Could Officials Have Stopped Cho? A Q&A With a Campus Counseling Expert

By SCOTT CARLSON

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With revelations about Cho Seung-Hui's history of mental illness emerging almost hourly, many are asking whether Virginia Tech and state officials should have seen warnings that he might commit some horrendous act -- and whether they should have detained Mr. Cho. People are also asking whether, and how, future shootings can be prevented.

It may not be easy. Gregory T. Eells, who is director of counseling and psychological services at Cornell University and president-elect of the Association for University and College Counseling Center Directors, spoke with The Chronicle about the legal restrictions on college counselors. Prior to the shootings, he said, Mr. Cho's case might not have seemed much out of the ordinary.

The following transcript has been edited for length and clarity.

Q. Could you spell out, very clearly, the legal limitations on counselors?

A. Basically, the only time that someone is ever mandated counseling is if they have some kind of criminal case against them. ... Other than that, it's a voluntarily process, as it should be. At most college and university settings, it's largely voluntary. These are college students. They don't usually have criminal records.

The challenge in cases where you might be concerned about someone's safety or concerned that they might harm someone else, is that first you have to engage them. One of the things you do as a counselor is a formal assessment. ... If as a counselor you are concerned that there is imminent risk that the client might hurt themselves or someone else, in most states you have the ability to hospitalize that person against their will. ... Most states have some kind of law that allows for involuntary assessment or hospitalization.

Q. But in terms of interactions with students and notifying authorities, you aren't able to violate client confidentiality, right? And is that a law or merely an ethical rule?

A. No, that's the law. There are federal laws -- HIPAA [the Health Insurance Portability and Accountability Act] is the one you hear about frequently -- but many states have laws with pretty strong protections around information-sharing of mental-health records. New York has pretty stringent laws -- they place it at the same level of attorney-client privilege. But even with an attorney, if your client says that he's going to kill somebody, you have an obligation to tell someone. That's the same with mental-health professionals.

So, basically, you can't break client privilege unless you believe that a person is at imminent risk.

Q. And when you say "at imminent risk," you mean you have a serious concern that someone is going to hurt themselves or someone else.

A. Yes, and that's a professional judgment.

Q. How do you make that assessment when symptoms can be so ambiguous?

A. It comes with professional judgment. We hospitalize between 50 to 70 students a year here. A fair chunk of them are involuntary. So we make these decisions on a weekly basis. You look at the risk factors, you look at their history of treatment and their willingness to comply with treatment, you look at things like concern from people on campus -- I mean, if you are getting calls from faculty members. ... And you make your best decision based on the information you have gathered.

I know that [the media] have been playing up the English professor who talked about Cho's writings. That's not an uncommon occurrence. I've worked at four other universities, and it's fairly common for a professor to say, "A student wrote something, and it was disturbing or sad. What do I do with this?" That happens on a fairly regular basis.

Q. So the writing is a window?

A. Sure it is. But you would hospitalize Quentin Tarantino? I mean, there are all sorts of writers who write about dark, violent themes, but most of them are not dangerous to themselves and others. It's an outlet, a creative expression. It's not necessarily [an indication of] something more nefarious going on.

That's what makes this so hard, and makes it challenging to say that this is ever going to be preventable. There are so many times when there are concerns from faculty members or roommates, or parents sometimes, or academic counselors. We take those things very seriously, and we try to find ways to connect with those students through various outreach programs.

But ... you don't have any way to control them or make them seek services, and you wouldn't want to. You wouldn't want to live in a society that did that.

Q. And in most cases, these are people who are going to hurt themselves, not others?

A. Oh, yeah, the vast majority. In 999 out of 1,000, it's about self-harm.

Q. And how often are the clients or their parents resistant to the idea of hospitalization?

Well, this is a tricky piece too. Legally, our students are adults, so to what extent do we tell the parents? We don't tell parents unless we feel like we have to. It's the same as with me and you. Your therapist wouldn't call your parents if you're age 40, but legally it's the same when you're 18, even though you could argue that, developmentally, an 18-year-old isn't at the same level. ... We will involve the parents if we feel like breaking confidentiality will keep people safe.

Q. Let's talk about the false positives. The media are going to focus on the judgments of the counseling staff at Virginia Tech. But disturbing behavior is something you see all the time.

A. On a daily basis. ... We get calls from faculty about students on a daily basis.

Hindsight is always 20/20. It's always easy to look back and say the friend was concerned, a faculty member was concerned, they had a previous hospitalization. Yeah, all of those things are concerning. But to make a jump and say that everyone who exhibits those signs is going to become the perpetrator of the worst shooting in American history is not a logical jump. That possibility is always there, but a million times that is not what is going to happen.

Q. What is the fallout from this going to be? Will the laws change? Will there be a call to get rid of client confidentiality?

A. Someone may call for changing that. It would be a disaster. The reality is that those protections are there to protect the sanctity of mental-health treatment. Those laws recognize that that's essential to creating an environment that is more conducive to seeking care.