By Carrie Spencer
The Associated Press

COLUMBUS - Every year the refusal to take medication to treat a mental illness leads to assaults, killings and suicides that could have been prevented, while a legal tool to enforce treatment is seldom used, advocates say.

A Cincinnati man with bipolar disorder was sentenced to death in February for torturing and killing an 85-year-old friend. A Dayton-area woman with a long history of mental illness was found incompetent in April to stand trial on charges that she killed her neighbor over loud music.

And a Columbus man who went long stretches without medication for his paranoid schizophrenia has been accused in a series of shootings along central Ohio highways, including one that killed a woman. He could face the death penalty if convicted.

Mental health advocates say severe mental illnesses can have a tragic symptom: The delusions convince the person that there is no illness. Worse, doctors and concerned family members recommending treatment could be seen as part of a plot.

"If we had the appropriate resources to bring to bear on treatment, we probably would be able to prevent some of these tragedies," said Jim Mauro, board president of the National Alliance for the Mentally Ill of Ohio.

Ohio is one of 42 states with some type of law allowing court orders to comply with treatment without commitment to a hospital, according to the Arlington, Va.-based Treatment Advocacy Center.

But many family members and even judges aren't aware of the ability, said Mary Zdanowicz, director of the Treatment Advocacy Center. Dwindling resources and court challenges also uphold use of the laws.

"In most courtroom settings, if the person does not present a danger to themselves or the community, judges are reluctant to order someone into anything," Mauro said. "There is a debate over whether or not that's an abuse of power over someone's life, someone who's not committed a crime."

The Alliance supports ordering treatment, he said, especially if the person's behavior is a health risk.

About 1.8 million people are not receiving treatment out of about 4.5 million people with the most severe mental illnesses, according to the Treatment Advocacy Center. "They think they don't need help," Zdanowicz said.

Ohio law contains a two-step process for ordering treatment, said Sam Hibbs, spokesman for the state mental health department.

A probate judge can order a person committed to a county mental health board, instead of a hospital, and the county can monitor the person's progress. After evaluation, a separate court order can require taking the medication.