A Richmond appeals court, in a decision that advances the rights of the mentally ill, has ruled that the government cannot force antipsychotic medication on a prisoner found incompetent to stand trial until he is ruled incompetent to make medical decisions for himself.

"It is plain that these two capabilities are not the same," a three-judge panel of the 4th U.S. Circuit Court of Appeals said Friday, reversing a lower court's decision in the case of Michael F. Charters Jr.

Charters, 27, was charged with verbally threatening the president in 1983 but was found by U.S. District Judge Albert V. Bryan Jr. in Alexandria to be incompetent to stand trial. Bryan ordered Charters to a facility for mentally ill federal prisoners.

The appeals court ordered Bryan to hold a hearing on Charters' competency to decide on his medical treatment. If his decision to reject antipsychotic drugs rests on rational reasons, Charters "must be permitted to refuse {the} medication," it stated.

Thomas Rawles Jones Jr., Charters' lawyer, declined to comment on the case yesterday.

The ruling last week, believed to be the first that separates the two kinds of competency, comes amid a national debate over the rights of the mentally ill to refuse medication and over the effectiveness of drugs in treating mental disorders.

"There is a tremendous conflict between two important values" of personal liberty and a person's right to effective treatment, said Laurie Flynn, executive director of the Arlington-based National Alliance for the Mentally Ill, a support organization for families of mentally ill people. "It's a very tough issue."

Although the appeals panel confined its findings only to pretrial detainees, and not to convicted prisoners, the decision is likely to bolster those supporting the rights of the mentally ill to decide on their treatment in future court debates, one legal expert said.

"It will be a useful precedent in future cases," said Arlene Kanter, a staff attorney at the Mental Health Law Project in Washington.

"A person can be competent to make decisions about treatment and still be adjudicated incompetent about other aspects of their lives," Kanter added.

"That's the first I've heard of that type of decision," said William Willingham, a spokesman for the Federal Correctional Institution in Butner, N.C., where Charters is being held. "That's a newly determined position of the courts we're dealing with."

In a related matter Friday, the appellate judges found that Charters is being illegally detained at Butner and ordered a hearing to determine whether the federal prison may continue to detain him.

The court record, they said, does not reflect efforts to place Charters in a state institution, a federal requirement for mentally ill prisoners after four months' detention in a federal facility.

Willingham said yesterday that Butner has tried "many, many times" to place Charters in a state facility but has been unsuccessful.

Noting that the Supreme Court has never "squarely decided" the constitutional protections for someone rejecting antipsychotic medication, Friday's 46-page opinion goes on to state that a mentally ill pretrial detainee "has a constitutionally protected interest in deciding for himself whether to accept or forgo medical treatment."

They are "entitled to be presumed competent" on their medical treatment until a court finds otherwise, it stated.

Even when a patient is adjudged incompetent for medical decisions, this "does not extinguish a patient's constitutional rights," the judges wrote. "The custodians of such a patient must apply for a court order permitting forcible medication." Especially so, the opinion stated, for antipsychotic drugs that can cause permanent harm to a patient and that affect a person's "thought processes that define individuality."

"It sounds like the judges are saying a separate hearing {for medical competency} should be held," said Judith Krasnow, director of the Alexandria Community Mental Health Center. As such, she said the decision appears to further protect patients' rights.