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Source: (consider it)
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Thread: Purgatory: Mentally ill students at universities
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welsh dragon
Shipmate
# 3249
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Posted
quote:
Originally posted by flickeringflame:
quote:
Originally posted by flickeringflame:
In fact, most of my patients have not committed a criminal act prior to being seen. Usually, they go and see their GP who makes a referral.
It is quite a straightforward process.
If someone really doesn't want to be seen, they may get as far as having an assessment for commital under the Mental Health Act before they see a mental health professional. This is because people have civil rights, and the threshold for forcing someone to be assessed or receive treatment is, appropriately, very high (just think about this one).
I don't have to "just think about this one". I know. And it ISN'T a straightforward process in the UK.
The point I was making is that there is a big difference whether the ill person themself wants to get help, or whether they don't want that help.
If someone sees their GP asking for help, and their GP thinks they are ill, a doctor-to-doctor referral will get them an appointment within 8 weeks and possibly much sooner. From where I'm sitting, that looks quite straightforward.
Now, if someone doesn't want help, or if the real problem is that they are taking lots of booze or drugs, or if they don't actually have a treatable mental illness, or if they have some variant on a personality disorder or a major attitude problem then, yes, it would get more complicated than that. But someone with schizophrenia or severe depression who needs assessment and drug treatment can get help very quickly, if they need it quickly, by going to their GP, at least in the areas where I've worked.
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Newman's Own
Shipmate
# 420
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Posted
I've found this to be quite an interesting thread - as one example, I found the contribution by welsh dragon quite thought provoking.
"Mental illness" is a very wide term, most certainly. I can recall Ship mates, of university age (among others), referring to periods of severe depression and the like - but this hardly makes them dangerous. Most schizophrenics are not dangerous, to take an extreme case, though how they would fare in a university environment I cannot know.
I can see potential for innocent people (known to have any sort of mental illness) being misjudged and possibly detained and so forth - not because they have been dangerous, but because of others' fears. (Sad to say, I've known clergy who won't have anything to do with even those who have had depression, because they so fear that the person will commit suicide, develop an undue attachment to them, or otherwise 'interfere with their treatment.' Balderdash, most of the time! It's a fear of mental illness, full stop.)
There certainly are people with mental problems (I am remembering a few kids I taught) who are no danger to others, but who might have panic attacks, outbursts, times of coming out with a stream of foul language, or otherwise broadly anti social actions. Often, it is provoked by panic and fear, not a desire to be violent. Yet, judging from what I've seen in some online articles, they can be classed as 'violent' for shouting during an attack of anxiety and therefore being guilty of 'verbal assault.' It only takes fear on the part of others - everyone wanting to shout for the police or ambulance.
Someone I know works in an outpatient mental health facility. Those who are in psychotherapy there often do not have the (previously helpful) opportunity to shout and express pain - security guards are running to the office the minute anyone raises his voice.
In my (limited and regrettable) experience of having some dealings with violent criminals, I could not help but notice that the genuine sociopaths often appear to be engaging, charming people. One can know them casually for months or years and may have no suspicion of their very dark side (until they talk of some of the things they have done, without batting an eye.) I could see a genuine sociopath going totally undetected, and some unfortunate student who has an outburst from depression or anxiety being considered 'dangerous.'
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Elizabeth
“History as Revelation is seldom very revealing, and histories of holiness are full of holes.” - Dermot Quinn
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by OliviaG:
IME, most students move several times during the course of their studies, sometimes as many as 2-3 times in a calendar year. More and more services - yes, including teaching and advising - are provided via e-mail and web applications. Snail mail - i.e. a home address - is pretty much obsolete at many institutions. OliviaG
I suspect that you are describing students at universities in large cities. In Blacksburg the apartment buildings are occupied almost entirely by students. They are usually full. It is rare for students to move during a semester; for one thing it's not that easy to find a satisfactory place to live when everyone else is settled in.
quote:
Originally posted by saysay
This isn't true in the US. Cho lived on campus, in campus housing, which means that not only did the university know where he lived (they assigned him the space), but also that he couldn't have moved rooms without the university knowing/ approving of the move.
Not only did the university know where Cho lived, they also knew who his roommates were. It was one of his roommates who reported that Cho was suicidal.
I know this contravenes Cho's privacy rights, butI think that if those roommates had been questioned, Cho would have been committed. Cho said he might as well kill himself after one of his roommates had told him he had to stop stalking a woman who lived down the hall. The woman was frightened and told the roommate.
The psychologist who evaluated Cho did not know that he had stalked a woman, that he surreptitiously photographed women's legs, and that some women refused to be in the classroom with him. I think if he had known these things he would not have decided that outpatient treatment was best. Several people on this thread have assumed that Cho was not committed because there was no space for him. This may be true, but there is no evidence for it. The psychologist may somply have thought that the university was a better environment for Cho than a mental hospital. When the governor's commission makes its report we will have the answer to this and many other questions.
I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.
Moo
[ 04. July 2007, 13:13: Message edited by: Moo ]
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Josephine
Orthodox Belle
# 3899
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Posted
For those interested, this page provides a summary of the laws regarding involuntary outpatient commitment of most of the 50 states. (I didn't know that involuntary outpatient commitment was even a possibility!)
In Virginia, it appears that, when Cho did not comply with the outpatient commitment, there should have been another hearing, and he should have been transferred to an inpatient commitment. However, unlike some other states, the Virginia law apparently doesn't specify who has to notify the court of the noncompliance. That's a legal loophole that ought to be closed, I would think.
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Duck
Shipmate
# 10181
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Posted
quote:
[...]
I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.
Moo [/QB]
It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.
Incidentally, even if I tell my uni what my new address is every year, they still aren't very good at keeping track of it - never mind trying to 'hide', administrative inefficiency means it's unlikely that a fully accurate record could be maintained for students who aren't actually living in university-owned accomodation.
Posts: 1014 | From: Lots of planets have a north | Registered: Aug 2005
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by Duck:
]It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.
Cho did not admit to mental health problems. He was reported by someone else to be suicidal. Since he did not admit to mental health problems, I cannot see why those who do admit to having problems should be deterred from seeking help.
quote:
Incidentally, even if I tell my uni what my new address is every year, they still aren't very good at keeping track of it - never mind trying to 'hide', administrative inefficiency means it's unlikely that a fully accurate record could be maintained for students who aren't actually living in university-owned accomodation.
I note that you are in Britain. In the US universities do not find it so difficult to keep track of where their students live. This post of saysay's confirms my statement.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Duck
Shipmate
# 10181
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Posted
quote:
Originally posted by Moo:
quote:
Originally posted by Duck:
]It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.
Cho did not admit to mental health problems. He was reported by someone else to be suicidal. Since he did not admit to mental health problems, I cannot see why those who do admit to having problems should be deterred from seeking help.
[...]
Moo
So he did admit to mental health problems, but to another student, rather than a health worker or university staff. IME most students will turn initially to friends, rather than health services, & might need encouragment to use formal sevices.
If fellow-students know that there will be adverse consequences from contacting health professionals or the university (contact with department, questioning other students, etc) that will make them less likely to encourage people who need it to seek help. I'd think twice about pushing a friend to see their GP if I knew that this would lead to questions being asked at their academic department.
I don't know how US systems work, but in the UK then health care on campus is provided by the NHS. Though we've a doctor's surgery in the university grounds, no-one there is employed by the university - they just rent the premises. Student's NHS health records are kept separately from their university files. I can sign a release allowing my GP to give information to the university (for example where health affects an exam performance) but that involves the GP physically posting a bit of paper to whatever academic I give the name of, same as any employer. Sharing information would mean joining the University's files to those of the whole NHS, which would be technically & legally very difficult if not impossible. I can't really see how it would work in practice over here - don't know enough about the US to say.
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'Truth is my authority, not authority my truth' - Mary Dyer, Quaker martyr.
Posts: 1014 | From: Lots of planets have a north | Registered: Aug 2005
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by Duck:
So he did admit to mental health problems, but to another student, rather than a health worker or university staff. IME most students will turn initially to friends, rather than health services, & might need encouragment to use formal sevices.
I'm not sure what you mean when you say he admitted to mental health problems to another student.
If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems. He thought that the problem lay outside himself.
Earlier on this thread I asked a question that no one has answered. If a roommate finds a student unconscious for no apparent reason, he will quite properly get help for that student. Is it wrong for the doctors to question the roommate about what the student had been doing lately? The doctor wants the information to help him make a diagnosis. I believe that when someone's behavior results in involuntary commitment, the doctors should get all the information they can.
quote:
I don't know how US systems work, but in the UK then health care on campus is provided by the NHS. Though we've a doctor's surgery in the university grounds, no-one there is employed by the university - they just rent the premises. Student's NHS health records are kept separately from their university files.
Cho's mental assessment was not done by the university health service. It was done by the state department of mental services to determine whether Cho was dangerous. The information that he had been stalking a young woman would have been highly relevant to this assessment.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Moo:
If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems.
If you locked people up for saying thigns like that that then ten percent of the studednts in London would be in the looney-bin.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by ken:
quote:
Originally posted by Moo:
If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems.
If you locked people up for saying thigns like that that then ten percent of the studednts in London would be in the looney-bin.
It's not appropriate to lock them up, but it's a good idea to have them evaluated, especially if they say they might as well kill themselves if they're not free to stalk.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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welsh dragon
Shipmate
# 3249
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Posted
quote:
Originally posted by Moo:
Earlier on this thread I asked a question that no one has answered. If a roommate finds a student unconscious for no apparent reason, he will quite properly get help for that student. Is it wrong for the doctors to question the roommate about what the student had been doing lately? The doctor wants the information to help him make a diagnosis. I believe that when someone's behavior results in involuntary commitment, the doctors should get all the information they can.
Well, many, many students have suicidal thoughts during their studies; some talk to their friends about it, quite a few even take overdoses.
One issue here is medical confidentiality, and we could discuss this at more length later if you like.
Another is that loads of people take overdoses. Even more think fleetingly of trying to kill themselves. Saying "I might as well kill myself" does not sound like a clear statement of suicidal intent to me, one would have to know the context.
So, the above statement is not like someone finding a fellow student unconscious. It is more like the fellow student having an unusual slight rash on their genitals perhaps. Now, the rash might be serious; it might be syphilis; if it were syphilis, it might be fatal and there might be public health consequences I suppose. But it is much much more likely just to be spots or something less serious, or just a rash, I suppose.
The student didn't do any harm by reporting what was said & might have done some good. Certainly a medical review was a sensible idea. But rushing round asking all the other students about someone else's intimate problem would embarrass that student; it would breach medical confidentiality and it would almost certainly give rise to very little benefit. Because so many people would have evinced a similar problem, staff would be spending all their time trying to ask prying and inappropriate questions and wouldn't have any time to teach.
By the way, just because someone is sectioned/committed, it doesn't completely remove all their rights for confidentiality, at least in the UK, unless there is a very good reason clearly apparent. Which there probably wasn't in this case.
ETA cross posted with Ken, evidently making same sort of point
[ 04. July 2007, 17:48: Message edited by: welsh dragon ]
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon
But rushing round asking all the other students about someone else's intimate problem would embarrass that student;
I did not suggest asking all or, for that matter, any other students. I suggested asking the student who reported the suicidal statement to give information about the context.
I do not see how this could be considered a breach of confidentiality.
Moo
[ 04. July 2007, 17:58: Message edited by: Moo ]
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Jengie jon
Semper Reformanda
# 273
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Posted
Right lets do some maths.
Student population in London 378000 from Wikipedia . So as all figures are historic, student numbers are growing and it makes it easier to do the maths, lets say 400,000. First lets divide by 4, as it is a quick way to work out how many per year. So that is 100,000. Right Ken's figure of 10% of students (which is probably low) that is 10,000 students. Lets say it takes 5 hours to do an assessment, two hours with the student and three hours doing other stuff including writing a report.
That gives us 50,000 hours of psychiatrist time. At 40 hours a week 50 weeks a year that means that a psychiatrist will work around 2000 hours a year. So you are asking Universities in London or the Health service to employ 25 psychiatrist in London alone.
Lets say there are 10,000 psychiatrists in United Kingdom (an over estimate because it is based on the Royal College of Psychiatrist membership level and that will include some overseas, some not in or seeking employment and possibly retired as well). Lets say 10% are in London. Then you are asking that 2.5% of the capitals total supply of psychiatrist be taken up with assessing these students, not with treating them, just assessing them.
Jengie
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"To violate a persons ability to distinguish fact from fantasy is the epistemological equivalent of rape." Noretta Koertge
Back to my blog
Posts: 20894 | From: city of steel, butterflies and rainbows | Registered: May 2001
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Moo
Ship's tough old bird
# 107
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Posted
Bear in mind that on that occasion two psychologists agreed that Cho was a danger to himself and others. This means that the referral was completely justified.
The point on which they disagreed was whether Cho should receive inpatient or outpatient treatment.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by Moo:
I did not suggest asking all or, for that matter, any other students. I suggested asking the student who reported the suicidal statement to give information about the context.
I could be stupid, but I can't see how they could have got so far as doing an assessment without asking the student who reported the information about the context.
Certainly, one can say, "I might as well just kill myself" without having any real suicidal intent, just as you can say, "I want to kill my boss" without having any homicidal intent. Given how limited psychiatric resources are, and given that even to do an evaluation for an involuntary commitment has implications regarding the subject's autonomy and liberty, I can't imagine that the person reporting the comment would not be asked to provide all the information they had before the decision was made to evaluate.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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Moo
Ship's tough old bird
# 107
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Posted
I gather that Cho's demeanor and behavior made the authorities think that an evaluation was in order.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon
So, the above statement is not like someone finding a fellow student unconscious. It is more like the fellow student having an unusual slight rash on their genitals perhaps. Now, the rash might be serious; it might be syphilis; if it were syphilis, it might be fatal and there might be public health consequences I suppose. But it is much much more likely just to be spots or something less serious, or just a rash, I suppose.
A genital rash is no one's damn business except the person who has it and his/her sex partners.
Our society generally holds that people should be prevented from committing suicide. I know not everyone agrees with this, but I believe it's the norm.
Therefore, if your roommate has a genital rash, look the other way. If he's talking about suicide and has always appeared to be very unhappy, call for help.
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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saysay
Ship's Praying Mantis
# 6645
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Posted
quote:
Originally posted by Moo:
Not only did the university know where Cho lived, they also knew who his roommates were. It was one of his roommates who reported that Cho was suicidal.
I know this contravenes Cho's privacy rights, butI think that if those roommates had been questioned, Cho would have been committed. Cho said he might as well kill himself after one of his roommates had told him he had to stop stalking a woman who lived down the hall. The woman was frightened and told the roommate.
I don't want to speculate too much, since I have limited knowledge of Virginia Tech, hindsight is 20/20, etc. But existing rules allow staff members to share otherwise confidential information about students if doing so is thought to be necessary.
In most places, if a student living in a dormitory were ordered to undergo a mental health assessment, the resident assistant or hall director would know about it. They would also usually know if a student had been told to stop harassing another student (particularly if that other student was also a resident). It's possible that Cho's roommates tried to deal with these problems by themselves and their R.A. didn't know about them.; it's also possible that the R.A. didn't have a general sense of Cho's behavior and how his roommates regarded him. But, IME, that's fairly rare.
Given that Cho's odd behavior was interfering with his education, I think that staff members would have been justified if they had decided that sharing otherwise confidential information was necessary. However, I'd guess that the professor who was troubled by Cho's behavior would not have known this, would not have known how to find out who a student's R.A. or hall director is, and would not have been able to do anything with the information anyway (so Cho acts oddly at home, too? I'm so surprised).
I also don't know what kind of computer system VA Tech uses, or how much flexibility it has in terms of recording non-standard things about students. At most schools, different aspects of a student's life (academic, housing, judicial) are handled by separate people and are kept completely separate. This is as it should be, since for most students, whether or not they've moved rooms several times is unrelated to whether or not they've had an alcohol citation which is unrelated to whether or not they can do the academic work. The problem is that for a small number of students, they are very much related, and people who have the security clearance to access one part of a student's record don't always have the clearance to access another part. And if VA Tech uses any of the popular educational database programs, there probably isn't any way for a staff member to record really odd information, such as the information about Cho's classroom behavior.
Which is one reason some universities (or schools or colleges within those universities) employ advisors whose job is largely to keep an eye on the whole student; they can keep a record of information and behavior that's been flagged by professors, other student support services, etc. And they can generally release that information to the counseling center without confidentiality/privacy concerns. That's expensive, though.
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I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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Josephine
Orthodox Belle
# 3899
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Posted
A court deemed, on the basis of an appropriate professional evaluation, that Cho was a danger to himself and others. The court ordered mandatory outpatient care for Cho.
Until this point, the system worked exactly the way it's supposed to. I don't know who did what to get Cho the evaluation, but whoever and whatever it was, it looks like the right things happened.
But the court sent Cho to a university facility that would not or could not provide the care that was ordered. Did the university counseling center let the court know, "We can't do that?" If not, then I would say that there are things that need to be changed at the university. I don't see that it's necessary to add staff to keep an eye on students, or make computer systems talk to each other, or have faculty members record personal impressions of their students along with the grades. All that needs to change is that the university counseling center needs either to comply with the court order, or to let the court know immediately that it can't or won't comply.
If the university counseling center did that, then the fault lies with the judge, who ordered something that wasn't available, then didn't change his order when he found out it wasn't available, and didn't make anyone responsible for following up to make sure Cho got the care that was ordered.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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saysay
Ship's Praying Mantis
# 6645
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Posted
I agree, but there are two systems in play in this scenario - the mental health care system (and the process for involuntary commitment), and the university system.
I hope that the governor's commission finds that there are holes in the mental health care system which need to be closed, and that the problems within VA Tech's system wouldn't have happened if the mental health system had been working properly. In other words, if Cho had received appropriate mental health care on an outpatient basis, or been ordered into inpatient care when he failed to comply with the order for outpatient care, then the problems he caused attending class wouldn't have happened, and therefore the fundamental problems that need to be addressed are within the mental health care system.
Given that a university's legal obligation to act in loco parentis is up in the air, and that the courts sometimes rule that educational institutions can be held responsible for the final results of certain policies but can't design policies to address those problems, I'm not sure that's what the governor's commission will find. But I may be having a particularly cynical week.
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"It's been a long day without you, my friend
I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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AverageGuyOnTheStreet
Apprentice
# 12501
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Posted
A couple of points I would like to reply to:
Firstly, finding someone unconscious in their room. That happened to me once. I had been ill for a couple of days with something related to my chronic illness (which I chose not to tell my flatmates about). Nobody knew why I was ill. Eventually, I passed out in my room and one of my flatmates found me and thought I had meningitis. I went insane at her once I had the energy to do so but I know that she did the right thing given the information she had. I always think it is best to assume that the person wants to live.
Secondly, is stating to a friend that you might as well kill yourself an indication of suicidal intent. I think it depends on the situation. People exaggerate all the time. But if the person is known to suffer from depression, then they need help. I know that I am far more likely to confide in my friends when I want to discuss problems than anyone else. I've never been honest about my feelings apart from to one person. I couldn't even be totally honest in my recent psychiatric assessment. But I know that the time I attempted suicide a few months ago, nobody knew anything until some time later.
Posts: 41 | Registered: Apr 2007
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welsh dragon
Shipmate
# 3249
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Posted
quote:
Originally posted by Moo:
I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.
Moo
Moo,
1. just because someone says “I might as well kill myself”, it does not mean he is actively suicidal.
2. suicidal thoughts are really common. Really, really common. For example, see this letter.
21% of junior doctors in the UK agreed or strongly agreed with the statement "I have been having more suicidal thoughts than usual". So at least 21% of junior doctors would admit to having suicidal thoughts! By Moo's standards that would give us at least 6,300 people to assess - and that's just the doctors!
Of course, if someone admits to feeling suicidal, it is sensible to listen and it may be helpful to tell services. We call this suicidal ideation . Often, it can be fleeting.
Suicidal intent is a bit different, at least in our usage. It tends to involve a plan. Someone with serious suicidal intent might think of hanging themselves or using a car exhaust.
People who have serious suicidal intent may have performed final acts . That is, they may have made a will or left a note or said goodbye to family.
Often, people being assessed by mental health services will actually have made a suicide attempt . Even if someone has gone so far as to make a suicide attempt, they most often would not be admitted to hospital. This is because many people have fleeting thoughts about suicide and even might take an overdose (the commonest form of suicide attempt) but usually they quickly regret their action.
Assessment of suicide risk is obviously not infallible; these are just some of the factors used but it gives you something of an idea.
So in the context of assessing behaviour and risk, Cho's comment in itself would not carry huge weight. In terms of risk, it was low grade. His assessors were not overlooking his "right to life" . From the information we have, no one could clearly predict either that he would go on to turn a gun onto other people or that he would soon lose his own life.
Posts: 5352 | From: ebay | Registered: Aug 2002
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Pastorgirl
Shipmate
# 12294
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Posted
All of which, and our attempt to "find an answer" point to the tendency we have when a tragedy happens to think "we could have stopped this if we had just done..." In a way, this is a form of denial, it's our "lizard brains" refusing to process this huge affront to reality. So we keep searching for explanations, thinking that'll lead us to some sort of magic bullet that will ensure this never, ever happens again. It's a natural, human tendency and one that does push us toward some positive, helpful transformations. But at some point we have to accept that this is a broken world and bad s**t is always going to be a part of that.
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Moo
Ship's tough old bird
# 107
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Posted
welsh dragon, I used to answer the phones for the Samaritans; I also used to give talks in schools about suicide-prevention. I know how to assess suicide risk.
It is a fact that a psychologist declared Cho a danger to himself a few hours after he said he might as well kill himself. This means that the roommates concern was fully justified.
Moo
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See you later, alligator.
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welsh dragon
Shipmate
# 3249
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Posted
Moo, the room mate's action was not altogether unreasonable. But that isn't at issue.
The point I was trying to make was that Cho's ultimate actions could not be clearly predicted from the limited information available. - in particular the rather vague comment about ending his life. So , at least from the information you have given, it isn't clear to me that there is any glaring omission, anything obvious that the University or mental health services ought to have done otherwise (especially not cross examining a student or other students for third party information. I rather give up on whatever scheme for this you were or were not suggesting). Though as we've said, it would be great if the mentally ill got a better deal and better financed services in both our countries.
What happened was very unusual and sad, wasn't it? But that, it would seem is life.
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon:
The point I was trying to make was that Cho's ultimate actions could not be clearly predicted from the limited information available. -
I don't think anyone ever suggested that his ultimate actions could be predicted at the time he was assessed. It's obviously impossible to predict anyone's ultimate actions, no matter how much information is available.
Moo
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See you later, alligator.
Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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welsh dragon
Shipmate
# 3249
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Posted
Ok, so Cho wasn't showing suicidal intent, you aren't suggesting that there would have been any point using other students to put him under surveillance and his bizarre behaviour couldn't have been predicted.
We agree ![[Smile]](smile.gif) !
Posts: 5352 | From: ebay | Registered: Aug 2002
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon:
Ok, so Cho wasn't showing suicidal intent, you aren't suggesting that there would have been any point using other students to put him under surveillance and his bizarre behaviour couldn't have been predicted.
We agree !
You make several points here;
1) Cho was not suicidal.
The evaluating psychologist said he was a danger to himself. I assume the psychologist was competent.
2) There was no point in using other students to put him under surveillance.
You are the only person posting on this thread who has mentioned surveillance. I suggested it was worthwhile asking Cho's roommates about HIS PAST ACTIONS. There was no suggestion that they should watch him in future.
3) His bizarre behavior couldn't have been predicted.
His specific behavior could not have been predicted. The fact remains that he had been declared a danger to himself and others. In this post saysay makes some very constructive observations.
quote:
n most places, if a student living in a dormitory were ordered to undergo a mental health assessment, the resident assistant or hall director would know about it. They would also usually know if a student had been told to stop harassing another student (particularly if that other student was also a resident). It's possible that Cho's roommates tried to deal with these problems by themselves and their R.A. didn't know about them.; it's also possible that the R.A. didn't have a general sense of Cho's behavior and how his roommates regarded him. But, IME, that's fairly rare.
Given that Cho's odd behavior was interfering with his education, I think that staff members would have been justified if they had decided that sharing otherwise confidential information was necessary. However, I'd guess that the professor who was troubled by Cho's behavior would not have known this, would not have known how to find out who a student's R.A. or hall director is, and would not have been able to do anything with the information anyway (so Cho acts oddly at home, too? I'm so surprised).
Moo
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Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Sir Pellinore
Quester Emeritus
# 12163
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Posted
It is always easy to be wise after the event.
Dealing with a complex real time situation is more difficult.
To a non-American the ease of access to weapons would be a worry. Particularly to a mentally ill person who might use it for suicide/murder.
This is not the first incident of this sort to happen at a US university.
Discipline/supervision at a US university dormitory seems to be a little different to residential colleges in Australia.
Americans also seem to have different attitudes to civil liberties to Brits or Commonwealth citizens.
Gun control could be a good way to start.
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Well...
Posts: 5108 | From: The Deep North, Oz | Registered: Dec 2006
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welsh dragon
Shipmate
# 3249
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Posted
In response to Moo
- re suicidal intent, the statement quoted per se was not proof of suicidal intent, please see previous post on assessing risk.
- obviously I don't know what the assessment showed and it would be based on a lot of detailed information not available here; it might be that chappie was a risk to himself; my point was really that the "might kill myself" was not the absolute proof of suicidal intent that it could on face value seem to be.
- of course "risk to self" and suicidal intent are not exactly the same thing (in case you didn't know that)
- and of course there are degrees of risk - low risk, moderate or high risk and so on. I'd have thought that the decision to go for outpatient treatment would reflect a decision about a lesser level of risk - don't know for certain of course.
- re surveillance - I wrote that we seemed to agree that that was not a good idea
- although your ideas about gathering third party information still seem a little over enthusiastic and impractical
- and we agree that one could not predict his behaviour
I do agree pretty much with everything Sir Pellinore put.
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon
my point was really that the "might kill myself" was not the absolute proof of suicidal intent that it could on face value seem to be.
I never said it was. I said it indicated that an evaluation was in order.
Moo
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See you later, alligator.
Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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welsh dragon
Shipmate
# 3249
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Posted
More specifically, you equated that rather vague comment to being found unconscious.
In terms of medical triage, the unconscious patient coming into A and E would be a very high priority for immediate attention and care, until the problem were diagnosed and treatment put in place.
In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
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Newman's Own
Shipmate
# 420
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Posted
Question: Even if someone were suicidal (and comments one could make do not seem to make that a certainty), wouldn't he be most likely to be a danger to himself? Would wanting to harm others be a part of this?
As well, wouldn't there be more behind Cho's actions than suicidal tendencies or mental illness? Most people who are mentally ill, even severely so, are not about to slaughter people around them.
(I will save my comments about the importance of gun control for another thread.)
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Cheers,
Elizabeth
“History as Revelation is seldom very revealing, and histories of holiness are full of holes.” - Dermot Quinn
Posts: 6740 | From: Library or pub | Registered: Jun 2001
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3M Matt
Shipmate
# 1675
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Posted
Skimmed over this thread very briefly, Welsh Dragon's comments strike me as very sensible.
The sad fact is that mental health is all about risk management. There is always some risk, and, when carrying out a mental health assessment, you have to use experience, guidelines, and, to some extent, gut-feeling to decide what is appropriate input for a particular patient.
If I admitted to inpatient care every patient I saw in outpatient clincs with suicidal ideation I'd need a half hourly bus service between the outpatient clinic and the inpatient hospital!
The key is picking up those who are close to a crisis point.
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3M Matt.
Posts: 1227 | From: London | Registered: Nov 2001
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saysay
Ship's Praying Mantis
# 6645
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Posted
quote:
Originally posted by welsh dragon:
In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
And you're talking about a hypothetical, while Moo and I are talking about an actual case in which a person made the statement and - because of his other disturbing behavior - was thought to be serious enough to warrant a mental health assessment, which found that he really was a danger to himself and others. Enough of a danger that it was initially recommended that he undergo involuntary inpatient care, which was modified to involuntary outpatient care.
I think what gets to a lot of people about this case (at least it's what gets to me) is the "so close" factor. Cho's behavior in the classroom and dorms was close to what it would have taken to have him suspended/ placed on involuntary leave from VA Tech (and there is some indication in what was released of his manifesto that he was targeting VA Tech students, so it's not necessarily true that if he had been removed from campus he would have simply gunned down people at a department store instead). He was close to being involuntarily committed for inpatient care. He was close to being prevented from purchasing guns. If he had been just a bit closer on any of those fronts, this tragedy might not have happened. Which is why some of us are interested in talking about whether or not the line distinguishing between "close" and "there" needs to be shifted.
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"It's been a long day without you, my friend
I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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Soror Magna
Shipmate
# 9881
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Posted
quote:
Originally posted by saysay:
I think what gets to a lot of people about this case (at least it's what gets to me) is the "so close" factor. ... He was close to being involuntarily committed for inpatient care. He was close to being prevented from purchasing guns. If he had been just a bit closer on any of those fronts, this tragedy might not have happened. Which is why some of us are interested in talking about whether or not the line distinguishing between "close" and "there" needs to be shifted.
If Cho had been in danger of flunking math, it would be the school's responsibility to help him. However, since his problems were health problems, not academic problems, I still feel that the responsibility for helping him belonged to the public health and legal authorities. And to me it looks like they dropped the ball when they ordered him to get care that wasn't actually available and then failed to follow up. ![[Frown]](frown.gif) OliviaG
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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"
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saysay
Ship's Praying Mantis
# 6645
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Posted
I think I agree that the primary responsibility for helping him/ failing to help him belongs to the public health system (or lack thereof).
However, I've read/heard enough about how much his behavior disrupted other students' educations (although I grant that some of it might not be accurate) that I'm not sure it's fair to equate VA Tech's responsibility to the responsibility they'd have if he were flunking math (which wouldn't affect anyone but him).
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"It's been a long day without you, my friend
I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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saysay
Ship's Praying Mantis
# 6645
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Posted
[too late to edit]
Which is also to say that I'm sympathetic to people who think that painting with too broad a brush ("mentally ill students at universities") is dangerous. But I also think that Moo's core topic (which is more along the lines of "students who have been judged to be a danger to themselves or others at universities") is worth discussing. Particularly since the reality is that universities have been sued for failing to prevent a student from committing suicide and for suspending a suicidal student.
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"It's been a long day without you, my friend
I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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welsh dragon
Shipmate
# 3249
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Posted
What you are talking about is a case in retrospect and after a very unusual event.
What I am trying to do is explain the principles of risk assessment and some of the issues around risk. I suppose that is on one level theoretical but on another level it is based on solid knowledge.
We have various snippets about Cho's management on this thread:-
saysay:
quote:
it was initially recommended that he undergo involuntary inpatient care, which was modified to involuntary outpatient care
Josephine:
quote:
The court ordered mandatory outpatient care for Cho
Moo
quote:
He was committed to a mental hospital overnight because psychologists had determined that he was a danger to himself and others.
and
quote:
It's not certain that he ever went to the health service. He was ordered by the court to undergo psychotherapy,
and
quote:
It is a fact that a psychologist declared Cho a danger to himself a few hours after he said he might as well kill himself.
pastorgirl
quote:
In terms of compulsory mental health care, which is what would be required here since Cho refused treatment, it simply doesn't exist.
I couldn't stand up in court that I swear I know what was going on with Cho's mental state and treatment because I don't (but then I don't think anyone else on this thread can give a professional-level opinion on that either). We have bits and pieces of information culled from articles here and there that might or might not be correct.
It might be more appropriate to discuss what actually was happening with Cho when the official report comes out. A psych assessment takes hours and a forensic report will have a dozen (or dozens) of pages of detail. That would be a more informed way to do this - if informed is what you want.
What does attract me to this thread is the discussion on risk. I do know a lot about assessing risky behaviour, because it is what I do for a living. And I am fascinated by how people understand risk and how to explain risk to people.
And we just don't have enough facts on Cho to discuss his diagnosis and management properly, but we can have a rattling good discussion on risk...
ETA - we could make that "risks among University students" if you like - which might actually deal with the proposed OP title...
[ 06. July 2007, 18:27: Message edited by: welsh dragon ]
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saysay
Ship's Praying Mantis
# 6645
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Posted
quote:
Originally posted by welsh dragon:
What does attract me to this thread is the discussion on risk. I do know a lot about assessing risky behaviour, because it is what I do for a living. And I am fascinated by how people understand risk and how to explain risk to people.
And we just don't have enough facts on Cho to discuss his diagnosis and management properly, but we can have a rattling good discussion on risk...
Except that I will be the first to admit that I am not qualified to discuss risk or how to assess risky behavior. I assume that those doing the assessment are generally competent.
I understand that not everyone who says "I might as well kill myself" is a danger to themselves (otherwise I, and several other people I know, would spend a lot of time having our mental health assessed, since 'or I could shoot myself' is a common phrase). I also understand that not everyone who stalks a girl is dangerous, and that not everyone who writes violent poems/play/fiction is dangerous. Post-Columbine, there was a lot of paranoia about kids who exhibited certain kinds of behavior, and I don't want to encourage that same paranoia on the university level.
And you're right, we don't know all the facts in this case (and privacy laws may keep us from ever knowing all the facts). AFAIK, Cho never received a diagnosis, because he never received psychiatric care beyond the initial assessment which determined that he was in need of care and was incapable or unwilling to volunteer for care.
So this:
quote:
So , at least from the information you have given, it isn't clear to me that there is any glaring omission, anything obvious that the University or mental health services ought to have done otherwise
is inaccurate. Documents that have already been made public have made it clear that he was ordered into psychiatric care which he didn't receive. This points to a flaw in the system somewhere.
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"It's been a long day without you, my friend
I'll tell you all about it when I see you again"
"'Oh sweet baby purple Jesus' - that's a direct quote from a 9 year old - shoutout to purple Jesus."
Posts: 2943 | From: The Wire | Registered: May 2004
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welsh dragon
Shipmate
# 3249
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Posted
Except that you make the diagnosis first - or a provisional diagnosis if you're not sure - and then you give the treatment.
And none of the symptoms described so far make one think "well he was obviously schizophrenic" or "gosh, they missed that manic episode".
So, no glaring omission there. That is what I meant.
As far as the committal goes, as I have also said, the process in the US is very different to that in the UK.
It isn't clear whether they will end up with a mental health diagnosis at all (despite the involuntary commital arrangements) but if they do, then "personality disorder" would be one possibility.
Personality disorder (PD) is often treated out of hospital and psychotherapy would be one sort of therapeutic possibility. So discharging someone from hospital and advising them to get therapy would be a reasonable plan in that circumstance. In fact, other things being equal, inpatient units in the UK would be keen to discharge PD patients from hospital as they don't tend to benefit much from sitting on your average acute ward.
On the other hand, psychotherapy set up as a mandatory activity is an unusual idea, as patient motivation and commitment is such an important part of the process. So it wouldn't be surprising if someone told to go to therapy in the community didn't attend. The main place I have heard of "enforced" psychotherapy was an open prison where prisoners had to attend groups (or go to a much more unpleasant set up). They really didn't have any choice!
I should say, also, that therapy is a fairly long term business. Someone's risk of harm to self or others might be reduced by it, but in the medium to long term, not overnight. So suggesting to someone that they take up therapy in the community would be the sort of option you choose if the risks are relatively low. Inpatient admission is what you would stick with if the risks are high.
So it really isn't obvious to me that mental health services missed something big. Nor does it seem particularly remarkable that the University had difficulty enforcing the therapy order (at least with the knowledge I have). I meant what I said.
I do wonder
a) why the order was being made by a judge (as I said before)
b) whether the therapy idea was the judge's own idea or
c) how much advice as to risk and to disposal he had from the medics/psychologists
d) whether this part of the decision-making could have been improved (the bit with the judge ordering therapy)
Also, in the UK, assessments and sectioning of the acutely mentally ill are carried out by psychiatrists not psychologists (who give therapy but do not prescribe), so I find that part a bit puzzling also.
But like I also said, this is just with the fragments of possibly incorrect information that I have.
[ 06. July 2007, 20:37: Message edited by: welsh dragon ]
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon:
More specifically, you equated that rather vague comment to being found unconscious.
In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
No.
You gave me the impression that you thought a student was never justified in notifying the health service that another student had problems. I gave the example of someone being found unconscious for no apparent reason. I said that under certain circumstances it is appropriate for a student's roommate to contact the health service on his behalf.
Most one-off suicidal comments mean nothing. Cho had always appeared to be very unhappy, and he was extremely agitated and despairing when he was told he would have to stop stalking. His roommates' reporting him to the health service was proven justified by the results of his assessment.
Moo
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Kerygmania host
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See you later, alligator.
Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by welsh dragon:
I do wonder
a) why the order was being made by a judge (as I said before)
Who else could give such an order?
On this side of the pond, the way it works (in broad general terms, with some variation amongst the states) is that someone goes to the court and presents some sort of evidence that the person may be a danger to himself or others -- usually a statement by someone with first-hand knowledge of the person or situation is enough at this point.
The court issues a warrant requiring the person to report to, or be taken to, a facility where a psychiatrist can do an emergency evaluation and report back to the court (usually within 24 hours).
Based on the report from evaluation, the judge can order that the person be held longer for additional evaluation or treatment. Usually, they can be held another 2 or 3 days for more evaluations. If they're to be held longer, another hearing will be scheduled within 7 days, or 10 days, or something of the sort.
All of this is intended to prevent abuse of the system, and to protect your right to liberty, even if you're weird, eccentric, or unpleasant.
quote:
b) whether the therapy idea was the judge's own idea or
Possible, but unlikely.
quote:
c) how much advice as to risk and to disposal he had from the medics/psychologists
Ordinarily, the order would be based entirely on the report from the mental health care professionals, unless someone was contesting the report.
quote:
d) whether this part of the decision-making could have been improved (the bit with the judge ordering therapy)
It's pretty clear that someone screwed up in this case -- whether it was the judge or the psychologist/psychiatrist making the recommendation, I have no idea.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
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welsh dragon
Shipmate
# 3249
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Posted
Re Moo's comment, not sure where you got your "impression" from, glad you agree with me re one-off suicidal comments, good.
quote:
Originally posted by Josephine:
quote:
Originally posted by welsh dragon:
I do wonder
a) why the order was being made by a judge (as I said before)
Who else could give such an order?
[snip]
All of this is intended to prevent abuse of the system, and to protect your right to liberty, even if you're weird, eccentric, or unpleasant.
[snip]
It's pretty clear that someone screwed up in this case -- whether it was the judge or the psychologist/psychiatrist making the recommendation, I have no idea.
In the Uk, the person would be sectioned to hospital (as an inpatient). The initial assessment would be 28 days, though it can be much less. Because people can be sectioned for assessment, it may be that after the assessment they are found not in fact to be mentally ill (at one training day on UK mental health law, we were told the story of the chap who was picked up exclaiming apparent gibberish...he was eventually found to have been an intoxicated Welsh man...taken off section next day when they worked it out)
In the UK, the people ordering treatment are medically qualified doctors, who have a training in law (under Section 12 of the Mental Health Act) and are working at consultant level, or their deputies. There is an assumption we are acting in the best interest of the patient, backed up by a complex appeal and review process, which does involve the legal profession and often second opinions from other doctors of equivalent seniority.
It seems decidedly unclear from the information we have whether Cho was treatably mentally ill (with schizophrenia or a mood disorder), personality disordered or to borrow your phrase "weird, eccentric or unpleasant".
This appears interesting, re our discussion here. According to that article, Cho was evaluated by a community services board worker and an independent doctor - who differed on whether he was a danger to himself or others, and on whether he required hospitalization. That's interesting to me because in UK law you need the agreement of 2 doctors and a social worker to detain someone for a 28 day assessment, for example.
I also note that the article goes on to state usually a judge would send someone to an inpatient unit. Usually, a treatment plan is relatively low key is that way because the risks are not thought to be very high. The disagreement among professionals may also have played a part in this.
This article, from TIME, suggests that an assessing doctor found that Cho was "mentally ill but not an imminent threat to himself or others". The TIME article says that, according to the polce, Cho technically went to hospital voluntarily.
So these give a picture with less associated risk, overall, than some of the other accounts on this thread. It is suggested in one article here that the diagnosis made was depression, although that does beg a number of questions. Another diagnosis mooted, searching the web, is autism; another that is discussed is a psychotic illness (there is some mention of possibly paranoid feelings towards rich students, which I hadn't seen before). These leave even more questions unanswered.
It certainly seems possible, even likely, that Cho was not committed to hospital at the time of assessment in December 2005 because the evidence did not suggest that he was very high risk. Evidence of risk of harm to self was minimal - he seems to have no history of overdoses or other self harm. Biological symptoms of depression -for example, weight loss - haven't been clearly described in the accounts I've seen. There don't seem to be plans to self harm. The other students haven't described heavy drug or alcohol use.
He does not seem to have used a weapon, or indeed physical violence of any sort, prior to the shootings. It appears that he had not directly threatened others (which is why he wasn't prosecuted for his contretemps with other students apparently). There is no forensic history (which is why he could purchase guns). There is no history of the specific psychotic phenomena that might be associated with increased risk of violence. These would all be important indices in gauging risk to others.
So a lot of the most important warning signs just aren't there. If that was why a low key approach was taken, well, that doesn't seem so very unreasonable. So it doesn't seem so obvious that "someone screwed up" - at least regarding TIME's account of the assessing doctor not finding a risk of imminent danger. And, mind you, this was about a year before the shooting, wasn't it, so a lot could have happened in that time.
[ 07. July 2007, 12:18: Message edited by: welsh dragon ]
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by welsh dragon:
In fact, other things being equal, inpatient units in the UK would be keen to discharge PD patients from hospital as they don't tend to benefit much from sitting on your average acute ward..
Well yes. Taking someone who is excessively angry, aggressive, hyperactive and bored. but also intelligent and thinking clearly, and then locking them in a building full of vulnerable, depressed, confused people, doesn't seem like a good plan for anyone.
[ 07. July 2007, 13:21: Message edited by: ken ]
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by welsh dragon:
So a lot of the most important warning signs just aren't there. If that was why a low key approach was taken, well, that doesn't seem so very unreasonable. So it doesn't seem so obvious that "someone screwed up" - at least regarding TIME's account of the assessing doctor not finding a risk of imminent danger.
That wasn't the screw-up I was thinking of. What I had in mind was the court ordering mandatory outpatient care at a facility that refused to provide that care. Either the judge screwed up by ordering treatment at that facility, or the facility screwed up by not notifying the judge that they wouldn't provide the care, or the facility did notify the judge and he didn't amend his order to send Cho somewhere else.
I also think that either the court was amiss in not assigning a guardian ad litem (or equivalent) to ensure that Cho complied with the order, or the guardian ad litem screwed up in not bringing Cho's noncompliance back to the attention of the court. The judge can't personally monitor and follow up on all his orders. That responsibility has to be assigned somewhere. Either that didn't happen, or the person to whom it was assigned didn't follow through.
So I'll stand by my assertion that someone screwed up. Not in the psychiatric assessment -- that may have been as good as was possible at the time and under the circumstances. But appropriate followup was lacking.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
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welsh dragon
Shipmate
# 3249
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Posted
Well, fair enough, there doesn't seem to have been follow up.
I would be reluctant, though, to blame the subsequent tragedy just on that. That is, maybe you personally wouldn't, but I guess it is somehow comforting for people (especially politicians) to fix on this sort of detail and use it as the entire excuse or explanation for a ghastly outcome, when - even if it is a significant part of the story- the truth is a whole lot more complicated.
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Moo
Ship's tough old bird
# 107
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Posted
quote:
Originally posted by welsh dragon:
...I guess it is somehow comforting for people (especially politicians) to fix on this sort of detail and use it as the entire excuse or explanation for a ghastly outcome, when - even if it is a significant part of the story- the truth is a whole lot more complicated.
It's not a matter of blame. It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
Moo
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Kerygmania host
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See you later, alligator.
Posts: 20365 | From: Alleghany Mountains of Virginia | Registered: May 2001
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Pastorgirl
Shipmate
# 12294
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Posted
quote:
It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
I doubt if that's a realistic goal-- or at least, not w/o such an infringement of personal freedoms that it would be unacceptable.
We certainly should look at the causes with an eye toward reducing risk. As indicated by my posts, I do think we can do much, much more-- particularly in increasing access to mental health care in the US, funding for mental health care, and in correcting the skew in the balance between autonomy and acting in the best intrests of those who can't care for themselves. But to suggest that we could ever say with any kind of certainty that this could "absolutely never happen again" is unrealistic and doomed to failure. And it's the kind of thinking that led to the Patriot Act and other excessive measures.
Posts: 757 | From: L.A. | Registered: Jan 2007
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Pastorgirl
Shipmate
# 12294
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Posted
quote:
It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
I doubt if that's a realistic goal-- or at least, not w/o such an infringement of personal freedoms that it would be unacceptable.
We certainly should look at the causes with an eye toward reducing risk. As indicated by my posts, I do think we can do much, much more-- particularly in increasing access to mental health care in the US, funding for mental health care, and in correcting the skew in the balance between autonomy and acting in the best intrests of those who can't care for themselves. But to suggest that we could ever say with any kind of certainty that this could "absolutely never happen again" is unrealistic and doomed to failure. And it's the kind of thinking that led to the Patriot Act and other excessive measures.
Posts: 757 | From: L.A. | Registered: Jan 2007
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