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.
In May, Cheltenham police arrested John Ruggieri on charges of harassment and ethnic intimidation after a racially charged blowup with a neighbor.
"He did wrong," his father said. "But somebody like my son shouldn't be in prison. He should be in a hospital."
Sam Ruggieri had his son committed three times before his latest arrest. In each case, John Ruggieri violently attacked his father.
But after John landed back in jail in May, the elder Ruggieri was told that his son had refused treatment and could not be committed again since he had been only orally, not physically, abusive in his latest run-in with the law.
"His disease was enough to put him behind bars, but not enough to get him help?" Sam Ruggieri asked.
Stephen Schmitz, the Towamencin teenager shot by his police-lieutenant father, tried to strangle his brother and stab himself in the stomach with a knife before his family and police succeeded in having him committed to Horsham Clinic in May.
According to a report by the Montgomery County District Attorney's Office after his death, the family had done everything possible to take precautions and treat Schmitz, who struggled with diagnosed anxiety and depression.
His father removed all of his personal weapons from the house and often hid his service revolver in the trunk of his car. His parents and siblings devised an emergency plan should Schmitz turn violent again.
But in even the most prepared families, evidence of the need of further commitment can come too late. Schmitz's death June 8 demonstrates the dangerous gamble in waiting for an attack before forcing a patient into care, advocates of mental health changes said.
A day after he was released, Schmitz went after his father with a hunting knife. The two struggled until the father pulled out his service weapon and fired.
"This law is not perfect," said Tony Salvatore of Montgomery County Emergency Service, a nonprofit psychiatric hospital in Norristown. "But at the same time I'm not sure how you can realistically improve it while protecting the rights of patients."
Advocates of mental-health change have seized on the Schmitz case as an example of how tragedies could be prevented with the right laws.
State Sen. Stewart Greenleaf (R., Montgomery) has repeatedly introduced a bill that would make involuntary commitment easier to secure through the courts. Warning signs - such as a patient's refusing to take prescribed medication - would suffice to prove danger, rather than waiting for a violent incident to occur. Outpatient care, like that provided for in New Jersey law, would also become an option. The bill has never made it out of committee in Harrisburg.
New Jersey's statute, too, has run into problems. After the involuntary outpatient commitment bill was passed in 2009, Gov. Christie said last year that he would postpone implementation for fear the plan would put added strain on state budgets during an already tight year.
Meanwhile, parents such as Sam Ruggieri struggle to do what they can. Since his son's most recent arrest and authorities' refusal to consider another psychiatric commitment, he has bailed his son out of jail and tricked him into checking himself into a Montgomery County facility. He told his son that a judge had ordered treatment until his case was resolved.
"I've given up a lot of my life to try and see him straightened out," Sam Ruggieri said. "It broke my heart to see him in prison, and then to have to lie to him. Inside, I've been bleeding."
Contact staff writer Jeremy Roebuck at 267-564-5218, jroebuck@phillynews.com, or @inqmontco on Twitter. Read his blog, "MontCo Memo," at www.philly.com/montcomemo
