Reader Responses to the Virginia Tech Killings

Balancing Privacy Rights and Public Safety

In the aftermath of the tragic events at Virginia Tech, we would like to suggest some ways in which psychiatrists, psychologists, and college personnel can help identify and treat students who have severe psychiatric disorders-and perhaps prevent another mass murder.

One issue is the "duty to warn," which is our professional responsibility to share relevant information about mentally ill persons who pose a direct danger to others.¹ Since we do not know the reasoning behind Seung-Hui Cho's rather rapid discharge from a psychiatric hospital, we cannot second-guess the judgment of the professionals who evaluated him in 2005.² However, at the time of discharge, a judge found enough evidence to declare Cho a danger to himself or others and mandated outpatient counseling.²

In addition to agreeing with the general recommendations already discussed in Dr Ronald Pies' recent Psychiatric Times editorial,³ we wish to raise the following heuristic questions:

• Should the psychiatrist who discharged Cho from inpatient care have alerted the college's counseling center of the potential danger he posed?
• Notwithstanding legitimate concerns about confidentiality, should there be more communication between campus security personnel and college mental health clinics if a student- patient poses a danger to himself or others?
• Should faculty have a "panic button" at their desks to alert campus police of an imminent threat?
• Should faculty be equipped with nonlethal means of defense, such as tasers or pepper spray?
• Should mandatory health screening (including mental health) be a condition of attending college?
• Should colleges be empowered to insist on and monitor mental health treatment when a judge has already mandated such care for a potentially dangerous student? In particular, should Virginia Tech have insisted on psychiatric treatment for Cho as a condition of his attending school? (In Cho's case, there was evidently no follow-up mental health treatment, as evidenced by statements made to the media by 2 of his former professors.⁴)

In the wake of this tragedy, we now have the momentum to advocate the modification of laws governing privacy issues in mental health care. We have the opportunity to give "teeth" to existing regulations in order to allow educators and mental health professionals to care for students while protecting the public. Finally, we strongly support the use of informational seminars, led by mental health professionals, to teach students and faculty how to recognize and respond to obviously disturbed behavior.

Manuel Mota-Castillo, MD, and Willy Newman, MD, JD
Lake Mary, Fla

References:

References

1.

Felthous AR. Warning a potential victim of a person's dangerousness: clinician's duty or victim's right?

J Am Acad Psychiatry Law

. 2006;34:338-348.

2.

Griffin D. When does a state disarm the mentally ill? CNN Web site. Available at:

http://www.cnn.com/2007/US/04/25/guns.mentallyill/index.html

. Accessed May 9, 2007.

3.

Pies R. School shootings and what psychiatrists can do to prevent them.

Psychiatry Times

. 2007;24(1):26.

4.

Shapira I, Ruane ME. Student wrote about death and spoke in whispers, but no one imagined what Cho Seung Hui would do.

Washington Post

.

April 18, 2007:A01.