There were subtle signs that Cho Seung-Hui had problems.
The 23-year-old South Korean immigrant - an outcast by his own account, a bully and a perverted loner by others' - who took his life and 32 others at Virginia Tech this week had troubled classmates and professors more than a year earlier with his dark writings and brooding.
He had been kicked out of class, and two women complained to campus police that they had received annoying and unwanted messages from him. Their complaints and an acquaintance's concern that Cho was suicidal were enough to get him taken for a psychiatric evaluation.
But they were not enough to have him committed under Virginia law, one of the most restrictive in the United States when it comes to forcing treatment on a person showing signs of mental instability. Mental health experts say his case will heighten a discussion about whether it is time to revise those laws.
"It does raise some questions and a concern about a system that can find someone imminently dangerous and not continue to follow up on them and make sure they are getting the treatment they need," said Mary Zdanowicz, executive director of the Treatment Advocacy Center.
State law allows involuntary commitment only if a person is determined to pose an "imminent danger" to himself or others or is "substantially unable to care for himself."
Only Georgia, Hawaii, Montana and Ohio have similar standards, according to the nonprofit Treatment Advocacy Center in Arlington, Virginia. Other states do not use the word "imminent" in conjunction with danger or harm, making it easier to force treatment.
Retired state police superintendent Col. W. Gerald Massengill, who was appointed by Gov. Timothy M. Kaine to head an investigation into the shootings, said he expects the review will cover mental health issues as well as law enforcement response.
Monday's shootings also will intensify a state commission's year-old scrutiny of the imminent danger standard, commission members and mental health experts said.
"We certainly welcome any effort to reform our system and make it as helpful as possible for treatment as well as public safety," said James Reinhard, the state mental health commissioner.
On Dec. 13, 2005, after the second woman complained about Cho, an initial evaluation found probable cause that Cho was a danger to himself or others and a magistrate ordered him evaluated at Carilion St. Albans, a private psychiatric hospital.
The next day, according to court records, doctors at Carilion examined him and Cho denied he was suicidal. An exam showed "his insight and judgment are normal," records state. A special justice concluded he was an imminent danger to himself - but not to others - and approved outpatient treatment, an alternative to commitment.
Virginia law makes it too difficult to get help for mentally ill people who are incapable of making their own treatment decisions, according to Pete Earley, a member of the state commission and its task force on commitment issues. The Fairfax County resident chronicled his own attempts to help his mentally ill son in the 2007 Pulitzer Prize finalist "Crazy: A Father's Search Through America's Mental Health Madness."
Earley said he was rebuffed by doctors and police who said they couldn't intervene until his son tried to kill himself or hurt someone else. Even after his son broke into a neighbor's house and took a bath, authorities refused to order treatment, Earley said.
"The police said he still will not be treated unless you tell the psychiatrist he threatened to kill you - otherwise he will go to jail," Earley said. "So I lied, and my son was taken to a hospital and 48 hours later he admitted himself."
Earley said there is sharp disagreement on the task force about whether the imminent danger standard should be broadened. He suggested the state does not have to resort to the antiquated and deplorable system of warehousing the mentally ill to get help for them before they become dangerous.
Ron Honberg, legal director for the National Alliance for the Mentally Ill in Arlington, said the imminent danger standard is too narrow.
"But if we're going to broaden the standard, we need to do it very carefully and make sure we don't turn the clock back 30 or 40 years," he said.
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