BLACKSBURG, Va., May 1, 2007 -- Two years before Seung-Hui Cho killed 32 people in a shooting rampage at Virginia Tech, he was ordered by a court to undergo outpatient psychiatric treatment at an on-campus facility, Cho's court-appointed lawyer told ABC News.
This was in addition to the already reported order that sent Cho to a private facility off campus for evaluation.
With no mandatory follow-up and no penalty for noncompliance, it is not clear whether Cho ever showed up for the Va.Tech counseling.
In an exclusive interview with ABCNEWS.com, Terry Teel spoke about his client for the first time since the shooting two weeks ago. Teel, who was appointed by Montgomery County to represent Cho in a 2005 detention hearing, said that Cho was ordered to receive outpatient care at Cook Counseling Center, an on-campus facility run by Virginia Tech.
"From there he was sent to Cook Counseling. … It is on court paperwork," Teel said to ABC News.
Cho was taken into police custody on Dec. 13, 2005, after a mental health evaluator found him to be "an imminent danger to himself or others as a result of mental illness" and "incapable of volunteering or unwilling to volunteer for treatment." According to court documents first obtained by ABC News, Cho was evaluated and detained for a hearing at Carilion St. Albans Psychiatric Hospital.
What had not been reported or publicly known until this point was what happened next -- specifically, that Cho was ordered to receive outpatient care at the university-run Cook Counseling Center.
In the months before his detention, Cho showed emotional distress, alerting his professors, roommates and family to the possibility that he was mentally ill. Faculty members of the English department had Cho removed from class and tutored one-on-one after fellow students were disrupted and frightened by his odd behavior.
"My brother was quiet and reserved, yet struggled to fit in," Sun-Kyung Cho, his sister, said in a statement released after the killings.
With no agency responsible for checking up on court-ordered psychiatric care, it is unclear whether Cho showed up for treatment or received care at another facility. As is standard practice for Montgomery County, the court would have sent Cho to the eligible provider nearest to his home. Cook Counseling center, which is located a few buildings away from Cho's senior-year dorm, is funded by student health fees and provides care to those enrolled at Virginia Tech.
Christopher Flynn, the head of the Cook Center, told ABC News he could not comment specifically on Cho's case due to confidentiality issues, but wrote in an e-mail to ABC News that "any student who was deemed to be suicidal or homicidal would never have been released from an inpatient facility to any outpatient facility."
Flynn previously told reporters during a news conference shortly after the shootings that his facility would not be the mandatory provider of court-ordered health care.
ABC News has learned, however, that Flynn was not the head of the counseling center at the time of Cho's court order and might not have seen the court paperwork requiring the 23-year-old to receive counseling at Cook.
Police documents show that Cho's counseling records were on file at the Cook center, but it is unclear whether that documentation is linked to the December 2005 court order.
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.
Two weeks after the shooting, plans for improved access to mental health care are already under way at Cook Counseling center. The center's staff are hoping to expand the counseling resources for students as soon as this summer.
"We are trying to meet the emotional needs of all students, including those who are graduating or will be in Blacksburg this summer," said Cook's Flynn, in an earlier interview with ABC News.
After the shootings, roughly 300 mental health volunteers were available on campus to assist students. The counseling center says it is seeing "more students than average" for this time of year because of the massacre.
Meanwhile, the questions and the scrutiny of mental health practices continue.
"Would this have had a different outcome if we had caught [Cho's mental problems] sooner? We'll never know," Kelly said.
"Early intervention, early diagnosis are crucial. And our system isn't really good at making that happen."