Sadly, Sergei and De-Kieu – whose heinous crimes were committed three months apart – reflect the deadly pattern of what happens when schizophrenia or manic-depressive illness – the two severest forms of mental illness – is allowed to progress untreated.

We cannot point to a lack of community services for the mentally ill to explain why this tragedy occurred. For years, Salt Lake City’s outpatient services for the severely mentally ill have been ranked very high when compared to other communities around the country. Why were Sergei and De-Kieu not benefiting from these community services? Two reasons: The nature of the illness, and a law that prevents timely treatment.

Nearly half of those individuals who have schizophrenia or manic-depressive illness lack awareness of their disease, which is a documented and diagnosable symptom. These individuals do not recognize that the other symptoms of their illness – hallucinations, delusions, paranoia and withdrawal – are, in fact, symptoms. As a result, they consistently refuse to take medication because they do not believe they are sick, and commonly will only take it under some form of assisted treatment.

When they refuse treatment, Utah’s assisted treatment law prevents them from receiving treatment until it is too late. Ironically, Utah’s law actually recognizes that people with these illnesses may lack ‘the ability to engage in a rational decision-making process regarding the acceptance of mental treatment as demonstrated by evidence of inability to weigh the possible costs and benefits of treatment.’ However, the law prohibits treating individuals over objection, until they pose an immediate danger of physical injury to themselves or others. In other words, an individual must have his or her finger on the trigger before any appropriate medical intervention will be provided.

Many states have already abandoned the immediate dangerousness standard for treatment. These states consider factors such as deteriorating to dangerousness, being unaware of a need for treatment, having a history of medication non-compliance or violence. Sergei and De-Kieu both had prior histories of violence. In 1996, a knife wielding De-Kieu went to a radio station looking for a disc jockey she believed was putting voices in her head. She was not required to continue taking her medication after that incident, and she started believing that television reporters were harassing her. In January, she killed one person and wounded two others when she tried to enter the television studio in Salt Lake City with a gun. Sergei should have been required to take medication after he was arrested for fighting and carrying a gun. Instead, he was not taking his medication yesterday when he killed two people and wounded four others.

Utah is one of 39 states that uses assisted community treatment to substantially improve the lives of those suffering from severe mental illness and enhance the communities in which they live. Using assisted community treatment laws, such as outpatient commitment (OPC) or conditional discharge, an individual is required to participate in treatment (including medication compliance) as a condition of living in the community. Long-term OPC has been shown repeatedly to be more effective in improving outcomes for severely mentally ill individuals than routine outpatient care. For example, among patients who had been outpatient committed in Arizona, 71 percent voluntarily maintained treatment contacts six months after their court orders expired compared to almost none of the patients who had not been put on outpatient commitment. A study in Iowa showed that 80 percent of patients in outpatient commitment complied with their treatment programs. After their outpatient commitment term expired, some three-quarters of that group remained in treatment on a voluntary basis. Sergei and De-Kieu, and their victims would have benefited from assisted community treatment. Unfortunately under Utah law, an individual must pose an immediate danger to qualify for such programs – past history does not count.

People are uncomfortable talking about mental illness and the need to help those who do not recognize they are ill, like the homeless and incarcerated mentally ill. But, that discomfort is nothing compared to the suffering that these illnesses cause. These are not pleasant illnesses. Victims of untreated schizophrenia suffer delusions and hallucinations – alterations of their reality that prevent them from enjoying the pleasures of life that we all enjoy: family, friends, homes, and careers. Many people spend their lives trying to escape demons that do not really exist.

The consequences of failing to treat these illnesses are devastating. For example, Americans with untreated severe mental illnesses represent less than one percent of the total U.S. population. These individuals commit nearly 1,000 homicides each year, or between four and five percent of the total annual murders. At least one-third of the estimated 600,000 homeless individuals suffer from schizophrenia or manic-depressive illness, and 28 percent of these people forage for some of their food in garbage cans. At least 10 percent, or 170,000 individuals, of our jail and prison populations suffer from these illnesses, costing American taxpayers a staggering $8.5 billion per year. Moreover, studies suggest that delaying treatment results in permanent harm, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms. In addition, persons suffering from severe psychiatric illnesses are frequently victimized. Studies have shown that 22 percent of women with untreated schizophrenia have been raped. Suicide rates for both males and females suffering from schizophrenia and manic-depressive illness are much higher than for the general population.

It’s time to reverse course. Mandatory treatment for those too ill to recognize their need for treatment is a much more humane intervention than what we have now: mandatory non-treatment. The legal standard for assisted treatment should be the need for medical care, not dangerousness. Society has an obligation to save people from degradation, not just death. This does not mean that we will have to reopen all the psychiatric hospitals that have closed as a result of deinstitutionalization. Most individuals with severe mental illnesses who have experienced severe deterioration in rational thought can live in the community with the proper medications. For some, living in the community must be conditioned on continued medication compliance. OPC and conditional hospital release must be available before a person becomes dangerous to ensure that these individuals succeed in the community and to prevent senseless tragedies like those witnessed in Salt Lake City this year.

Utah’s laws failed Sergei Barbarin, De-Kieu Duy, their victims and the families of everyone concerned.