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Virginia Tech shooter Seung-Hui Cho was taken to Carilion Saint Albans Behavioral Health on Dec. 13, 2005, where he was determined to be a danger to himself or others. A second evaluation the next day said Cho was mentally ill but did not present a danger. A special justice disagreed at a later hearing.

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More than a year before he killed more people than any lone gunman in U.S. history, Seung-Hui Cho had a brush with the mental health system that had at least the potential to drastically alter the course of his life and so many others.

What happened after a Montgomery County special justice ordered Cho to undergo counseling isn't known. Even the audiotape of the hearing where the order was given is shielded by privacy laws.

However, Virginia has no mechanism to ensure that such an order is carried out. Cho's continued antisocial behavior in his classes at Virginia Tech, as well as his cultural background -- mental illness carries a severe stigma among many Koreans -- suggests he may not have followed Special Justice Paul Barnett's direction.

It's a gap in the system that has been discussed for years, and one that state legislators will be eager to close, some of the region's members of the General Assembly predicted.

"I don't think we'll have another session go by without addressing this issue," said Del. Morgan Griffith, R-Salem. "Clearly the mental health issue and the follow-up or lack thereof will be looked at."

Virginia sets a higher threshold for requiring someone to undergo mental treatment than do many states, and it's time for legislators to look at how that affects people, said Del. Jim Shuler, D-Blacksburg.

"Mental health is the thing we all like to sweep under the rug ... and we've got to get it out in the open it and deal with it," Shuler said. "In retrospect, this guy had probably been crying out for help for a long time."

On Dec. 12, 2005, some 16 months before he killed about 30 people on Tech's campus and then shot himself, Cho was the subject of a complaint to police. A female student said he had been sending her unwanted instant messages and she wanted him to have no further contact with her. The same day, an acquaintance told police that Cho might be suicidal.

On Dec. 13, a temporary detention order was filed in Montgomery County General District Court. That night, Cho was taken to Carilion Saint Albans Behavioral Health outside Radford, where an evaluation determined that he was a danger to himself or others. After a second evaluation the next day, a doctor felt that Cho was mentally ill but did not present a danger.

However, at a Dec. 14 commitment hearing, Barnett decided that Cho was, indeed, a danger to himself. But he ruled that outpatient treatment was a suitable alternative to involuntary hospitalization.

And then Cho disappeared from the legal system, at least as far as mental health treatment was concerned.

"The court-ordered mandate for treatment doesn't have a lot of teeth," said Mike Wade, a spokesman for New River Valley Community Services. "That court order really doesn't carry a lot of weight if the individual isn't willing to get help."

Cho's willingness isn't known, but his background suggests he would have been a reluctant participant in treatment.

"Koreans have a very low awareness of mental health issues," said Esther Park, executive director of the Korean Community Service Center of Greater Washington in Annandale, Va. Mental illness is viewed among many Koreans and Korean-Americans as a "terrible, shameful, guilty matter," she said.

Koreans traditionally are stoic and not eager to seek help, Park said.

"We were educated as an early baby ... never to discuss your emotions," Park said.

"If your family is suffering from mental health issues, it is very shameful," echoed Sookyung Chang, a psychologist who heads the Korean American Family Service Centre in Los Angeles.

Cho's family immigrated from South Korea and settled in Detroit in 1992. Chang described Korean-American attitudes on mental health as similar to those of the mainstream culture of not too many decades ago.

"They are in denial," she said.

A follow-up mechanism to force people into court-ordered treatment is one topic being studied by the state Commission on Mental Health Law Reform, which was appointed in October.

"It's a resource issue," said Richard Bonnie, the commission's chairman and director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia. Treatment can be ordered, he said, "but where is the mechanism by which this order is going to be implemented?"

Besides increasing follow-ups, the commission hopes to expand service options so people ordered into treatment will be more likely to attend.

"Being taken to court and having the court tell you to do something is not necessarily taken well by some people," Bonnie said. "If people feel like they're being listened to, they object less."

Bonnie said the commission should make legislative proposals sometime next year.

Terry Grimes, co-founder and board president of the New River Valley-based Empowerment for Health Minds and a longtime advocate for people with mental illness, is a member of Bonnie's commission.

She described the issue as finding a balance between public safety and the rights of people with mental illness.

"We haven't committed a crime, so why would we want to check with a court officer?" asked Grimes, who herself has a mental illness.

Del. Onzlee Ware, D-Roanoke, agreed. "Horrendous as this incident is," he said of Monday's shootings, "we have to make sure ... any legislation we consider does not infringe on a person's individual rights."

State Sen. John Edwards, D-Roanoke, thinks legislators need to revamp the follow-up process for mental health cases.

"The interaction between the mental health community and the law enforcement community needs to be tighter," Edwards said. "There are times when you need some coercion behind treatment programs for those who are not complying."

Del. Dave Nutter, R-Christiansburg, advised legislators to wait until the mental health commission and a review commission Gov. Tim Kaine appointed to look at Monday's shootings deliver their reports.

"I hope instead of having a hodgepodge of legislative remedies, we can look at this in a broad-based way," Nutter said.

Del. William Fralin, R-Roanoke, wondered if Cho's parents were notified after his mental health evaluation -- or if the law even allowed them to be, given that Cho was an adult.

"I think there's going to be some good to come out of this tragedy to prevent something like this from happening again," Fralin said. "At least I hope that is the case."

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