Norma and Andrew Westwood routinely set a place at the dinner table for their younger son, even though they know he won't join them.

The simple gesture is an attempt to impose normalcy on a home life made unpredictable by mental illness.

In the eight years since the Fairfax County couple's 24-year-old son was diagnosed as schizophrenic, the illness has become a central focus of their lives. They have spent their life's savings on his care, and have grown fearful of leaving him home alone. He has done such things as sever their phone lines and shatter television sets.

Most of all, they worry about how to prepare their son for the time when they are no longer there to care for him.

"You get these impossible choices all the time," said Andrew Westwood, a retired federal official. "This is not the right place for him to live. This is the wrong choice, but it is better than being on the street."

Although an estimated 10 percent of people with serious mental illnesses are in hospitals, as many as 40 to 50 percent live with parents, spouses or other family members, according to mental health experts. Some live in special group homes and the rest live on their own, sometimes on the street.

The Westwoods, a middle-class couple who live near Mount Vernon, are among thousands of Virginians who care for a mentally ill relative at home. Their son, whose name is not being used in this story at his parents' request, has spent most of the past five years at home. Before that, he was hospitalized for 2 1/2 years.

Mental health advocates say that people such as the Westwoods' son have little choice but to return to their families, if they have them, because state and local governments have failed to develop adequate alternatives to institutionalization. The few group homes in Northern Virginia, for example, have long waiting lists.

In the next six fiscal years, an estimated 13,100 mentally ill Virginians will need community residential facilities, although there are only 673 beds in such facilities throughout the state, according to an October report prepared by state mental health and housing officials.

The projection of need is conservative, because the officials measured only the known demand for services, such as people on waiting lists.

Mental health officials have asked for an additional 1,281-bed capacity at new residential facilities in the next six fiscal years, though they say this still would not meet demand.

It would be expensive, however -- an estimated $8.9 million for the first 579 beds, or more than $15,000 per bed for two fiscal years.

Mental health officials recognize that they are competing against other substantial needs within the state, such as educational programs.

The Virginia General Assembly is expected to make mental health a top priority in the legislative session beginning next month.

The first signs of mental illness appeared in the Westwoods' son when he was 14, when he would shut his eyes during class, consumed by his own thoughts. Soon after that, his behavior became more erratic, and he confided to his brother that he was hearing voices.

The realization that their son had schizophrenia hit the Westwoods hard.

"What I went through at the beginning was shock," said Norma Westwood, a social worker before becoming a homemaker to rear their three children. " . . . I cried every day for two months. I couldn't cope with the idea. You think of kids getting into a car accident, getting addicted {to drugs}. You never think of schizophrenia.

"Now, she said, "I just go from day to day. You adjust."

"What happens with a son or daughter {with serious mental illness} is they die in a sense," said Andrew Westwood, who before retirement was a GS 15 with the Agency for International Development and the Small Business Administration.

Westwood recalls his son once saying during a period of lucidity, "It is absolutely terrifying to have your mind going out of control and not being able to do anything about it."

Medicine has been prescribed for their son, but he stopped taking it nearly three years ago because of the side effects, such as acute agitation and overall numbness.

This refusal is common. Mental health professionals estimate that 40 to 70 percent of those for whom medication is prescribed for mental illness will not take it, making it more difficult for a family to manage the person at home. There is little that even qualified therapists can do because the law prevents forced medication, except in emergencies.

About 1 percent of the population develops schizophrenia, the most chronic and debilitating mental illness, according to the National Institute of Mental Health. This translates into about 10,000 people in Northern Virginia who have or will have the disease sometime in their lives.

They may answer voices they hear inside their heads, imagine that others are conspiring against them, stare into space or, in rare cases, turn violent. The disease usually comes on during the teen-age years or young adulthood, stunning parents who may have to abandon visions of college, career or family for their child.

An even higher number, about 6 percent of the population, will suffer at some point during their lives from serious forms of depression, according to mental health experts. One of every 25 families nationally is directly affected by serious, long-term mental illnesses, according to the National Alliance for the Mentally Ill.

For decades, the chronically mentally ill were routinely institutionalized. That policy changed in the late 1950s, and state hospitals began to empty. The theory of deinstitutionalization into smaller, community-based residences or back to families was that most of the mentally ill could be better cared for in environments less restrictive than a hospital.

Mental health advocates and families argue that the state and local governments have failed to develop the alternatives that were promised for those who require intensive care.

Often the result is that families must try to understand and cope daily with the psychological disorders of a child, spouse or parent.

"What are the options? There aren't any," said the Westwoods' older son, Andy, who lives in suburban Maryland. "There is no cure. There is no place he can go and live happily ever after."

Andy Westwood emphasizes that it is not simply the mentally ill who suffer. He is frustrated and angry on behalf of his parents.

"There is no acceptable alternative to keeping him at home," he said. "This is the end of my parents' lives, this is {my father's} retirement, the end of any plans for a normal rest of a life."

Despite the constant frustrations and worries, Norma Westwood maintains that her son is not well enough for a group home. At least for now he belongs home with them, she says.

For some time, when he was still taking his medicine, he was better able to mix in the community, his parents said. When he was 19, they took him home from the hospital, where he had earned his high school diploma. When he was almost 20, he lived for nearly a year in the District as a volunteer with advocate for the homeless Mitch Snyder and volunteers with the Community for Creative Non-Violence.

"The three of us were as happy as we have been," said Norma Westwood about that period, during which she and her husband also did volunteer work for CCNV.

But he broke down again and came home. He subsequently tried going to college at Northern Virginia Community College, where he got good grades, and did other types of volunteer work for local charities, such as driving for United Community Ministries. His mother said he made his own movies and was even interviewed about it on a local television station. But, she added, he grew discouraged because he was not doing as well as he hoped.

Since he stopped taking his medication nearly three years ago, "he has been really sick. He can't even read or watch television," Norma Westwood said.

Part of the strain of the disease is the unpredictable behavior that accompanies it. Years ago, the Westwoods recalled, their son disappeared and was later picked up for vagrancy in New Jersey. At times now, he remains silent for weeks, or wanders aimlessly talking to himself.

His hospitalization several years ago at a private hospital in Maryland was not an easy alternative. The initial decision was difficult enough. What followed was worse.

He escaped twice, once on a winter day wearing one shoe and no jacket. Someone finally saw him and called the police. On another occasion, one of the toughest for the family, they forced him to return to the hospital because a hospital doctor told them he was suicidal.

A more pragmatic difficulty of the hospitalization was the expense, even for a family with good insurance coverage. Care at private mental hospitals in Virginia generally costs more than $500 a day.

Under their plan with the federal government, the Westwoods said they paid 20 percent of the hospitalization costs. Ultimately, however, their insurance ran out.

They estimate they have spent about $100,000 of their own money for their son's care -- all their savings and stocks, plus a small inheritance.

"We've spent the money we have," said Andrew Westwood matter-of-factly. "Even when you have resources, it pretty soon runs out." The Westwoods carry more life insurance than they otherwise would.

To augment the family income, Norma Westwood started working part time at the American Horticultural Society a few years ago.

The Westwoods worry that the burden of their son's care eventually will fall on his older brother, with the help of a younger sister who now is away at college.

"I honestly don't know what I would do," Andy said of the possibility.

Andy shook his head when Norma and her husband mentioned the possibility that after they are gone he might find his brother an apartment nearby and help watch over him.

"If I did that, it would be the end of my life," he said.