Grim choice for families of children refusing psychiatric treatment

With his 46-year-old schizophrenic son in jail, Sam Ruggieri wasn't thrilled about the lack of psychiatric care available behind bars.

But he couldn't help looking at recent headlines involving mental illness and wondering about the alternative.

In March, a 23-year-old Upper Merion man fatally stabbed his parents and twin brother after years of struggling with what relatives had decided was schizophrenia. Then, last month, a Hatfield police lieutenant shot and killed his 17-year-old son while fending off an attack from the teen a day after a mental-health clinic had released him.

"How can you not hear stories like that and think about your own situation?" asked Ruggieri, 75, of Cheltenham. "I pray to the Lord and hope I'm doing the right thing here for my son. So far, it's been a failed mission."

Those stories and Ruggieri's case highlight the difficult choices faced by families grappling with grown children who resist care for mental illness.

Under Pennsylvania law, involuntary commitment to a mental-health facility is an option only if patients have demonstrated within the last month that they are a danger to themselves or others. Even then, forced treatment can last no more than five days without a court order, and, once released, the patient is under no obligation to continue treatment or medication to control the illness.

New Jersey's laws echo Pennsylvania's. But the state passed legislation in 2009 allowing for outpatient care after an involuntary commitment to ensure that patients stick with their treatment plan.

In many cases, those tight restrictions - while protecting patient rights - leave families on edge, waiting for the worst to happen. In some, the evidence they need comes too late.

"It can be scary," said Joseph Rogers, chief advocacy officer at the Mental Health Association of Southeastern Pennsylvania. "Families often circle the wagons and close down because of the negative stigma around this type of illness."

Ruggieri is all too familiar with that stigma. His son John, whose paranoia and schizophrenia were diagnosed when he was 24, has become a target for taunting over the years from those who encounter his odd behavior. Lashing out, he has landed in jail a handful of times for causing scenes fraught with violent and offensive language. Often, his father says, his son doesn't remember his actions.