mental health treatment a challenge for families.(Front)

By Gillian Flaccus

The Associated Press

TUCSON, Ariz.

Jared Loughner had never been in major trouble with the law or overtly violent, but his behavior at his community college was so disturbing that campus police gave him and his parents an ultimatum: Get a mental health evaluation or don't come back.

Loughner went away, but his deteriorating mental condition didn't. Just more than three months later, he is charged in a mass shooting that killed six people and left Rep. Gabrielle Giffords wounded with an uncertain recovery.

For those living with mentally ill family members or friends, the tragedy plays on their deepest fears and raises a more heart-wrenching and personal question: When and how should loved ones intercede to force someone to get help?

Parents who suspect that their child might have a major mental illness face an array of emotional and bureaucratic hurdles, including their own fears, strict laws that limit involuntary commitment, and severe cuts in services. For many, the battle for intervention and treatment seems like a never-ending nightmare.

"I would bet that every parent who has a son or daughter with schizophrenia or bipolar disorder or any major brain disorder all feel the same thing now: There, but for the grace of God, go I," said the mother of a 35-year-old son with schizophrenia, who has been off his medication for nine years. The woman requested anonymity because she believes that her son - an avid reader of Internet news - would sever contact with her forever for speaking to the media.

"My heart goes out to the family," the mother said. "They didn't cause this; you can't cause a brain disorder in your family."

Police are also hamstrung by legitimate concerns about civil rights and due process that are rooted in historic abuses of the mentally ill, said Timothy Schmaltz, chief executive of the Phoenix-based group Protecting Arizona's Family Coalition.

In Loughner's case, it appears that despite the concerns of campus police, professors and other classmates, the 22-year-old was never diagnosed with what experts say seems to be a clear-cut case of schizophrenia.

That he fell through the widening cracks of the mental health system is a common scenario for families who might want help with a major mental illness.

They are confronted with an overwhelming struggle - a fight that often begins with the person they're trying to help.

One of the key symptoms of schizophrenia, for example, is a lack of awareness and denial that anything is wrong, said Mark A. Kalish, a practicing psychiatrist who also teaches at the University of California, San Diego.

This means that even as a person's behavior spins increasingly out of control, he or she refuses treatment.

In many states, adult patients cannot be involuntarily committed unless they are found by a court to be a danger to themselves or others.

It's unclear what the Loughners did, if anything, to get their son help after the meeting with campus police, and it's also unclear if the college reported his bizarre behavior to local authorities. College officials did not return calls.

In the wake of the Virginia Tech killings in 2007, the federal government set up teams from the Department of Education and the FBI to determine how to identify individuals whose behavior causes concern or is disruptive and assess whether the person has the intent or ability to carry out an attack.

The Virginia Tech shooter, Seung-Hui Cho, had been involuntarily committed to outpatient therapy by a judge before killing 32 people and himself.

Arizona has one of the most flexible statutes for involuntary commitment and allows anyone with knowledge of the person's behavior - a teacher, a parent, a police officer, a friend - to petition for a court-ordered mental health evaluation, the first step toward involuntary treatment, said Kristina Ragosta, legislative and policy counsel at the Treatment Advocacy Center in Arlington , Va.

But even within the context of a flexible law, parents or government authorities seeking to have someone committed find services eviscerated by budget cuts that in some cases have slashed everything but crisis services for those with mental illness, said Robert Bernstein, a psychologist and the executive director of the Bazelon Center for Mental Health Law in Washington, D.C.

In Arizona over the past two years, for example, 14,000 mentally ill patients have had all services cut except for their medications.

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