Virginia Tech gunman Cho Seung-Hui appears in a photo he mailed to NBC the day of the shootings. After complaints that he had stalked two women in 2005, a judge pronounced Cho “mentally ill.” Associated Press/NBC

The question is, with all the warning signs, should the university have taken more aggressive action to deal with him? Could something have been done to prevent the massacre?

Virginia Tech police investigated complaints about Cho stalking women two years ago. Professors reported concerns about his classroom behavior and writings laced with violence.

At one point, Cho was permanently removed from a class when other students became afraid to attend class with him.

After the stalking complaints in the fall of 2005, he was questioned by police and voluntarily attended a session with a mental health counselor. A county court magistrate judge then pronounced him "mentally ill" and dangerous and ordered him treated briefly at a psychiatric hospital.

He was evaluated at Carilion St. Alban's, a private mental health facility in Christiansburg, Va. According to records from that examination, Cho was "alleged to be mentally ill."

Because Cho told them he had no plans or hallucinations about killing himself or others, he was held for 24 hours and then released on a court order recommending he volunteer for counseling. Cho apparently never sought help.

But he remained enrolled at Virginia Tech, where his mental state deteriorated. However, he apparently committed no crime and threatened no violence to others until Monday.

The painful second-guessing of Virginia Tech's actions could prompt changes in the way U.S. college campuses handle students with mental illnesses. It's already a widely debated issue complicated by questions of medical confidentiality, universities' legal liability and a rising population of college students with serious mental illnesses.

It's an acute problem, according to the National Survey of Counseling Center Directors conducted last year. Ninety-two percent said the number of students with severe psychological issues has increased in recent years. They said 40 percent of students seen at counseling centers have severe problems, including 8 percent whose impairments are so serious that they can't remain in school or can do so only with extensive treatment.

IDENTIFYING PROBLEMS

Ironically, college counselors attribute the rise to improvements in psychiatric drugs that allow more people with mental illnesses to make it to college in the first place.

It has created new problems for universities, where counseling centers often are not equipped to deal with serious illnesses and growing numbers of students who need treatment.

Kevin Kruger, associate executive director of the National Association of Student Personnel Administrators, said the Virginia Tech tragedy is likely to influence many colleges' policies about how they identify students who may be dangerous.

"My gut on this is we're going to become more likely to want to remove students from the educational environment," he said.

There are no easy answers.

After a 2002 lawsuit by the parents of an MIT student who committed suicide, more universities began to force suicidal students to withdraw from school, at least temporarily. Another lawsuit by a George Washington University student claimed that the school violated the federal disability law when it suspended him after he sought help for depression.

"Everyone's going to be looking at those threshold points, and (ask) 'When do we take more drastic action?' " Kruger said. "It's the classic tension between individual freedom — the right of every individual to stay on campus — with the interests of the community."

In 2004, San Francisco's Academy of Art University was assailed for its decision to expel a student who wrote an explicit essay. School officials said that the incident was an example of a university putting security first.

"People were saying free speech, but it was a lot more complicated," said Sallie Huntting, the school's vice president for public relations. She said she was reluctant to criticize Virginia Tech, but suggested that schools should treat threatening speech with more alarm.

"If a student is disturbed, you can't say it's a moody student," Huntting said. "It has to be taken seriously. We all have that responsibility."

Sheldon Steinbach, a former attorney for the American Council on Education, said universities are well versed in handling troubled students, and only with 20-20 hindsight could one have predicted such trauma.

"On any given campus, particularly one that is as academically selective as Tech is, there are individuals that exhibit peculiar tendencies, and increasingly more and more students come to school with a variety of emotional problems and on medication," Steinbach said. "No one is suggesting that these people ought to be barred from campus."

Sophisticated protocols are in place on most campuses to deal with seriously troubled students, Steinbach said. "It seems that Virginia Tech dotted every i and crossed every t."

JUDGMENT CALL

Strange behavior is largely a judgment call, and forcing students into treatment isn't usually an option, said Maggie Olona, head of student counseling at Texas A&M University and president of the Association for University and College Counseling Center Directors.

"They said there were signs there," Olona said of Cho. "There can be signs, but it's not a crime to be odd."

Many universities have case management teams that meet to evaluate students whose behavior repeatedly raises red flags. But it's also easy for students to slip through the cracks.

Texas A&M, for example, employs 27 counselors for 45,000 to 46,000 students — "and we are well staffed and well funded," Olona said.

"You do the math."

Some gun-control advocates and mental health experts questioned why Cho was able to buy two handguns after having been declared mentally ill.

Authorities said that while Cho might have been extremely troubled, he was legally permitted to buy the guns because there was no record in his background check of him being involuntarily committed to a mental institution. In Virginia and many other states, even if someone voluntarily commits himself to a mental institution, he still might be able to purchase guns when he gets out.