Friday, October 05, 2007

Virginia Tech Shooting: Final Report

The final report on the investigation of the Virginia Tech tragedy was released in September (see also Washington Post story).

Some of the Recommendations:

11 recommendations by the panel (go to past 2 pages of the pdf), including:
  • short- and long-term counseling to affected individuals
  • crisis-management training for colleges
7 recommendations about changing privacy laws (last 3 pages), including:
  • exempting university clinics from FERPA, so medical treatment info can be released without student's consent;
  • adding good faith, safe harbor provisions for certain disclosures;
  • reducing privacy rights for "troubled students";
  • deeming law enforcement and medical personnel to be "school officials", which permits greater access to students' records;
  • consider making all commitment hearing results public information
12 recommendations [.pdf] about changes in college mental health services (beg on pg 53), including:
  • system of linking "troubled students" to counseling services on and off campus;
  • adequate, culturally-competent community MH services for children and adolescents;
  • requirements that professors and resident hall staff report all "aberrant" behaviors to the dean;
  • repeated incidents of aberrant behavior be reported to the counseling center and to parents;
  • counseling center report all students in court-ordered treatment to the threat assessment team;
  • expansion of outpatient MH services statewide to meet community needs
14 recommendations [.pdf, same as above link] for changes (pg 60) in Virginia laws, including:
  • extension of time period for temporary detention on an Emergency Petition (EP); allowing ER docs to do EPs (weird, they can do them in Maryland);
  • lowering the "imminent danger" standard;
  • increase the # of crisis stabilization beds to reduce waiting in ERs;
  • assuring the "independent evaluator" has access to "necessary reports and collateral info" prior to the independent commitment eval;
  • setting certain standards for the commitment hearings (ones I think Maryland already meets);
  • reducing privacy rights for anyone going thru commitment proceedings;
  • tightening up involuntary outpatient commitment procedures;
  • "the sanction(s) to be imposed on the no-compliant [sic] person who does not pose an imminent danger to himself or others";
  • requiring providers to report noncompliance with involuntary outpatient orders


Gerbil said...

psst, Roy--the links to the recommendations don't work. :(

Sarebear said...

Hrm, some of these strike me as extremely severe; while I think much can and should be done, especially in the vein of some of these recommendations, to help close gaps in the mental health care system that , when closed, will make an event like this shooting a good deal more unlikely, it is, like the war on terrorism, a needful balance between security, and civil liberties.

More later, perhaps, but it'll probably all get said by others anyway.

Sarebear said...

Um, not that the mentally ill are terrorists, or akin to them (although some terrorists are most likely mentally ill, or have disorders possibly).

I guess it seems like some of these measures place the ill person in a "Danger, Will Robinson" role. And I'm not talking a funny robot with dryer ducts painted black for his arms.

The people working on this, discussing, considering, in positions to do something about this (there's probably few lone people, or lone small groups of people, who can do much on their own to do something about this, but one has to start somewhere), will do so with the thought of their mother, sister, brother, child, or self, in the position of a mentally ill person.

There are a good many positive (IMHO) suggestions here, though.

There's one (extend community MH services . . ..) that is pretty much the biggest broken bone in the mental health care system, in my opinion, anyway. Social Security Disability is another one, but another of the recommendations here, about the consequences for mandated outpatient treatment non-compliance, well, I went to a support group twice, and one of the guys there, was court-ordered to see someone at a specific clinic or somewhere, and he had no insurance so they wouldn't treat him.

Actually, INSURANCE and other financial issues related to mental health care would be the biggest broken bone of the mental health care system, followed by the one I said above. But then, that's probably the biggest one of all-around medical care, too . . . .

I think these things and issues are finally rising to the top as the, or near the, top domestic issues that are on the "agenda" for presidential and other candidates. From what I've been hearing, anyway.

It's about damn time. (Sorry, but the sad state of matters needed a swear word.)

Oh, and you've officially been sprinkled with IAMHI dust. Pass it on. (See my blog post 10/05 for why I AM HI.)

Sarebear said...

Um, yet another amendment, lol. Mentally ill persons can definitely be a danger to themselves and others; it's just that some of the measures seem to use too broad of a brush . . . . especially with all the "report aberrations" stuff . . . some would be prudent, but . . . again, too broad of a brush seems so . . . orwellian.

THAT is what I meant by the painting the mentally ill in the "dangerous" role; that it seemed/felt to me like too broad of a brush was being used, potentially; to use another potentially sensitive analogy, like locking up Japanese Americans during WWII.

How much is too much, when it comes to trying to prevent another tragedy? How much is too little, and just throwing one's hands up and saying, well, bad things happen and we shouldn't overreact (which I'm not trying to say we shouldn't do anything, either, although I think it would be wise to react more like that shooter, that shooting, was a symptom of a system that fails to treat a large variety of the mentally ill, and not just a, oh no, we need to cast a net, with really fine holes, to prevent this kind of tragedy again, kind of thing)

Those questions I just asked are the crux of the matter, I suppose, and not easily settled. I'd assume it's been debated for a long time, but these recommendations add s'more wrinkles. Some scary (to me) ones, and some c'mon already, you guys should've already KNOWN that one, FUND s'more stuff already, ones, to hey, that's a new, innovative way to perhaps address another aspect of the problem, ones . . ..

Roy said...

Thanks, Gerbil. The links should be okay now... they are pdf's so, depending on your browser, they may open up or they may just download to your default download folder (which is what they did for me on Firefox).

Thanks for the comments, Sara. I agree... there are some recommendations that are good (like increasing access to MH care) and others which could be detrimental (like easing access to health records).

FYI, you all might want to make a public comment about a new proposed Medicare Rule which would reduce access to Rehab services. The deadline is Oct 12.

The Bazelon Center noted these changes that may be especially problematic:

1) “Intrinsic Elements” provision – new language prohibits federal payment for services that CMS deems “intrinsic elements” of other programs, including foster care, child welfare, education, child care, vocational and prevocational training programs, housing, parole and probation, juvenile justice and public guardianship. Individuals in those programs would remain eligible for Medicaid but Medicaid dollars would only pay for rehabilitation services if the services are not provided by the other programs. This provision may exclude services to consumers served by more than one State agency.

2) Requirement of a written rehabilitation plan – new language requires a plan that must include recovery goals and must be re-evaluated at least annually to assess the individual’s achievement. If there was no “measurable reduction of disability and restoration of functional level” a new plan would be required to include revised goals, strategy, services and/or methods.

3) Requirement that services result in change in status – CMS explains in introductory language that the rehabilitation benefit “is not a custodial care benefit for individuals with chronic conditions” and should result in a change in status. Services should restore a prior, higher level of functioning rather than maintain the individual’s current, possibly static, level of functioning. New language eliminates federal dollars for “habilitation services, including those provided to individuals with mental retardation or related conditions.” Again, CMS makes a distinction between “rehabilitation” (restoring the individual’s ability to perform an activity they used to perform in the past) and “habilitation” (“services that are for the purpose of helping persons acquire new functional abilities”).

4) Rehabilitation may not include recreational and social activities – new language would prevent coverage of those activities unless the activity is “specifically focused on the improvement of physical or mental health impairment and achievement of a specific rehabilitative goal” as stated in the written rehabilitation plan.

Anonymous said...

What the F**K!!!!! So...if you are a have no right to privacy? I am all for students going to counceling on campus. My issue is this: Who the hell has the right to open up a students medical records to the college administrators?

How about we start telling employers about people STD status?

If someone is a danger to themselves and other...all that inpatient commitment stuff is fine, and college campus counceling centers should beef up their services to be able to identify at risk students.

However...those students should be granted privacy.

Perhaps assertive outpatient (involuntary) treatments should made law...

Just another neon sign of stigma

Anonymous said...

Shouldn't all that medicare stuff be it's own post?

And, sadly, I don't believe there's much that could have been done to prevent the VA tech shootings. Even these recommendations don't mandate weird people into care. People were aware this man was having problems, professors tried to link him with available care, his only hospitalization had been years before for a few days when he'd been distressed about a girl, and he was able to leave the hospital then, so probably not deemed imminently dangerous.

As is, if you tell your student mental health professional that you're suicidal or homicidal, you get followed pretty closely and may end up involuntarily hospitalized. I believe we had a whole blog series on student mental health issues and being thrown out of college, pre-dating Cho. I worry that anything that reduces the perception that mental health care is private, increases fear and decreases the desire to access it even if it is available.

Anonymous said...

Excellent article. I'm a college student researching mental health discrimination at the college level and in the community at large. What I found was shocking.

Protected Health Information is routinely disregarded on the college campus. Furthermore, people with so-called "hidden" illnesses and disorders, primarily psychiatric disorders, are highly stigmatized by college officials at all levels. This we know is based on ignorance and stereotyping; Secondly, we know from recent and past court cases, that colleges routinely dish out punitive measures against students who have or develop a psychiatric disorder during the school year that brings attention either to themselves by way of a drop in grades/attendance, or incidents in residence halls. In one recent case settled out of court 2007, an honors student who was suffering from major depressive disorder and possibly PTSD from his roommates recent suicide (he was present), checked himself into the hospital for anxiety related to having suicidal ideation from his new Zoloft script. The college dismissed him, violated his privacy, harassed him, and threatened him with criminal prosecution if he sets foot on the campus again (this was hours after being newly admitted to the inpatient psych unit).
I'm utterly appalled at how stigmatized people suffering from mental health disorders are. It seems the suggestions in this article you posted, is much like the above case I mentioned. Treating college students with these disorders who seek help or don't seek help with punitive measures for doing so is discriminatory, and only reinforces stereotypes based on ignorance. In addition, measures such as those that reach into the PHI of the student, is actually HARMING, not HELPING, exacerbating conditions, and driving others to not disclose or seek treatment at all. This is a disgrace upon America...

Roy said...

Anon-Jan6: The discrimination is sad. Please let your elected state and federal representatives how you feel about it. They need to hear about this and know that people want this situation to change.

Anonymous said...

Don't worry the Catholic church is already doing this.
Why should schools be any different? You're only resisting progress.