Rules Separate Mentally Ill From Treatment

Keisling said he recently referred a man to a hospital who thought he was a secret agent. A hospital official asked the man whether he had a problem. He said no, Keisling said, and was promptly sent away.

"We have a system that is unsophisticated," said Joanmarie I. Davoli, a former Fairfax public defender and longtime advocate for the mentally ill. She said that the law does a poor job of defining who is mentally ill, that judges are poorly trained to decide how to handle such people and that a lack of public awareness results in underfunded resources.

Davoli defended Alfred L. Head, who in 1998 repeatedly threatened his parents and slashed his own throat in Reston. Six months later, he beat his mother to death with a baseball bat shortly after walking out of a string of mental health facilities.

Head was found not guilty by reason of insanity and placed in a state psychiatric hospital for seven years, where he responded extremely well to treatment. He eventually was found fit to be released by doctors and a Fairfax judge. Today he attends college, has a job and lives on his own, his lawyers said.

"The tragedy there is," Davoli said, "had the civil commitment laws not been so restrictive, his mother might be alive."

In Maryland, mental health advocates recently succeeded in getting the legal standard for treatment relaxed, according to Evelyn Burton of the Maryland chapter of the National Alliance for the Mentally Ill. "Getting rid of that 'imminent' part made a difference," she said, but Maryland also does not provide for formal outpatient treatment under the law, unlike Virginia and the District.

The National Alliance on Mental Illness estimates that the most serious mental illnesses afflict 5 million to 10 million adults and 3 million to 5 million children. Most of those people don't pose a danger to anyone. Many of those illnesses, such as schizophrenia, begin to appear in the late teenage years or early 20s, experts said.

Numerous studies show those who go without medication or treatment are more dangerous than the general population. A Justice Department study once found that people with a history of mental illness committed more than 4 percent of all homicides and 25 percent of all homicides in which a parent was killed.

The danger is particularly acute for law enforcement officers, often the first people to encounter a mentally ill person during a psychotic episode. In 1998, according to the Treatment Advocacy Center, people with mental illnesses killed law enforcement officers at a rate 5 1/2 times greater than the rest of the population. In the Washington area alone since 1998, eight officers have been killed by mentally ill people, including Fairfax Detective Vicky O. Armel and Officer Michael E. Garbarino on May 8, by Kennedy.

Kennedy's parents tried repeatedly to get treatment for him in recent months, only to be told by various mental health professionals that he didn't qualify, said Richard F. MacDowell Jr., their attorney. MacDowell said the mental health system in Virginia was "essentially broken," particularly in Northern Virginia, where population has increased as state funding decreased.

"Unless we do something about this problem now," MacDowell said, "tragedies like this are inevitable in the future."

Virginia has been trying to shift its resources away from state hospitals to local community services boards. But in 2003, for example, $12.5 million was cut from the community budgets, and the boards have about 3,000 adults waiting for services, according to the state mental health department.