Agonia: Mental Health Advocates

A Mental Health Consumer and Advocate
Reads the Involuntary Commitment Petition
of Seung-Hui Cho (Poly-Murder-Suicide Perpetrator):
A Matter of Existential Dread

On April 17, 2007, the day prior to my 6oth birth anniversary, an event transpired in Virginia that is certain eventually to affect me as a mental health consumer and advocate. On that day in Blacksburg, at the university known as Virginia Tech, a "should-be" mental health consumer named Seung-Hui Cho-- a Korean immigrant apparently on a student visa-- shot-to-death 32 people with a high-powered rifle-- having been jilted by a girl whom he loved.

I deliberately-- out of penitance-- avoided listening to the news of this horrible event, except of very late to read the story of the published involuntary mental health petition taken out by an LCSW -- Kathy Godbey-- of Carilion Saint Albans Behavioral Health, New River Valley, Virginia. Then my aversion to the mass-psychological frenzy of the day was place in "the back seat," and with anguish I read these legal papers from the Christiansburg, Virginia, mental health court dated December 14, 2005-- which are public documents for which no claim of confidentiality can be raised-- "pressed" at http://www.slate.com/id/2164842/entry/2164844/ and sequence.

In places, the graphology of this document is physically hard to read on the Web-- probably because the handwriting in the original is close to a scrawl in the first place. Nevertheless, the message that comes through quite clearly is that Godby-- and apparently a psychiatrist at the Center-- thought that Cho "[p]resents an imminent danger to himself as a result of mental illness," the magic words-- or some of the words at any rate-- that get a person locked-away in an involuntary psychiatric place. This was sought, with the proviso that "court-ordered o-p [out-patient] to follow are recommended treatments." Cho had no prior psychiatric admissions, or even psychiatric treatments. He was not considered a "danger to others." Godbey wrote-- as best I can determine-- in her fairly clear but still hard-to-read calligraphics-- "Oriented X 4 [meaning that the patient knew who-he-was, when-it-was, where-it-was, and what-the-situation-was at the instant of the psychiatric-history-taking]. Affect is flat [which is usually taken as a "negative symptom" of schizoprenia-- but I know from practice that it is often applied to depressed patients, as well] and mood is depressed. He denies suicidal ideation [but! just four months later Cho killed himself with an AK-47 after killing the innocent 32 with the same gun!] He is not ... [Internet transcription of this word is not clear at this word] symptoms of a thought disorder [this almost certainly means that the mental health professional-- who had to be sufficiently qualified to put information on this petition-- did NOT believe that Cho was schizophrenic-- she does not put in a diagnosis but all this COULD HAVE BEEN diagnosed as a "schizo-affective disorder"]. His insight and judgment ... [somewhat illegible on the computer screen-- likely to be the word "decompensated," which means that insight-and-judgment-were-not-working-properly.] A "doctor of medicine" -- whose name appears to be "Roy Crowe"-- also signs the petition, which is to be expected [mental health petitions for involuntary commitment typically will permit a psychiatric social worker, psychologist, master's-level nurse or nurse-practitioner, etc. to fill out such a petition-- PROVIDED AN M.D. ALSO SIGNS THE "PAPERS"; in my experience-- inpatient and outpatient as a professional and consumer-- the "heavy lifting" in these matters is done by social workers-- at the complete behest of doctors; the work is nasty, unrewarding, yet requiring-perfection-- in all of which you can lose your social work license if/when the wrong "moves" are made.]

According to www.Slate.com -- in the article by Bonnie Goldstein posted Tuesday, April 24, 2007, at 11:26 a.m. Eastern (Daylight) Time-- in the subsequent hearing the mental health center's petition for involuntary confinement was turned down by Judge Terry W. Teel (gender uncertain and irrelevant), and Cho was referred to outpatient treatment instead. One can be certain-- in view of what did happen with this case-- that "Hell" will be paid for the eventful decision not to "commit." But -- as a former social worker who did this sort of work-- and as a mental patient who has experienced around 20 involuntaries ( all for "danger to self" of a LOUD/SCREAMING kind more than what is truly life-treatening!) I have some input here-- which a world all-too-ready to judge SOMEONE ought to "hear."

Mental Health centers for "the masses" are harried places these days. The psychiatrist tends to be a guy who gives-five-minute-medication-consults-and-writes-it-up-as-fifteen-minutes; the nurse-practitioner has nearly "eclipsed" the M.D. as the primary medical person for "these welfare people," the people who lack the resources to pay-- as being closest to "the skids" in society-- for a private psychiatrist; the social worker-- who as I say would have to have a clinical license to write-up an involuntary petition-- is the REAL HELPER in such places-- and it is thankless, undesired, and usually counter-productive to both the healing process and the ultimate success in mental health court to pursue "an involuntary," as these are called.

It is no surprise that the M.D. who was recently called to testify in Cho's "post-mortem" hearing did not show up-- she/he may have had almost zero proximic, face-to-face, interaction with the patient: this would have all been done-- really-- by the social worker. CMHCs [Community Mental Health Centers] with almost no variance do NOT with joy enter into the fray required for involuntary commitment, which is inevitably a vast expenditure of time, effort, and agency money. "Business-as-usual" seems to be the operant principle behind the apparent dearth of action in the Cho case.

But this is not all of the context necessary for understanding these events. Of late, since the 1990s the budgets for CMHCs all over the U.S.A. have been cut back and programs "shriveled" [yes! having a Democrat in the White House certainly made for better quality-of-care in those bygone days!] Instead of a good 10-15 clients in a caseload now, a social worker may see or have accountability for 50 clients; and DON'T ASK about the CMHC medical staff-- they have long since virtually been "booked-up-and-out!"

In this business the "loud and squeaky" are the ones likeliest to be EMIed [ "emergency-mental-inquested"]; the "lurkers"-- like the notorious "Son of Sam" of old-times and apparently Cho now-- tend to be shoved off to the side because they do not "make a lot of noise" about their psychopathology. Almost all of mental health service depends on talk-- what the patient says and how she/he says it, what is uttered in staffings ["treatment planning," and other case-conferences] by mental health professionals, and -- let it be known for certain that this is Truth-- by the COPS-- for the police are the last-recourse, emergency mental health professionals who-- on the front lines-- must say to their level of psychological expertise whether a person is/is-not a threat by reason of mental illness.

Like any other assay, the business of mental-health determination and of dangerousness is an empirical investigation which has TRUE POSITIVES (the person is both mentally ill and dangerous), TRUE NEGATIVES ( "patient is not dangerous + mentally ill"), as well as some certainly more-undesirable FALSE POSITIVES (the patient may/may-not be mentally ill but is NOT deemed a danger to society); yet it is exactly the case that the FALSE NEGATIVES ( when the patient IS dangerous because of mental illness and HAS NOT BEEN DETECTED AS SUCH) that cause the most problems to the entire system. Typically, the mental-health/criminal-justice complex will "miss/pass-over" the quiet types-- most of whom are men-- who scheme mayhem in silence, never breaking any laws down to the least traffic ticket, not even "uttering a peep" that would betray ill intent: THEN ONE DAY ERUPTING IN VIOLENCE THAT SHOCKS THE WORLD INTO AN OUTCRY, "WHY DON'T THEY LOCK UP ALL THOSE PEOPLE; WHY DON'T THEY DO THEIR JOBS?"

In actuality, the TRUE POSITIVE rate for all psychological assessment is much lower than anyone would like to tout: this certainly was the stuff of mental health banter as far back as the 1970s-- when courts and legislatures started demanding the involuntary commitment include and assessment of DANGEROUSNESS-- REAL AND IMMEDIATE-- as well as a psychiatric/psychological diagnosis. The System since those early days of this requirement has REALLY tended to err in the conservative direction-- TOWARD LOCKING UP PEOPLE ON SCANT SUSPICION THAT THEY MAY CAUSE HARM TO SELF/OTHERS [whom I call "FALSE POSTIVES" in this business.] I must give the mental health "pros" credit for this: the least suggestion of harmfulness in a mental health consumer will usually warrant an involuntary. BUT THAT IS MORE THE REFLECTION OF A "MOUTHY" PATIENT THAN-- FREQUENTLY-- SUICIDALITY/HOMICIDALITY BY A MENTAL PATIENT.

I -- a person who can this minute get myself hospitalized by going out as I am dressed -- in my bathrobe-- and shouting at the sky oaths and obscenities until the cops come-- I know that all you really have to do to create yourself an involuntary as a mental health consumer is to MAKE A LOT OF NOISE-- i.e. what under other circumstances is "disorderly conduct" or "disturbing the peace" becomes convincing -- unbreakable-- inexorable-- "dangerousness to self/others by reason of mental illness" to busy cops, who-- thinking that they have better things to do than this-- perfunctorily handcuff the nut with metal cuffs-- throw her/him into the back of a squadcar like any other "criminal," and off to the involuntary-mental-place. This demand of the cops on the mental health system is almost always met with compliance-- the gal/guy is kept for (on the average nowadays) less than a week, fed well, humiliated maximally, and sent out thereafter with an appointment slip to see a worker at a CMHC.

In all of this, we are dealing with human-all-too-human circumstances. No one should lock up a person who is NOT uttering mayhem, and it is the "mob" factor in society that makes a hue-and-cry/uproar/demand-for-villification when the quiet little Schlemiels fowl up a place with unspeakable violence-- SCIENTIFICALLY ONE CANNOT MAKE JUDGMENT ON INFORMATION THAT ONE IN NO WISE HAS; ALSO, ONE WHO "SHOUTS" IS AUTOMATICALLY-- RIGHTLY OR WRONGLY-- MOST-LIKELY TO BE DETERMINED A SOCIAL RISK. "SMILE, THE SITUATION IS HOPELESS!"

However, a few obvious factoids loom out for explication on this matter: 1. In terms of odds/likelihood/probability, an adequate mental health system-- with a complete complement of staff and ready/willing/able to respond when the patient "gets risky" -- will more accurately and effectively deal with "problem cases" than a service-system which has been cut-into-the-marrow-within-the-bone-- i.e. exactly the condition of the mental health system now; 2. something needs to be done to validly incarcerate the dangerous-mentally-ill for substantial periods of time (and of course-- as I can attest-- the converse-- that the "merely-shouting" mental patients do not need such "asylum" is true as well); 3. the system-- which includes all-of-the-American-social-order -- needs to recognize that assessing the suicidality/homicidality is an iffffffffffffffffffffffffy matter, far more likely to be inaccurate than accurate-- AND THAT'S "THE FACTS," AS SARGEANT FRIDAY [of the old t.v. show "Dragnet"] SAYS, "JUST THE FACTS"; [there will always be mistakes made-- FALSE POSITIVES and FALSE NEGATIVES in such matters-- and I for one have learned-- as a practical matter as a practical nut-- to just "pipe down" and not do malapropism as a way to keep the cops at bay-- and they are the real "missers-of-the-mark," both-ways, in the "street assessment" of dangerous mental illness]; 3. then it follows that SOMEBODY with real mental health savvy needs to do mental-health runs; if the police CANNOT exercise this ability then the call for increased MH training in criminal justice is all-the-more valid; if the police simply fail all-the-way-around in this, then such matters should best be turned over to people like EMS workers-- who at least have medical sensitivity by training/experience.

As the old popular song goes, "I've seen the world from both sides now, and still somehow it's life's illusions I have found: I really don't know life at all." It does inconvenience a person to lose one's liberty for mere shouting-- as is typically the case with me-- the handcuffs and the cop-stuff are a total embarrassment after nearly a career in forensic (psychiatric) work. Nevertheless, the system is only trying to do what it can to protect mentally-ill people-- and ultimately society-- from the Sons-of-Sam and Leon-Klinghoffers and Cho Seung-Huis of the world. I REALLY don't think they will ever fully "do it," will never make a clean-break with no FALSE POSTIVES or FALSE NEGATIVES in involuntarily hospitalizing the truly dangerous mentally ill. But that is by-far no excuse for abandoning psychiatry and mental health: the call instead should be

posted by Louisville Hermitage @ 2:31 AM 0 comments