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Preventable Tragedies?

Too often, insufficient treatment of mental illness end in tragedy.

Three weeks ago on May 8, Michael W. Kennedy, 18, drove a carjacked minivan to the Sully District Police Station in Chantilly and opened fire with an AK-47 and other high-powered firearms, killing two Fairfax County police officers.

Four days later, 24-year-old Nathan P. Jones stabbed his mother to death in the kitchen of their home in the Mosby Woods neighborhood of Fairfax, according to police.

On Christmas morning of last year, Nathan W. Cheatham, 27, went on a shooting rampage in Great Falls that left his mother, three family friends and himself dead of gunshot wounds.

All three young accused killers sought treatment for mental illness in Northern Virginia psychiatric clinics, according to interviews with neighbors, attorneys and police records.

None, however, apparently received the treatment they needed to quell their violent impulses, said mental health advocates and public officials.

In the case of Kennedy, the troubled teenager's parents had sought psychiatric help for their son over a three-month period. At least four times, the family's attorney said, Northern Virginia mental health clinics turned them away.

"Too many people with mental illness are slipping through the cracks," said Fairfax County Supervisor Cathy Hudgins (D-Hunter Mill), chair of the Board of Supervisors' human services committee. "The situation is grim, very grim."

MULTIPLE BARRIERS exist for people with mental illness to receive timely, comprehensive treatment.

In fall 2004, hospitals in Woodbridge, Alexandria, Falls Church and Arlington closed their psychiatric wards, reducing the number of spaces for in-patient care in the region by 100.

In the last 15 years, the amount of available psychiatric treatment beds in Northern Virginia has been reduced by more than half. In all, the region has only 196 psychiatric treatment beds, serving a total population of about 2 million residents.

"We're losing beds and that's a big cause for concern," Hudgins said. "As it stands now, we're waiting until the most serious situations before we offer treatment."

With fewer psychiatric treatment beds, waiting lists for public mental health services have grown. There are 300 patients currently seeking an initial assessment of their mental health problems, and each one will wait between one and three months, according to statistics provided by the Fairfax-Falls Church Community Services Board.

Once evaluated, the patients with the most acute problems — who need to enter a residential psychiatric treatment center — are waiting even longer. More than 600 people with mental illness are currently on the residential treatment list, waiting anywhere from a few months to a few years, said Dr. John Defee, director of mental health services at the Community Services Board.

With the lack of available beds, people with mental illness often must travel far outside the region for treatment, discouraging many patients from making the trip, mental health advocates said.

"If people can't be treated within their own community, they're less likely to seek treatment," said Carol Ulrich, president of the National Alliance on Mental Illness of Northern Virginia.

FAIRFAX COUNTY offers 24-hour emergency mental health services at the Woodburn Center for Community Mental Health in Fairfax and a mobile crisis unit patrols the county to assist people with mental illness who are "in crisis."

"No one is denied services," said Dr. Jim Kelly, manager of emergency services for the Community Services Board. "People should know we're always accessible."

People with mental illness who believe that they are "in crisis" will receive treatment, jumping ahead of other patients on the waiting lists, Kelly said.

Doctors cannot easily force an unwilling patient to enter emergency services.

Police officers may only detain a person with mental illness for four hours under an "emergency custody order." To hold a person for longer, a "temporary detention order" must be obtained from a Community Services Board evaluator within the four-hour window.

A temporary detention order allows officials to detain a person who is deemed to be in "imminent danger" to himself or others for 48 hours. Only a court order allows the state to commit a person with mental illness for an extended period of time.

Police officers frequently complain they cannot obtain the two-day detention order within the four-hour window, causing them to turn loose a potentially dangerous person with mental illness, Ulrich said.

Moreover, some advocates said, Virginia's "imminent danger" requirement stymies treatment for people who are likely to harm themselves or others, but haven't done anything yet.

Too often, advocates said, mental health treatment officials will interpret the "imminent danger" guidelines too strictly and inconsistently, offering space only to the most obviously dangerous patients.

In Kennedy's case, the Centreville teenager was apparently not considered to be in "imminent danger" and was turned away from Northern Virginia clinics.

"He was turned away, but he was actually in serious trouble," Ulrich said. "We now know just how serious his problems were."

PETE EARLEY, a Fairfax resident and author of "Crazy: A Father's Search Through America's Mental Health Madness," encountered the barriers of the mental health system when he sought treatment for his college-age son at a Fairfax hospital.

Earley's son was delusional and had been hospitalized twice for bipolar disorder. He believed pills were poison and refused treatment. However, a doctor decided the young man did not pose an "imminent danger," and turned Earley away.

Two days later, Earley's son, Mike, broke into a house to take a bubble bath. The homeowners decided to press charges.

"When I tried to get my son help, I couldn't get him help," Earley said.

Det. Vicky O. Armel, who was gunned down by Kennedy in the May 8 shooting, was assigned to Earley's son's case. Through each step of the criminal justice process, Armel served as an advocate for his son, Earley said. In the end, she convinced the homeowners to agree to a light sentence in a community treatment program.

Earley believes Virginia's "imminent danger" requirement for involuntary treatment needs to be amended to more easily allow people with mental illness to get meaningful treatment at critical times.

"I really think Virginia's imminent danger rule needs to be examined because it's keeping people in trouble from getting the help they need," he said.

Kelly, of the Community Services Board, said that just because someone has mental illness does not mean they are dangerous. The decision to treat someone against his or her will, he said, must always be weighed carefully.

"You can look back and say 'This was a missed opportunity' or 'That was a missed opportunity,' but we're all under the constraints of the law. And that's not a bad thing. The law is there to preserve people's civil liberties," he said. "It's a very serious judgment to deny someone their freedom."

OVER THE PAST DECADE, health insurance companies have steadily reduced coverage for mental health treatment, said Dean Montgomery, executive director of Health System's Agency of Northern Virginia.

"The services have certainly not kept up with the growing demands," he said.

Typical health insurance plans, Montgomery said, once covered comprehensive in-patient mental health treatment. Now, health insurance companies typically agree to pay only for the cheaper out-patient care, he said.

"There is, and has been for some time, a need for a broader array of both in-patient and out-patient mental health services across the board in Northern Virginia," Montgomery said.

Effective treatment of mental illness requires a sustained combination of pharmacological and psycho-social therapy, reducing symptoms and improving quality of life for 70 and 90 percent of patients, according to the National Alliance on Mental Illness.

Nationally, the advocacy group estimates that untreated mental illness costs upward of $100 billion.

Mental illness affects between 5 and 10 million adults (2.6 to 5.4 percent) and 3 to 5 million children, aged five to 17 (5 to 9 percent) in the United States, according to the alliance.

According to the Treatment Advocacy Center in Arlington, between 34 and 54 percent of people with mental illness are not receiving treatment.