Story Highlights• Cho Seung-Hui's behavior raised warning flags long before shooting rampage
• Cho declared "imminent danger to himself because of mental illness" in 2005
• Cho was sent to facility for evaluation and released for outpatient treatment
• Officials: There was nothing that could or should have led them to put Cho away
By Jim Crane
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(CNN) -- Cho Seung-Hui's behavior raised red flags long before he slaughtered at least 30 people on the Virginia Tech campus and killed himself, and many people now wonder what, if anything, could have been done to head off the atrocity.
University police visited Cho twice in 2005 when two female students complained he was stalking them and a third time after getting a report that he might be suicidal, according to police Chief Wendell Flinchum.
A former classmate said the plays Cho submitted for one writing class were so twisted that students feared he could be dangerous.
Cho's poetry teacher threatened to quit if he wasn't removed from her class. Another professor worked with him individually and then notified police and university authorities because she was so concerned by the disturbing contents of his writing assignments.
After the second stalking complaint and a suitemate's reports he might be suicidal, the campus police obtained a temporary detention order, and Cho was evaluated at a mental health facility in December 2005.
Following the evaluation, a magistrate determined that Cho was "an imminent danger to himself because of mental illness" and ordered outpatient treatment for the disturbed young man, according to court documents filed at the time.
A medical examination found that Cho "denies suicidal ideations. He does not acknowledge symptoms of a thought disorder. His insight and judgment are normal," according to the court papers.
On the court order, Paul M. Barnett, a special justice, checked a box that said Cho "presents an imminent danger to himself as a result of mental illness" but did not check the box that would indicate he was a danger to others.
Cho was released for outpatient treatment --- whether or not he got it isn't known --- and police didn't hear about him again until Monday's rampage.
Officials said that despite the warning signs, there was nothing that could, or should have led them to put him in jail or commit him.
"Clearly if anyone had any warning about a violent incident, people would have stepped in and acted," said Christopher Flynn, director of Virginia Tech's Cook Counseling Center.
Although Cho's writings were disturbing, mental health professionals say the student's behavior didn't reach the threshold that would have demanded more aggressive intervention.
But Gregory Eells of Cornell University's health center points out that "a lot of the things that have been said about this young man are applicable to hundreds of thousands of college students, in terms of dark writings or violent writings, and even problematic behavior, even sometimes stalking behavior. That's more common than you would like to believe."
"You can't do anything unless there's imminent risk that's somewhat foreseeable to take away someone's civil rights. I mean, you can have them hospitalized if you, as a mental health professional, feel that that risk is there," said Eells, associate director for counseling and psychological services at Cornell's Gannett Health Services.
According to the American College Health Association, about 44 percent of students were so depressed that it was difficult for them to function at some point in the 2006 school year. It also found that nearly 10 percent reported seriously considering suicide at least once last year.
Richard Kadison, chief of Harvard University's mental health services, said most students tackle the often overwhelming demands of student life such as developmental issues, parental and societal pressures, and economic hardships with "incredible strength and resilience."
Kadison, who also is the co-author of the book "College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It," said students are less willing to accept help than the rest of America.
"They are off in college now, and they feel like they should be more autonomous and do things by themselves," Kadison said. Counseling also has a heightened stigma on campus, he said.
Ben Locke from Penn State's Center for Counseling and Psychological Services said, "It is the role of the community to collaborate around those students and get them the help they need."
Teachers have little power to force a student to get help.
"If a student in distress does not follow the recommendation of the teacher to seek help, there is little they can do to force them to get it," Locke said.
In some extreme cases, such as a violation of campus rules or a serious complaint, officials can require that a student gets counseling as a condition for allowing them to stay in school.
Kadison said that a counselor may suggest that the student seek help through a church, family or a support group, if that makes the student more comfortable.
When a student is in distress, Locke said, it's important to be persistent -- to listen carefully, be supportive, and to encourage them, repeatedly if necessary, to seek the help they need from the sources they are willing to use.
Cho Seung-Hui points a pistol at himself in one of the images he mailed to NBC between Monday's shootings at Virginia Tech.
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