When Laws Create Barriers to Care, the Consequences Should Be No Surprise

From: Bruce Stevens <[email protected]>
Date: Apr 23, 2007 3:42 PM
Subject: Mental health double bind

When Laws Create Barriers to Care, the Consequences Should Be No Surprise
By Marc Fisher
Friday, April 20, 2007; A12

In 2005, a Virginia court magistrate, having concluded that Cho Seung Hui posed an immediate danger to himself, ordered the student to get psychiatric treatment.  The head of the Virginia Tech counseling service, Christopher Flynn, says the college never followed up on Cho after the court order. "We are not part of the mental health system of the state," Flynn said yesterday. "You would have to check with the court system."

The magistrate who handled the case, Paul Barnett, says it wasn’t his job to make certain that Cho followed the order. We’re hard into the ducking and weaving now. Luckily for those who knew that Cho was a disaster waiting to happen, the law is their shield. The law says that even when kids are in dire straits, universities don’t have to — indeed, in most cases, may not — tell parents or take action. The law says that even when peers and teachers and mental health professionals agree that a student has taken leave of his senses, universities may not boot the kid from campus. The law manages to bite back at colleges just as it protects them from doing the right thing.

As George Washington University President Stephen Joel Trachtenberg wrote in The Post, when GW sought to protect students by ordering a suicidal young man to go on medical leave, the school found itself slapped with a lawsuit. "Had the student stayed at GW and hurt himself or others . . we probably still would have faced a lawsuit," Trachtenberg said.

All too many institutions and individuals react to this Catch-22 by choosing inaction. Sorry, we’d love to help, but we can’t; gotta go with what the lawyers tell us, they say. But when you face a decision about a human life that is crumbling before your eyes, and the law reduces the complexities of a malfunctioning mind — or, if you prefer, a lost soul — to a printed checklist ("Alternatives to involuntary hospitalization and treatment . . . were deemed suitable," says choice "A" on Virginia’s Form DMH-1006), it’s time to treat the law as it treats people in pain: dismissively.

Some colleges are developing end runs around the law, asking students to sign consent forms so their medical records can be shared with parents, or requiring kids to agree upfront that they can be put on involuntary leave if they become unstable. The current system of laws was created to counter the abuses that occurred in an era of huge institutions that warehoused the mentally ill and treated them like animals. But the pendulum has swung so far in the opposite direction, protecting the mentally ill at the expense of the broader
community, that caring people find themselves stymied at every turn. "You cannot get help for someone you love who is psychotic until they have hurt themselves or someone else," concluded Pete Earley, a Fairfax father whose son drove a car with his eyes closed, wrapped tinfoil around his head to protect himself against the CIA tapping into his brain, and broke into a neighbor’s house to have a bubble bath — none of it enough to win treatment from the state mental health system. A system that requires you to say the magic words ("imminent danger") before it will take action leads people to say things that aren’t true, as Earley did: "I went in and I lied. I said my son was threatening to kill me." That got his son the treatment he needed.

I’ve heard this week from parents who despair for their children and cannot understand why their country’s laws create barriers to effective, compassionate care. A mother in Loudoun County tells of collecting medical
reports concluding that her 12-year-old son is a danger to himself and others, and then presenting those reports, along with her son’s drawings of men wielding knives and guns, only to be told that her son has "minor
deficits" and doesn’t need intensive treatment. When a mother says of the child she loves that "he has no empathy,  conscience or remorse," you’d think someone would pay attention. We don’t yet know what effort, if any, Cho’s parents made to get help for  their son. But a system that requires lies, superhuman effort or
embarrassing publicity before it will address desperate ills is one that deserves the disrespect it now attracts.
E-mail:[email protected]
Bruce R. Stevens, Ph.D.
College of Medicine
Department of Physiology & Functional Genomics
University of Florida
1600 SW Archer Road, Room M552
P.O . Box 100274
Gainesville, FL USA 32610-0274
Office phone (352)-392-4480
Laboratory phone (352)-392-8095
Fax (352)-846-0270
e-mail: [email protected]