Arizona makes it much easier than many other states to force a mentally disturbed person to get psychiatric help, even without evidence of dangerous behavior.
A provision in state law, little known outside the law enforcement and mental-health systems, gives any adult the right to petition the court for a psychiatric evaluation and, if needed, court-ordered care for someone "persistently and acutely disabled" by symptoms of mental illness but unwilling to seek or follow medical advice.
Mass-shooting suspect Jared Lee Loughner of Tucson - who shouted at his college teachers, rambled incoherently to campus police and posted delusional tirades on the Internet - appears to fit the criteria for such a court-ordered evaluation, said Charles "Chick" Arnold, a leading Arizona expert on mental health and the law.
Yet no one sought such an intervention, and no evidence has emerged that Loughner received care of any kind.
Arnold, a Phoenix attorney, believes Pima Community College officials dropped the ball by not taking steps to initiate a court-ordered evaluation of Loughner, even when he became such a discipline problem they suspended him from campus last fall.
Loughner instead received a letter telling him not to come back until he'd been assessed by a mental health professional. He responded by dropping out, a few months before he's accused of going on a shooting spree that targeted U.S. Rep. Gabrielle Giffords, killing six people and wounding 13.
Arnold said the college was under no legal obligation to seek a court-ordered screening for Loughner, but should have done so because of the student's obviously deteriorating condition.
By simply kicking him out of school, he said, officials "took action that they believed would protect the college community. What they failed to do was was protect the community at large."
Alice Callison, a lawyer for the college, defended the handling of the case.
"I think the college responded in a very reasonable fashion," she said. Loughner "had not committed any crime. He was not a danger to self or others. He didn't seem to be in an acute crisis."
It's not Pima's practice to seek court-ordered screenings of such students, she said. Campus police typically summon help from Mobile Acute Crisis teams - psychological emergency squads run by the Southern Arizona Mental Health Corp. - but only if a student's behavior is overtly violent or threatening.
In such cases, it's the mental-health team's call as to whether to seek a court order for psychiatric care, Callison said.
Joel Dvoskin, a Tucson forensic psychologist who also works as a threat-assessment consultant, said while it may be tempting to second-guess what the college did or didn't do, officials likely did the best they could at the time with the information they had.
However, he said, college officials should try to learn from what happened.
"My advice to Pima College would be to enter into a potentially self-critical but open-minded review of what happened and what could possibly be done differently in the future," said Dvoskin, who helped train crisis responders at the University of Arizona after a student shot and killed three people at the College of Nursing in 2002.
Loughner did not receive publicly funded mental-health services in Pima County, said Neal Cash, executive director of the Community Partnership of Southern Arizona, which contracts with the state to supervise that system.
"Believe me, it's one of the first things we checked," he said.
Because Loughner had never been hospitalized for mental illness, he was legally able to buy a pistol that he's accused of using in the shooting.
Although Arizona's law can compel mentally ill patients to get help, people rarely use it.
Often it's because they don't know about it, explained H. Clarke Romans, executive director of the Southern Arizona chapter of the National Alliance on Mental Illness. "It's not something they teach you about it civics class," he said of the statute.
Family members often are reluctant to seek help because they feel overwhelmed or embarrassed by a loved one's strange behavior, or they may be ignorant about the symptoms of mental illness, he said
"Families are in many ways just as devastated by these illnesses as the person themselves," Romans said. "It just crushes families."
Often, those outside the family are reluctant to get involved.
The law doesn't require that the person who petitions the court be related to the potential patient. It says only that the petitioner must be a "responsible individual" with knowledge of the person's behavior. That can be a friend, a neighbor or anyone else who has information and is willing to fill out the paperwork.
"People are often afraid to intervene," said Mindy Bernstein, executive director of Coyote Task Force, a downtown agency that has offered support and services to the seriously mentally ill since 1992. "But my experience is that when someone is that ill, it's more dangerous to not intervene."
She and her staff have initiated some 200 petitions over the years.
The Pima County Attorney's Office typically files about 1,800 petitions a year seeking treatment for the mentally ill, said Amelia Craig Cramer, chief deputy for the Pima County Attorney's Office, which is involved in bringing such petitions before the courts.
Some cases are precipitated by violent outbursts or suicide attempts that involve law enforcement, others by worried family members.
Roxanne Prillwitz, a longtime manager of Coyote Task Force's Our Place Clubhouse, said she encourages family members and others to not be afraid of the petition process.
"If someone were having a heart attack or was hit by a car and bleeding, we don't have a second thought about calling an ambulance for help," she said. "But when someone is experiencing a psychiatric crisis, too often we don't want to get involved."
But we're a community that must look out for each other, said Suzanne Hodges, chief compliance officer with the Community Partnership of Southern Arizona.
"People think that somebody else will make the call," she said. "They think it's not their place to call. But it's everybody's place. What kind of a community are we if we don't accept responsibility for everybody?"
In the Tucson area, seeking a court-ordered psychiatric assessment starts with a call to the 24-hour community-wide crisis line at 622-6000 or 1-800-796-6762 or visiting the midtown offices of the Southern Arizona Mental Health Corp., 2502 N. Dodge Blvd.
The agency, known as "Sam-hac," helps people through the process. After paperwork is completed and notarized, the agency sends a team to visit the person. If there is cause to move forward, the County Attorney's Office notifies law enforcement to pick up the person and transport him or her to the hospital for evaluation.
Once a petition is filed, law enforcement has 10 days to get the person to the hospital. If they are unable, the petition expires and the process starts again, says Dr. Laura Waterman, clinical director for the mental health corporation.
Once the person is at the hospital, they are evaluated by two psychiatrists, Waterman said. Then there is a hearing before a judge, who hears testimony from doctors, the petitioner and possibly the patient.
The result could be a court order for treatment, which typically involves a hospital stay until a patient is stabilized followed by outpatient care. If patients don't comply with treatment - by not taking medication or going to therapy, for example - the court can order them back into the hospital.
The court order, which is good for one year, includes a certain number of days available for inpatient treatment. But the time periods differ depending on whether people are deemed a danger to themselves (90 days), to others (180 days) or "persistently and acutely disabled" (180 days).
Calls can be made anonymously to a crisis line to report concerns about someone's mental health. However, those who make formal petitions to the court are identified once the case is in the legal system.
- M. Scot Skinner