Martha note: Today, Virginia Public Radio will air a story on what it's like to be a severely mentally ill "client" hospitalized at Western State. And tonight at 7, Tom Graham will host an Assembly Conversation  on the subject of Virginia's mental health services. 

The heartbeat of state-funded Mental Health Services in Virginia are its 40 Community Service Boards (CSBs), which were formed back in the early seventies in response to a Federal mandate to provide 24-hour coverage for mental health, intellectual disabilities, and substance abuse emergencies.  

As part of my research for the story on Western State, I sat down with Dr. Robert Tucker, Director of Emergency Services for  Valley Community Service Board  (VCSB), to get some idea about how these "emergency services" work. 

Cho Seung-Hui was the starting point of our discussion that morning in the conference room at VCSB.

On April 17, 2007, Cho killed 32 people and wounded 25 others at Virginia Tech in what is now generally referred to as the Virginia Tech Massacre.

On April 18, 2007, CNN published the following:

Killer's manifesto: 'You forced me into a corner' 

Cho Seung-Hui said Monday's massacre on the Virginia Tech campus could have been avoided and said "you forced me into a corner," in a videotaped message he mailed to NBC News. 

NBC News reported that Cho mailed the package at 9:01 a.m. Monday -- during the two hours between the shootings at the West Ambler Johnston Hall dormitory and Norris Hall, which left 33 people dead, including Cho, who took his own life. 

"You had a hundred billion chances and ways to have avoided today," Cho said in one of the videos that aired Wednesday night on NBC. "But you decided to spill my blood. You forced me into a corner and gave me only one option. The decision was yours. Now you have blood on your hands that will never wash off."

No one disputes that Cho had needed effective intervention and treatment long before he exploded into violence. But, said Robert Tucker, it's just not that easy.

Tucker remembers watching a "Town Meeting" on Good Morning America right after Cho's rampage. People were encouraged to call with concerns about bizarre behavior.  But, Tucker asks, what about Cho's Constitutional right to behave bizarrely as long as he's not breaking laws or actively threatening harm to himself or someone else?

And as for calling, call whom?  To do what?

Here are a couple of the post-Cho scenarios Robert Tucker laid out.

Say you call the police and say that your neighbor's behavior is scaring you. The police come out, agree with you. The officers can then, under their own authority, issue  what's called a "paperless custody order," which allows  them to bring your neighbor into a secure facility for evaluation by someone on Robert Tucker's VCSB Emergency Services staff.. Legally, this evaluation has to be done within 4 hours, with a possible  2-hour extension.

After evaluation, your neighbor can be committed on a Temporary Restraining Order (TRO), if the examining mental health professional deems him to be at risk in the reasonable near future (7-10 days) of inflicting serious mental harm on himself or others. Or if he's deemed not able to take care of himself..

Pre-Cho, individuals could only be TRO'd if they were of imminent danger to themselves or someone else, but they could then be kept in a hospital for treatment based on an inability to care for themselves. Now you can be TRO'd because you can't take care of yourself.

Dr. Tucker gave the following example of how this system plays out:

Say a person is manic-depressive. Bipolar. He's on meds and doing fine, and then get's physically ill and is put on a steroid which sends him into a manic episode. He starts spending money and soon he's in danger of losing both his house and his family. In the past, the system would have had to wait until this man hit rock-bottom before they could do anything. Now, the system can intervene once he's deemed not able to take care of himself. Then, based on past behavior, he can be picked up, evaluated, and put in a hospital for treatment before he hits rock bottom. 

And there's another relevant change in how emergencies are handled..

Post-Cho, police are now offered CIT (Crisis Intervention Team) training, which is 40-hours of instruction in how to tell when someone is mentally ill, or physically or intellectual impaired. This makes it less likely that ill people will get sent to jail where they will only get worse.

Someone calls VCSB complaining that Joey is acting weird. Before, we might ask officers to go out there and check and see how Joey’s doing. Now, however, we’d request CIT-trained officer. And maybe, Dr. Tucker says,  I'd  send one of our CIT clinicians out with officer.  When doing crisis intervention, you want a secure protected environment, which the police/clinician partnership has a much better chance of providing. The two trained  professionals then try to engage Joey in conversation and, if appropriate, to get him to come in for services. This way, Joey avoids the stigmatization of getting involved with the criminal justice systems.

Over and over and over again, Dr. Tucker pointed out that, if a person does not meet commitment criteria, there's not a lot the system can do. But, he says, this process continues to change, with increasing emphasis on  empowering recovery and de-stigmatizing  mental illness from  a legal/criminal perspective.

The main thing I took away from my conversation with Dr. Robert Tucker and other staff members at VCSB, was an impression that Community Service Boards are staffed with skilled, compassionate, astonishingly committed and hard-working people, who need all of us to involve ourselves in understanding more about mental health issues.

You can make a start   tonight, by tuning in and calling in  (866-611-639) to Assembly Conversations. Tom Graham's guests will be Richard Bonnie, Chair of the Virginia Mental Health Law Reform Commission;  Patrick Hope (D-Arlington), House of Delegates Member and former Arlington County Community Services Board Chair]; and  Bonnie Neighbor from the advocacy group for mental health consumers “VOCAL.”


Cho Seung-Hui was the starting point of our discussion in the conference room at VCSB.