June 12, 2007

Privacy and Protection

Experts repeatedly returned to the rules, regulations and lack of resources that can prevent college and government officials from most effectively responding to campus mental health concerns during a meeting Monday of the Independent Virginia Tech Incident Review Panel appointed by Virginia Gov. Tim Kaine.

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“Has the pendulum swung too far in terms of privacy rights?” asked Diane M. Strickland, a former judge and a member of the eight-person panel appointed to study the April 16 slaughter of 32 faculty members and students by Cho Seung-Hui, a student, before he turned the gun on himself. The tensions between privacy and protection continually mounted throughout Monday’s meeting at George Mason University, with college officials stressing a need for a freer flow of information even as complete information about Cho’s own medical history continued to be withheld from the investigative panel itself.

A statewide report on the incident released Monday by the Virginia Inspector General for Mental Health, Mental Retardation and Substance Abuse Services outlined a series of ever-more aggressive behaviors on Cho’s part that were in fact properly reported by faculty and students during the killer’s junior fall semester in 2005.

A diagram attached to the report tracking the frenzied on-campus communications surrounding Cho’s behaviors includes such entities as residence life, the Thomas Cook Counseling Center, campus police, judicial affairs and the university’s umbrella “CARE” team. For example, police responded to student complaints of Cho’s harassing behavior, judicial affairs reviewed a particular paper he wrote to see if it violated university policies, residence life staff spoke to Cho about complaints it had received about him, and one instructor even asked for police coverage of the classroom, the report said. “There was university response,” said James Stewart, the inspector general, to the significant number of incidents “in which other students and faculty members perceived or experienced his actions as odd, frightening or threatening.”

Cho’s subsequent involuntary commitment — and his prompt release for court-ordered outpatient treatment in December 2005 — will likely become a major target for scrutiny in the state policy arena, given the tight legal timetable mental health professionals were operating on and incomplete resources they were working with, as documented in the report. Meanwhile, back on the university level, Cho essentially fell off the radar screen and grew increasingly isolated after his release and until April 16. “As far as the OIG was able to determine, there were no more reports or complaints about his behavior from students or faculty,” the inspector general’s report reads. “His roommate and suitemates who described him during this period said he never made eye contact, frequently stared into space ‘as if he were thinking about something’ and usually did not respond if spoken to except for one word answers on occasion…. None saw any signs of violence and none noticed any weapons. All said, ‘I didn’t really know him.’ ”

The Virginia Tech counseling center — where Cho made an appointment the day of his discharge for mandated outpatient treatment — does not accept court referrals for involuntary treatment and does not report information to outside agencies, including the courts. Nor did a local community services board monitor or report noncompliance: While Virginia law stipulates that the patient must be monitored, it does not assign responsibility for noncompliance to any designated provider. When the panelist Tom Ridge, the first U.S. secretary of homeland security and a former governor of Pennsylvania, asked Monday whether there was any record of Cho having received outpatient treatment at all, Stewart could not comment due to privacy laws. “Fascinating,” Ridge said sarcastically — clearly not fascinated so much as frustrated.

Though the gaps in publicly available information prevent a completely clear picture from emerging about in what ways, if any, privacy laws or policies complicated Virginia Tech’s response to Cho’s behaviors, those same or similar gaps could have implications for university counselors and even faculty dealing with potentially dangerous students elsewhere.

The stresses on university counseling centers have never been higher, with the 2005 National Survey of Counseling Center Directors finding an increase in self-injury reports, eating disorders and reports of sexual assault; a need to identify a better referral service for long-term care and offer more services for students with learning disabilities; and, more generally, a growing demand for services as resources remain stagnant, Jerald Kay, chair of the College Mental Health Committee for the American Psychiatric Association, testified at Monday’s meeting.

Meanwhile, to make matters worse, experts pointed out Monday that counselors sometimes face incomplete information on students’ medical background. And, as for faculty — those on the front lines — well, they often find themselves cut out of the feedback loop altogether.

For instance, Christopher Flynn, director of Virginia Tech’s Thomas Cook Counseling Center, described his inability to find out the release date of a former patient of his who had been hospitalized. Nor could he, Flynn said in response to Judge Strickland’s probing, be alerted if a Virginia Tech student were to be committed involuntarily in another jurisdiction — not without the student’s permission, at least.

Kerry Redican, a professor of learning sciences and president of Virginia Tech’s Faculty Senate, also raised some panelists’ eyebrows when he described referring a student to the counseling center who scribbled unsettling comments about fellow students all over a multiple choice test. “I felt that this test represented a student in need,” Redican said — adding that he never found out what happened after the referral. “I never saw the student again.”

“Does anyone know if the student’s still on campus?” Ridge asked, again in frustration, a copy of the test in an outstretched hand. “It was a few years ago, sir, I would doubt it,” Redican responded. But he had no sure answer.

Along those lines, Jerome Niles, dean of Virginia Tech’s College of Liberal Arts and Human Sciences, stressed a need to involve faculty in a university response when appropriate. Following that, Kay of the College Mental Health Committee described the importance of maintaining the involvement of another constituent potentially on the front lines: parents.

Because of the Family Educational Rights and Privacy Act, “most schools do not talk to parents,” Kay said. He drew attention to a bill in Congress, H.R. 2220, that would amend FERPA to allow educational entities to disclose certain information to the parents of students who may pose a risk to themselves or others as a potential solution.

“You get into trouble when you treat it in isolation,” said Kay, also chair of the Wright State University School of Medicine’s psychiatry department. “As a clinician, I want to pull in as many resources as I possibly can.”

— Elizabeth Redden

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