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Review Focuses On Tech Mental-Health Care

July 12, 2007

By Tammie Smith

Virginia Tech gunman Seung-Hui Cho fell through an "unusual gap in coverage," concludes a psychiatrist writing about college mental-health services in The New England Journal of Medicine today.

Even so, it is hardly unusual for there to be lapses in mental-health services on college campuses, with resources often scarce until a crisis happens and something is done, Dr. Miriam Shuchman, a national correspondent for the journal and a clinical assistant professor of psychiatry at the University at Buffalo, writes in a perspective piece.

"He might have fallen through the cracks even if a serious effort had been made to provide care," said Shuchman, "but given the state of the mental-health service and intracampus communication in 2005, it appears that Virginia Tech was unable to make that effort."

Shuchman writes that policies or issues at Virginia Tech made it difficult to identify or help mentally troubled students. Some of the shortcomings:

There was no protocol for re-entry screening evaluations of students returning to school after taking medical leave for psychological reasons.

Students had to self-refer or come on their own for help. Counseling was not mandatory, and court-ordered or involuntary referrals were not accepted.

Virginia Tech officials said the journal article appears to be a "genuine attempt" to understand the tragedy but that finding simple answers to issues as complex as those raised by the tragedy are not possible.

Virginia Tech spokesman Mark Owczarski said in a statement that the university "continues to review actions" taken at the Cook Counseling Center. "The review is not complete, and will examine broader mental-health issues, including interactions with community agencies, which under Virginia law requires involuntary patient commitment be coordinated by the local community service board, not by a university or private practitioner."

In an unprecedented rampage, Cho, 23, fatally shot 27 fellow students and five faculty members before killing himself April 16.

The events at Virginia Tech have prompted college mental-health experts to take a hard look at what they do. Some say the journal perspective is too critical of Virginia Tech — that mental-health services across the community are underfunded and underappreciated.

"It's very easy to look at things retrospectively and pick it apart and see where the cracks are and where people fell through the cracks," said Leonard Carter, assistant director of the University of Virginia's Counseling and Psychological Services. "The reality of it is, each college has sort of a different mental-health system. Some of them are really outstanding and some are probably woefully inadequate. That is probably no different from the community mental-health system."

Peter LeViness, director of Counseling and Psychological Services at the University of Richmond, said the article seemed to chide Virginia Tech for not having a mandatory counseling policy.

"In fact, that is not that unusual, in that mandatory counseling is seen as not particularly effective," LeViness said. "Counseling is a collaborative process. If there is someone else saying you have to fix that person and that person does not want to be fixed, it sets up an adversarial relationship."

The article notes that professors troubled by Cho's sometimes bizarre behavior and writings raised concerns, but there did not seem to be coordinated campus intervention.

The Times-Dispatch reported June 30 that Cho may have had at least one appointment at the campus counseling center.

Contact Tammie Smith at TLsmith@timesdispatch.com or (804) 649-6572.