Roy Crouse, a physician who examined Cho the day after he was taken into police custody, said in court documents that although Cho showed signs of depression he denied having suicidal thoughts.
"His insight and judgment are normal," Crouse wrote in a court document.
That assessment led the court to determine that Cho was not a danger to others and that the appropriate next step for Cho was outpatient psychiatric care. He was ordered to receive treatment at Cook, Teel said, and then released from police custody.
As is standard practice in Montgomery County, no report on whether Cho ever got treatment or medication and no update on his status would have been provided to the court. This situation of no report back is where, Teel and others say, Cho slipped through the cracks.
Elinor Williams, the magistrate who signed the order for Cho's release, confirms that there was no mandatory follow-up.
"It's not a small crack that this young man slipped through. It's a very large crack," Randy Neff, a psychologist and 30-year clinical social worker in Milwaukee, told ABC News.
According to Neff, like in Cho's case most mental health detentions around the country end with the individual being released from custody.
"The vast majority of the cases the courts do not detain the person, but rather pursue a suspension agreement. The case is suspended as long as the person pursues outpatient care," Neff said.
With few checks and little follow-ups, Neff says that "many, many of those people have been allowed to drift away from mental health treatment."
Virginia's mental health professionals and law enforcement personnel are scrutinizing what could have been done differently in Cho's case, looking for possible improvements to the current system.
"Obviously somewhere along the line our treatment of the mentally ill failed," said Chief Ray Lavinder of the Roanoke, Va., police department.
Lavinder, a member of the Mental Health Association of Roanoke Valley, says that Cho's case and the Virginia Tech shootings indicate a need for better follow-up.
"I would like to see some follow-up evaluation on a regular basis, some determination saying if medication had been prescribed to the person, whether the person is taking it, et cetera," Lavinder said.
Another problem with the current system is the standard for deciding whether a person poses an imminent danger to others, says Diane Kelly, executive director of Mental Health America in Roanoke, Va.
On April 16, a year and four months after a Montgomery County court determined that Cho was not a threat to others, he went on the shooting rampage that killed 32 people at Virginia Tech.
Kelly says the standard in Virginia is too restrictive and agrees that there is a chicken-and-egg paradox: An individual is not considered a threat to others until he or she has already threatened or harmed others.
"You need to be suicidal or homicidal. It's almost as if we're saying you need to have a stroke before we treat your high blood pressure," she said.
Kelly believes that within the structure of mental health care law and policy, Virginia Tech did all it could to help Cho.
"I don't think there's anything Tech could have done differently. I don't think they dropped the ball," Kelly told ABC News. Whether or not the laws and regulations need to change, she said, is a separate question.