience.” He breaks away
and runs to the bathroom “I can’t do this.…I ington and the American Revolution, but Bean
have no moral right.…” The story continues by advised him that this was not within his major.
Cho next suggested the April 1960 revolution in
relating that he is approached by a “gothic
girl.” He tells her “I’m nothing. I’m a loser. I Korea—again rejected because the topic was not
can’t do anything. I was going to kill every god in his major. Cho then decided to write “an objec-
tive real-time” experience based on Macbeth and
damn person in this damn school, swear to
god I was, but I…couldn’t. I just couldn’t. corresponding to serial killings.
Damn it I hate myself!” He and the “gothic On April 17, 2006, one school year prior to the
girl” drive to her home in a stolen car. “If I get shooting to the day (because it was also a Mon-
stopped by a cop my life will be forever over. A day), Bean asked Cho to stay after class again.
stolen car, two hand guns, and a sawed off The professor explained to Cho that his work was
shotgun.” At her house, she not satisfactory and that his topic was not accept-
retrieves “a .8 caliber automatic rifle and a able. He recommended that Cho drop the class
M16 machine gun.” The story concludes with and that he would recommend that a late drop be
the line “You and me. We can fight to claim permitted. Cho never said a word, just stared at
our deserving throne.” him. Then, without invitation, Cho followed Bean
Cho encountered problems in another English to his office. The professor offered for him to sit
class that semester, Technical Writing, taught down, but Cho refused and proceeded to argue
loudly that he did not want to drop the class. Bean
by Carl Bean. The professor told the panel
that Cho was always very quiet, always wore was surprised because he had never heard Cho
his cap pulled down, and spoke extremely speak like that before nor engage in that type of
conduct. He asked Cho to leave his office and
softly. Bean opined that “this was his power.”
By speaking so softly, he manipulated people return when he had better control of himself. Cho
into feeling sorry for him and his fellow stu- left and subsequently sent an e-mail advising that
he had dropped the course.

50
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

Bean did not discuss the matter with Dr. Roy is reasonable and cogent. The professor awarded
and he was not aware that Nikki Giovanni Cho a B for the course.
had encountered problems with Cho the prior
semester. After the massacre of April 16, it Cho’s senior year roommate explained to the
panel that he tried speaking to Cho at the begin-
was discovered that Cho had mailed a letter to
the English Department on that same day. ning of the semester, but Cho barely responded. “I
Bean stated he knew Cho was antisocial, hardly knew the guy; we just slept in the same
room.” Cho went to bed early and got up early, so
manipulative, and intelligent. Cho, he said,
had obviously “researched” Bean after drop- his roommate just left him alone and gave him his
ping Bean’s course, because in the April 16 space. The only activities Cho engaged in were
studying, sleeping, and downloading music. He
letter Cho wrote numerous times that Bean
“went holocaust on me.” Bean has a great never saw him play a video game, which he
thought strange since he and most other students
interest in the Holocaust.
play them. One of the suitemates mentioned that
Fall 2006 – Cho enrolled in Professor Ed he saw Cho working out at McCommis Hall and
Falco’s playwriting workshop in the fall saw him return to the room from time to time in
semester. During the first class when each workout attire. Cho kept his side of the room very
student was asked to introduce him/herself to neat. Nothing appeared to be abnormal—no
the class, Cho got up and left before his turn. knives, guns, chains, etc. The only reading mate-
When he returned for the second class, Profes- rial the roommate saw on Cho’s side was a paper-
sor Falco informed him that he would have to back copy of the New Testament, which he
participate; Cho did not respond. In his inter- thought may have been for a class. (Cho took a
view with the panel, Professor Falco described course in the spring 2007 semester: The Bible as
Cho’s writing as juvenile with some pieces Literature.)
venting anger.
The resident advisor for the section of Harper Hall
Post April 16, 2007 students from this class where Cho resided had been forewarned by the
were quoted in the campus newspaper as say- previous year’s RA that “there were issues” with
ing that some classmembers had joked that Cho. She knew about his unwanted advances to-
they were waiting for Cho to do something. ward female students and that he was suspected
One student reportedly had told a friend that of writing violent song lyrics on the dorm walls
Cho “was the kind of guy who might go on a that also were posted on his web site. However,
rampage killing”. she did not encounter a single problem with him.

According to an article in the August 10, 2007 That fall semester, Cho enrolled in Professor
edition of The Roanoke Times, Professor Falco, Norris’ Advanced Fiction Workshop—a small class
director of Virginia Tech’s creative writing of only about 10 students. Cho had taken one of
program, recently proposed and participated her classes the previous spring, on contemporary
in the drafting of written guidelines for deal- fiction, so she knew how little he participated in
ing with students who submit disturbing and class. Norris realized that the workshop class
violent work. The guidelines suggest that fac- would be a problem for Cho because there would
ulty concerned about a student’s writing pur- be discussions and readings. Cho appeared in
sue a series of actions including speaking to class with a ball cap pulled low and making no eye
the student, encouraging the student to seek contact. Norris checked with the dean’s office to
counseling, and involving university adminis- see if it was safe—if Cho was okay—and she
trators. asked to have someone intervene on his behalf.

Cho also took a class called “Contemporary The English Department did not know about
Horror” in the fall of 2006. His final exam Cho’s dealings with campus police and the
paper which appears to analyze a horror film

51
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

communications generated from Residence a night at St. Albans as a result of such detention
Life about his stalking behavior. order. The Care Team did not know the details of
all these occurrences.
Norris told Cho that he had to come see her if
he was going to able to make it through this Residence Life knew through their staff (two resi-
particular class. She ascertained that Cho had dent advisors and their supervisor) that there
trouble speaking in both English and Korean, were multiple reports and concerns expressed
and she offered to connect him with the Dis- over Cho’s behavior in the dorm, but this was not
ability Services Office. brought before the Care Team. The academic
component of the university spoke up loudly about
After meeting with Cho, she e-mailed him to a sullen, foreboding male student who refused to
reiterate her offers to go with him for counsel- talk, frightened classmate and faculty with maca-
ing or for other services. He did not pursue bre writings, and refused faculty exhortations to
those offers. His written work was on time get counseling. However, after Judicial Affairs
and he was on time for class, but he missed and the Cook Counseling Center opined that Cho’s
the last 2 weeks of class. Cho earned a B+ in writings were not actionable threats, the Care
Norris’s class that semester. Team’s one review of Cho resulted in their being
satisfied that private tutoring would resolve the
The following semester, spring 2007, Cho
problem. No one sought to revisit Cho’s progress
began to buy guns and ammunition. His class
the following semester or inquire into whether he
attendance began to fall off shortly before the
had come to the attention of other stakeholders on
assaults. There were no outward signs of his
campus.
deteriorating mental state. In their last phone
call with him the night of April 15, 2007, Mr. The Care Team was hampered by overly strict
Cho and Mrs. Cho had no inkling that any- interpretations of federal and state privacy laws
thing was the matter. Cho had called per their (acknowledged as being overly complex), a decen-
usual Sunday night arrangement. He tralized corporate university structure, and the
appeared his “regular” self. He asked how his absence of someone on the team who was experi-
parents were, and other standard responses: enced in threat assessment and knew to investi-
“No I do not need any money.” His parents gate the situation more broadly, checking for col-
said, “I love you.” lateral information that would help determine if
this individual truly posed a risk or not. (The
MISSING THE RED FLAGS interpretation of FERPA and HIPAA rules is dis-
cussed in a later chapter.)
T he Care Team at Virginia Tech was estab-
lished as a means of identifying and work-
ing with students who have problems. That
There are particular behaviors and indicators of
dangerous mental instability that threat assess-
resource, however, was ineffective in connect- ment professionals have documented among mur-
ing the dots or heeding the red flags that were derers. A list of red flags, warning signs and indi-
so apparent with Cho. They failed for various cators has been compiled by a member of the
reasons, both as a team and in some cases in panel and is included as Appendix M.
the individual offices that make up the core of
the team. KEY FINDINGS – CHO’S COLLEGE
YEARS TO APRIL 15, 2007
Key agencies that should be regular members
of such a team are instead second tier, non-

T
permanent members. One of these, the VTPD, he lack of information sharing among aca-
knew that Cho had been cautioned against demic, administrative, and public safety enti-
stalking—twice, that he had threatened sui- ties at Virginia Tech and the students who had
cide, that a magistrate had issued a tempo- raised concerns about Cho contributed to the fail-
rary detention order, and that Cho had spent ure to see the big picture. In the English Depart-

52
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

ment alone, many professors encountered undoubtedly clouded his ability to evaluate his
similar difficulties with Cho—non- participa- own situation, he, ultimately, is the primary per-
tion in class, limited responses to efforts to son responsible for April 16, 2007; to imply other-
personally interact, dark writings, reflector wise would be wrong.
glasses, hat pulled low over face. Although to
any one professor these signs might not neces- RECOMMENDATIONS
sarily raise red flags, the totality of the IV-1 Universities should recognize their
reports would have and should have raised responsibility to a young, vulnerable
alarms. population and promote the sharing of
Cho’s aberrant behavior of pathological shy- information internally, and with parents,
ness and isolation continued to manifest when significant circumstances pertaining to
throughout his college years. He shared very health and safety arise.
little of his college life with his family, had no IV-2 Institutions of higher learning should
friends, and engaged in no activities outside of review and revise their current policies
the home during breaks and summer vaca- related to—
tions. While he was an adult, he was a mem- a) recognizing and assisting students in dis-
ber of the household and receiving parental tress
support, but he did not hold a job to help earn
b) the student code of conduct, including en-
money for college. Unusual by U.S. standards,
forcement
a high, sometimes exclusive focus on academ-
ics is common among parents from eastern c) judiciary proceedings for students, includ-
cultures. ing enforcement
d) university authority to appropriately in-
Cho’s roommates and suitemates noted fre-
tervene when it is believed a distressed stu-
quent signs of aberrant behavior. Three
dent poses a danger to himself or others
female residents reported problems with
unwanted attention from Cho (instant mes- IV-3 Universities must have a system that
sages, text messages, Facebook postings, and links troubled students to appropriate medi-
erase board messages). One of Cho’s suite- cal and counseling services either on or off
mates combined many of these instances of campus, and to balance the individual’s
concern into a report shared with the resi- rights with the rights of all others for safety.
dence staff. The residence advisors reported IV-4 Incidents of aberrant, dangerous, or
these matters to the hall director and the threatening behavior must be documented
residence life administrator on call. These and reported immediately to a college’s
individuals in turn, communicated by e-mail threat assessment group, and must be acted
with the assistant director of Judicial Affairs. upon in a prompt and effective manner to
protect the safety of the campus community.
Notwithstanding the system failures and
errors in judgment that contributed to Cho’s IV-5 Culturally competent mental health ser-
worsening depression, Cho himself was the vices were provided to Cho at his school and
biggest impediment to stabilizing his mental in his community. Adequate resources must
health. He denied having previously received be allocated for systems of care in schools
mental health services when he was evaluated and communities that provide culturally
in the fall of 2005, so medical personnel competent services for children and adoles-
believed that their interaction with him on cents to reduce mental-illness-related risk as
that occasion was the first time he had occurred within this community.
showed signs of mental illness. While Cho’s IV-6 Policies and procedures should be
emotional and psychological disabilities implemented to require professors

53
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

encountering aberrant, dangerous, or ing center, and parents. All parties should be
threatening behavior from a student to educated about the public safety exceptions to the
report them to the dean. Guidelines should privacy laws which permit such reporting.
be established to address when such reports IV-11 The college counseling center should
should be communicated by the dean to a report all students who are in treatment pur-
threat assessment group, and to the school’s suant to a court order to the threat assess-
counseling center. ment team. A policy should be implemented to
IV-7 Reporting requirements for aber- address what information can be shared with fam-
rant, dangerous, or threatening behavior ily and roommates pursuant to the public safety
and incidents for resident hall staff must exceptions to the privacy laws.
be clearly established and reviewed dur- IV-12 The state should study what level of
ing annual training. community outpatient service capacity will
IV-8 Repeated incidents of aberrant, dan- be required to meet the needs of the common-
gerous, or threatening behavior must be wealth and the related costs in order to ade-
reported by Judicial Affairs to the threat quately and appropriately respond to both
involuntary court-ordered and voluntary re-
assessment group. The group must formu-
ferrals for those services. Once this informa-
late a plan to address the behavior that will
tion is available it is recommended that out-
both protect other students and provide the patient treatments services be expanded
needed support for the troubled student. statewide.
IV-9 Repeated incidents of aberrant, dan-
The panel’s report deals with facts. Sometimes,
gerous, or threatening behavior should be
however, police investigation requires educated
reported to the counseling center and
guesses and speculation—such as in instances
reported to parents. The troubled student
where a “profile” of an unknown killer is gener-
should be required to participate in counseling
ated by FBI profilers, who are specially trained in
as a condition of continued residence in cam-
this area. Set forth in Appendix N is such a work,
pus housing and enrollment in classes.
written by panel member Dr. Roger Depue, who
IV-10 The law enforcement agency at col- is, among many other qualifications, a former FBI
leges should report all incidents of an is- profiler. While no member of the panel can defini-
suance of temporary detention orders for tively ascertain what was in Cho’s mind, this pro-
students (and staff) to Judicial Affairs, file offers one theory.
the threat assessment team, the counsel-

Part B – Virginia Mental Health Law Issues

serve the needs of people with mental illness,


The Commonwealth of Virginia Commission on while respecting the interests of their families
Mental Health Law Reform was appointed in
and communities.”
October 2006, by Virginia Chief Justice Leroy R.
Hassell, Sr. The 26-member commission, The commission has held four meetings with
chaired by Professor Richard J. Bonnie, Director another scheduled for November 2007 and is
of the Institute of Law, Psychiatry and Public working through five task forces with more than
Policy at the University of Virginia, is charged 200 participants. The Task Force on Civil Com-
to “conduct a comprehensive examination of mitment is addressing criteria for inpatient and
Virginia’s mental health laws and services” and outpatient commitment, transportation, and the
to “study ways to use the law more effectively to emergency evaluation process, procedures for

54
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

hearings, training, and compensation for par- cause. The concerns raised included that it is
ticipants in the process, and oversight. often difficult to promptly secure qualified per-
sonnel to perform the prescreening evaluation
The Task Force on Civil Commitment will sub- given staff resources and required travel time,
mit its final report to the commission in Novem-
particularly in rural jurisdictions. It is often
ber 2007. The commission intends to prepare a even more difficult to locate the available bed
preliminary report during the winter and to required for a temporary detention order (TDO)
submit a final report by the fall of 2008 for con-
to issue. Four hours do not allow sufficient time
sideration by the 2009 General Assembly. to gather meaningful collateral information
The discussion that follows constitutes an from family, friends, or other health care pro-
abridged effort, due to constraints of time and viders nor to secure proper evaluations for
manpower, to address some of the issues that medical clearance. Some noted, however, that
will be dealt with by the commission in a far an extension of the 4-hour period may require
more comprehensive manner. Many of the police departments to spend more time with a
panel’s recommendations are framed in general person in emergency custody in those locales
terms with the expectation that the commission where hospital security are unable to assume
will formulate specific proposals. responsibility.

Throughout the panel’s work, there was close The American College of Emergency Physicians
collaboration with Professor Bonnie and James (ACEP) has recommended that emergency
Stewart, the Inspector General for the Depart- physicians trained in psychiatric evaluation be
ment of Mental Health and Mental Retardation given more authority in the involuntary hold
and Substance Abuse Services. The inspector process. Since emergency departments are 24-
general released a report in June 2007 detailing hour facilities, resources are already in place.
his findings concerning Cho’s interaction with Because the CSB serves an independent
mental health services in Virginia. “gatekeeper” role under the Virginia TDO
process, emergency physicians and CSB staff
TIME CONSTRAINTS FOR are generally expected to work collaboratively in
EVALUATION AND HEARING determining whether a TDO is needed for those
patients screened in emergency departments.
Va. Code 37.2-808 establishes the procedures for However, where CSB pre-screeners are not
involuntary temporary detention of persons who immediately available, properly trained
are mentally ill, present an imminent danger to emergency physicians can effectively screen
self or others, and are in need of hospitalization patients under an emergency custody order and
but unwilling or unable to volunteer for treat- communicate with the magistrate to obtain the
ment. Subsection H provides that no person TDO when needed. If such a gate keeping
shall remain in custody for longer than 4 hours responsibility were to be conferred on
without a temporary detention order issued by a emergency physicians, further questions would
magistrate. In Cho’s case, the New River Valley have to be addressed regarding the respective
CSB was able to provide a pre-screener in a roles of the emergency physicians and the CSB
timely manner, and she was able to conduct the staff in exploring alternatives to hospitalization
screening and locate an available bed in order to and in participating in the commitment hearing.
present the matter to the magistrate within the
required 4-hour period. Under current Virginia law, the duration of
temporary detention may not exceed 48 hours
However, mental health service providers and prior to a hearing (or the next day that is not a
special justices interviewed for this report set Saturday, Sunday, or legal holiday). The mental
forth numerous arguments as to why this period health service providers in Cho’s case were able
should be lengthened to either 6 hours or to to comply with the 48-hour requirement;
permit one renewal of the 4-hour period for good however, the information available to the

55
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

special justice was extremely limited. There was involuntary admission. At the commitment
no history regarding prior treatment; there were hearing, the special justice did find Cho to be an
no lab or toxicology reports, nor the report imminent danger to himself; however, he agreed
regarding access to a firearm. At the hearing, with the independent examiner and treating
there were no witnesses present such as family, psychiatrist that a less restrictive alternative to
roommate/suitemates, the CSB pre-screener, involuntary admission, outpatient treatment,
the independent evaluator, or the treating was suitable. Perhaps Cho presented himself
psychiatrist. differently at various stages of the commitment
process or perhaps the professionals had differ-
Mental health professionals interviewed ing evaluations of someone who did not speak
reported that 48 hours is one of the shortest
much or perhaps they had differing interpreta-
detention periods in the nation and recom- tions of the standard set forth in the Virginia
mended that it be lengthened. Reasons cited for
Code.
expanding this period included the need to con-
tact family or friends and to explore the person’s Mental health professionals advised the panel
prior history. Also cited was the need for a more that the standard “imminent danger to self or
comprehensive independent evaluation and the others” is not clearly understood and is subject
difficulty in securing a complete report of the to differing interpretations. They recommend
treating psychiatrist in time for the hearing. It that the criteria for commitment be revised to
was suggested that a psychiatric “workup” as achieve a more consistent application. Service
well as a toxicology screen be available to the providers and special justices suggest that the
independent examiner. A further concern was “imminent danger” criterion should be replaced
that often psychiatric inpatient bed space is not by language requiring “a substantial likelihood”
available within the 48 hours. As a financial or “significant risk” that the person will cause
consideration, it was argued that a longer period serious injury to himself or others “in the near
would allow patients an opportunity to stabilize future.” A few disagreed on the basis that per-
or recognize the need for voluntary treatment, sonal rights of liberty should be paramount, and
thereby reducing the number of commitment that changing the standard would lower the
hearings and the costs associated with special threshold for admission. Proponents for modify-
justices and appointed counsel. ing the criteria respond that Virginia’s commit-
ment standard is one of the most restrictive of
STANDARD FOR INVOLUNTARY all the states. They contend that the threshold
COMMITMENT finding prevents intervention in cases of severe
illness accompanied by substantial impairment
The judge or special justice ordering commit- of cognition, emotional stability, or self-control.
ment must find by clear and convincing evi-
dence that the person presents (1) an imminent PSYCHIATRIC INFORMATION
danger to himself or others or is substantially
unable to care for himself, and (2) less restric- Many of those interviewed expressed serious
tive alternatives to involuntary inpatient treat- concerns regarding the paucity of psychiatric
ment have been investigated and are deemed information available to the independent
unsuitable. Cho was found to be an imminent evaluator and judge/special justice. As noted
danger to himself by the pre-screener who also above, the independent evaluator for Cho had
found that he was “unable to come up with a only the report from the CSB pre-screener and
safety plan to adequately ensure safety.” He was no collateral information or medical records.
unwilling to contact his parents to pick him up. The independent evaluator plays a key role in
However, Cho was found not to be an imminent the commitment process in many jurisdictions.
danger to self or others by both the independent In Cho’s case, notwithstanding the finding from
examiner and the treating psychiatrist at St. the independent evaluator that Cho did not pose
Albans, and accordingly neither recommended an imminent threat, the special justice,

56
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

nevertheless convened the hearing and actually vacy (VaHRP) often make it difficult to acquire
made a finding that differed from that of the background medical/psychiatric information on
independent evaluator. He did, however, agree a patient previously treated elsewhere. Legal
with the independent evaluator that inpatient experts from a research advisory group for the
treatment was not required. The panel was Commission on Mental Health Law Reform par-
advised that in many jurisdictions, absent a ticipated in the development of a questionnaire
finding by the independent evaluator that an for judges and special justices to complete fol-
individual poses an imminent danger or is lowing civil commitment hearings in the month
substantially unable to care for himself, many of May 2007. More than 1400 questionnaires
special justices will decline to hold a hearing. were returned. They reflected that approxi-
mately 60 percent of the May hearings lasted no
It is unclear under existing law whether the in- more than 15 minutes and only 4 percent
dependent evaluator is intended to serve as a
required more than 30 minutes.
gate keeper. If the opinion of the independent
evaluator is to be given great weight, then it is Cho was the only person to testify at his com-
critical that sufficient psychiatric information be mitment hearing, and he was not very commu-
available upon which an informed judgment nicative. The pre-screener was not present nor
may be made. Background information includ- was any representative from the CSB. The
ing records from the current hospitalization independent evaluator was not present. The
must be assembled for review. The Cho case officer who detained Cho was not present. Cho’s
calls attention to the need to assure that the roommate, suitemates, and Cho’s family were
independent evaluator has both sufficient time all absent. This apparently is not an unusual
and information to conduct an adequate evalua- scenario for commitment hearings in Virginia.
tion. Often the pre-screener is off duty by the time of
the hearing. CSBs with limited staff frequently
At Cho’s hearing, the only documents available do not send a substitute. (The commission’s sur-
to the special justice were the Uniform Pre- vey reflected that the CSB representatives
Admission Screening Form, a partially com-
attended only half of the hearings held in May,
pleted Proceedings for Certification form 2007). Independent evaluators, paid $75 per
recording the findings of the independent commitment evaluation, often feel compelled to
evaluator and a physician’s examination form
return to their private practice rather than
containing the findings of the treating psychia- waiting for hearings that may be held hours
trist. No prior patient history was presented; no after the evaluation is complete. (The responses
toxicology, lab results, or physical evaluation
to the questionnaires indicated that the inde-
from the treating psychiatrist were available. pendent evaluators were present at approxi-
The admitting form indicating that Cho had mately two-thirds of Mays hearings.) Due to
access to a firearm was not presented. time constraints and concerns regarding HIPAA
Panel members have been advised by mental and VaHRP restrictions, friends and family are
health providers and special justices from other often not notified.
locales in Virginia that it is not unusual for the HIPAA and VaHRP generally require that no
evidence presented at commitment hearings to
health care entity disclose an individual’s health
be minimal. Due to the time constraints and records or information. However, permitted
limitations of resource personnel, the informa- exceptions are information necessary for the
tion available to the judge/special justice is often
care of a patient and information concerning a
very limited. Witnesses cannot be located patient who may present a serious threat to
quickly and hospital records have often not been public health or safety. Therefore, a treating
transcribed. Additionally, conflicting interpreta-
physician at the facility where a patient is
tions of the constraints of the Health Insurance detained should be granted access to all prior
Portability and Accountability Act (HIPAA) and psychiatric history. These exceptions, however
Virginia Code 32.1-127.1:03 Health Records Pri-

57
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

do not clearly permit these records be shared for involuntary outpatient treatment and to
with the judge or special justice at the commit- monitor compliance. However, the Code does not
ment hearing. Although a person may consent specify how or by whom the CSB will be notified
to the release of information to any person or that outpatient treatment has been ordered if a
entity, detained individuals are often unable or representative is not present at the hearing.
disinclined to do so. There exists a disagreement as to whether the
CSB was advised of the entry of the outpatient
Because interpretation of HIPAA and FERPA
order in Cho’s case. The clinical support
were key in stopping adequate exchange of in- representative for St. Albans advised that he
formation concerning Cho, the panel requested always calls the CSB following commitment
that its legal council research the interpretation
hearings to report the results. The CSB reports
and exceptions under these laws, which is pre- that they have no record of having been notified.
sented in the next chapter. If the CSB is represented at the hearing, there
INVOLUNTARY OUTPATIENT ORDERS can be no reason for confusion. However, if
Virginia Code is not amended to require the
In conducting the investigation, the panel presence in person or telephonically, it must be
encountered many questions concerning invol- amended to designate who has responsibility for
untary outpatient orders. What specificity certifying a copy of the outpatient order to the
should be required of outpatient orders? To CSB. There should also be clear guidance
whom should notice of outpatient orders be provided in the Virginia Code as to who has
given? How should compliance with outpatient responsibility for notification if a private mental
orders be monitored? What procedures should health practitioner is to provide the mandated
be available to address noncompliance and what outpatient treatment.
resources are needed?
No notice of the hearing or the order issued by
The special justice ordered that Cho receive the special justice was given to Cho’s family, his
outpatient treatment; however, the order pro- roommate/suitemates, the VTPD, or the Vir-
vided no information regarding the nature of the ginia Tech administration. The Code of Virginia
treatment other than to state “to follow all rec- authorizes no such notice. The recordings of the
ommended treatments.” The order did not spec- hearing must be kept confidential pursuant to
ify who was to provide the outpatient treatment Va. Code 37.2-818(A). The records, reports and
or who was to monitor the treatment. court documents pertaining to the hearing are
kept confidential if so requested by the subject
There was considerable support among those
of the hearing under 37.2-818(B) and are not
interviewed by panel members for greater guid-
subject to the Virginia Freedom of Information
ance in the Virginia Code regarding outpatient
Act. HIPAA and VaHRP restrictions may fur-
treatment orders. Some felt that the order
ther limit dissemination of certain information
should track recommendations from the treating
as no person to whom health records are dis-
physician as to the frequency and duration of
closed may redisclose beyond the purpose for
treatment and whether medication was
which disclosure was made. Concerns were
required. Others observed that often physician’s
raised by many interviewees and speakers at
evaluations and orders were not available and
panel hearings that family members, those
the special justice/substitute judge did not have
residing with the subject of a commitment hear-
the expertise to order specific treatment. How-
ing, the police department and school officials
ever, all agreed that more specificity in out-
should all be notified of the hearing and its out-
patient treatment orders is essential.
come in the interest of public safety.
New River Valley CSB did not have a
In Cho’s case, there are conflicting reports re-
representative at Cho’s hearing due to financial
garding the issue of notice to the treatment pro-
constraints. Va. Code 37.2-817(C) currently
vider, Cook Counseling Center. An appointment
requires the CSB to recommend a specific course

58
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

had been scheduled by Cho with the assistance On June 22, 2007, the Commission on Mental
of the clinical support representative for St. Health Law Reform released the final report of
Albans. The representative reports that he its study of the current commitment process.
faxed a copy of the discharge summary to Cook. This study, undertaken for the commission by
Cook, however, contends that they did not Dr. Elizabeth McGarvey of the University of
receive any written documentation until Janu- Virginia School of Medicine, involved intensive
ary, and even then it was the physical examina- interviews with 64 professional participants in
tion which indicated that Cho would be treated the process, 60 family members of persons with
by the St. Alban’s psychiatrist. Following Cho’s serious mental illness, and 86 people who have
in-person triage appointment on December 14, had the experience of being committed. Accord-
the Cook Counseling Center left it to Cho’s dis- ing to Dr. McGarvey’s report, professional par-
cretion whether to return for follow up treat- ticipants and family stakeholders are uniformly
ment. When he did not, it was not reported to frustrated by almost every aspect of the civil
the special justice, St. Alban’s, or the CSB. The commitment process in Virginia. Among the
Virginia Code imposes no legal obligation for most common complaints were a shortage of
Cook Counseling Center to do so, and Cook beds in willing detention facilities, insufficient
counselors question whether they have the right time for adequate evaluation, the high cost and
to do so given the restrictions of HIPAA and inefficiency of transporting people for evalua-
VaHRP. tion, inadequate compensation for professional
participants in the process, inadequate reim-
Furthermore, there exists the question of bursement for hospitals, inconsistent interpre-
whether Cho was noncompliant given the gen- tation of the statute by different judges, and
eral language of the involuntary treatment
lack of central direction and oversight.
order; and if Cho were considered noncompliant,
how was that to be addressed. There is no con- CERTIFICATION OF ORDERS TO THE
tempt provision in the Virginia Code for those
CENTRAL CRIMINAL RECORDS
noncompliant with involuntary outpatient
EXCHANGE
orders. There is no guidance as to the nature of
the hearing to be held for noncompliance; nor is Va. Code 37.2-819 requires the clerk to certify,
there a basis for compensating the special on a form provided, any order for involuntary
justice/substitute judge or attorney for followup admission to the Central Criminal Records
proceedings. Many questions are raised. If a Exchange. The section does not specify who
form is created to report noncompliance, can a bears responsibility for completion of the form.
treatment provider file the report without vio- The failure of Va. Code 37.2-819 to specify
lating HIPAA and VaHRP? If the noncompli- responsibility for preparation of the order fur-
ance report is filed, how does the special justice nished by the Central Criminal Records
secure the presence of the individual for a fol- Exchange was noted to be a problem. It is
lowup hearing? If the noncompliant individual reported that in some jurisdictions, if the clerk
does not pose an imminent danger to himself or is not furnished the completed form, no form is
others at the time of the followup hearing, an forwarded to the exchange. There is lack of con-
emergency custody order cannot be issued; nor sistency throughout the Commonwealth regard-
can the special justice order involuntary in- ing who prepares the forms. In some jurisdic-
patient treatment. Should there be a Code pro- tions, the forms are completed by the special
vision allowing for a short period of inpatient justice/substitute judge, in others by the clerk of
treatment for those not compliant with the out- court, and reportedly in others, the forms are
patient order yet not an “imminent danger” at often not completed at all.
the time returned for noncompliance? Will
commitment for noncompliance pose yet another Of further concern was the issue of under what
burden on the already overcrowded inpatient circumstances the forms are to be completed.
facilities? Mental health and legal professionals

59
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

interviewed by panel members felt that there order to the CSB resulted in an absence of over-
was no reasonable distinction to be drawn sight for Cho’s outpatient treatment.
between
persons ordered for involuntary inpatient The lack of a requirement in the Virginia Code
to certify outpatient commitment orders to the
treatment and those ordered for involuntary
out-patient treatment when a finding has been CCRE resulted in Cho’s name not being entered
made that the individual poses an imminent in the database, which could have prevented his
danger to self or others. If firearms restrictions purchase of firearms.
apply, they should be based upon the fact that There was a lack of doctor-to-clinician contact
an individual poses a danger, not on the basis of between St. Albans Hospital and the Cook
the type of treatment ordered; therefore, both Counseling Center.
involuntary inpatient and involuntary out-
patient treatment orders should be certified. In the wake of the Virginia Tech tragedy, much
While the governor has addressed this matter of the discussion regarding mental health ser-
by executive order, it was felt that legislation vices has focused on the commitment process.
should be enacted embodying the certification However, the mental health system has major
requirement. Mental health and legal experts gaps in its entirety starting from the lack of
also raised the question of whether persons short-term crisis stabilization units to the out-
electing voluntary admission upon being patient services and the highly important case
advised of their right to do so during the management function, which strings together
commitment hearing should also be reported. the entire care for an individual to ensure suc-
(The commission’s survey indicated that 30 cess. These gaps prevent individuals from get-
percent of the commitment hearings in May ting the psychiatric help when they are getting
resulted in voluntary admission.) ill, during the need for acute stabilization, and
when they need therapy and medication man-
It was also noted with concern by the mental agement during recovery.
health and legal experts interviewed that the
reporting requirement does not apply to orders RECOMMENDATIONS
for juveniles found to pose an imminent danger,
regardless of whether inpatient or outpatient IV-13 Va. Code 37.2-808 (H) and (I) and
treatment was ordered. They further expressed 37.2-814 (A) should be amended to extend
concern regarding the absence of any provision the time periods for temporary detention to
in the Virginia Code requiring the clerk to cer- permit more thorough mental health
tify orders pertaining to persons found not evaluations.
guilty by reason of insanity.
IV-14 Va. Code 37.2-809 should be amended
to authorize magistrates to issue temporary
KEY FINDINGS detention orders based upon evaluations
Statutory time constraints for temporary deten- conducted by emergency physicians trained
tion and involuntary commitment hearings sig- to perform emergency psychiatric evalua-
nificantly impede the collection of vital psychi- tions.
atric information required for risk assessment.
IV-15 The criteria for involuntary
The Virginia standard for involuntary commit- commitment in Va. Code 37.2-817(B) should
ment is one of the most restrictive in the nation be modified in order to promote more
and is not uniformly applied. consistent application of the standard and
to
The fact that a CSB representative did not allow involuntary treatment in a broader
attend the commitment hearing and the failure range of cases involving severe mental
to certify a copy of the outpatient commitment illness.

60
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

IV-16 The number and capacity of secure IV-22 Virginia Health Records Privacy and
crisis stabilization units should be Va. Code 37.2-814 et seq. should be amended
expanded where needed in Virginia to to ensure that all entities involved with
ensure that individuals who are subject to treatment have full authority to share
a temporary detention order do not need to records with each other and all persons in-
wait for an available bed. An increase in volved in the involuntary commitment
capacity also will address the use of inpatient process while providing the legal safe-
beds for moderately to severely ill patients that guards needed to prevent unwarranted
need longer periods of stabilization. breaches of confidentiality.

IV-17 The role and responsibilities of the IV-23 Virginia Code 37.2-817(C) should be
independent evaluator in the commitment amended to clarify—
process should be clarified and steps taken
to assure that the necessary reports and • the need for specificity in involuntary
collateral information are assembled be- outpatient orders.
fore the independent evaluator conducts • the appropriate recipients of certified
the evaluation. copies of orders.

IV-18 The following documents should be • the party responsible for certifying cop-
ies of orders.
presented at the commitment hearing:
• the party responsible for reporting non-
• The complete evaluation of the treating compliance with outpatient orders and
physician, including collateral infor- to whom noncompliance is reported.
mation.
• the mechanism for returning the non-
• Reports of any lab and toxicology tests compliant person to court.
conducted.
• the sanction(s) to be imposed on the no-
• Reports of prior psychiatric history. compliant person who does not pose an
• All admission forms and nurse’s notes. imminent danger to himself or others.

IV-19 The Virginia Code should be • the respective responsibilities of the


amended to require the presence of the pre- detaining facility, the CSB, and the
screener or other CSB representative at all outpatient treatment provider in assur-
commitment hearings and to provide ing effective implementation of involun-
adequate resources to facilitate CSB tary outpatient treatment orders.
compliance. IV-24 The Virginia Health Records Privacy
IV-20 The independent evaluator, if not statute should be clarified to expressly
present in person, and treating physician authorize treatment providers to report
should be available where possible if noncompliance with involuntary outpatient
needed for questioning during the hearing. orders.

IV-21 The Virginia Health Records Privacy


statute should be amended to provide a safe
harbor provision which would protect
health entities and providers from liability
or loss of funding when they disclose infor-
mation in connection with evaluations and
commitment hearings conducted under
Virginia Code 37.2-814 et seq.

61
CHAPTER IV. CHO’S MENTAL HEALTH HISTORY

IV-25 Virginia Code 37.2-819 should be IV-26 A comprehensive review of the


amended to clarify that the clerk shall Virginia Code should be undertaken to
immediately upon completion of a commit- determine whether there exist additional
ment hearing complete and certify to the situations where court orders containing
Central Criminal Records Exchange, a copy mental health findings should be certified
of any order for involuntary admission or to the Central Criminal Records Exchange.
involuntary outpatient treatment.

62