Donna Pitcher tried all summer to get her son committed to a psychiatric facility after she saw disturbing changes in his behavior. While she believed Dylan Collins posed a serious threat to himself and others, his doctors disagreed and her attempts to get him committed failed.

Pitcher’s situation illustrates how difficult it is to commit people with mental illness to hospitals against their will and the challenge that mental health professionals and the courts face in balancing public safety against individual rights.

Collins is accused of setting a fatal fire in a Biddeford apartment building on Sept. 18 that killed two young men and displaced two dozen tenants. He has been charged with two counts of murder and one count of arson.

Pitcher said the system failed her son, but those who work with the mentally ill in Maine say it’s not easy to commit someone to a mental health facility – especially an adult – against their will.

The threshold for involuntary commitment is high and in general requires several mental health professionals and a judge to assess whether someone does indeed have a mental illness, whether their recent actions and behavior pose a likelihood of serious harm, whether hospitalization is the best available treatment and whether a hospital’s individualized plan is adequate.

William Lee, a Waterville lawyer who has led seminars for the Maine Bar Association on involuntary commitment of the mentally ill, said it’s easy to pass judgment on how Collins’ case was handled in light of the tragic fire he’s accused of setting, but such cases are complex.

“Anybody who has raised a teenager knows kids get depressed, angry, upset. You can’t say we’re going to lock up every kid who says something threatening,” Lee said. “On the other hand, you can’t help but be very concerned and shocked when things go badly.”

Pitcher became concerned about her son when he began collecting materials to make bombs and started researching the 1999 mass shooting at Columbine High School in Colorado.

“He stated that he hears things, that messages are coming to him, in and out of his brain, from far away,” Pitcher said. “There was a major crack that occurred early this year.”

She was successful in getting her son admitted at least twice to a local hospital for short-term psychiatric evaluation, but Pitcher said there was never a court hearing to determine whether he should be hospitalized long term and treated for mental illness.

Pitcher said one doctor at Southern Maine Health Care declined to petition the court to have Collins committed at Riverview Psychiatric Center in Augusta, suggesting instead that Collins spend time in a homeless shelter.

Sue Hadiaris, a spokeswoman at Southern Maine Health Care, wouldn’t confirm Friday whether Collins had been admitted to the hospital over the summer or identify doctors that treated him, citing privacy laws.

Maine has a clearly defined legal process for admitting people with mental illnesses to hospitals against their will, but the system is not foolproof, according to professionals who operate within it.

Helen Bailey, an attorney with the Disability Rights Center, said she would not comment on Collins’ case, but spoke generally about the process of involuntary commitment.

“There is some inconsistency among hospitals and from one doctor to another on how a patient presents. It’s not a precise science,” she said. “I would like to see more consistency. We see people forced into hospitalization who don’t need it and we see people who are admitted and don’t get what they need.”

THE COMMITMENT PROCESS

The procedure by which a person can be committed against his or her will to a psychiatric hospital or a psychiatric unit within a general hospital is known as emergency involuntary admission.

Anyone can ask that someone be committed by filling out a form, commonly called a “blue paper,” saying that the person has a mental illness and poses a likelihood of serious harm because of that illness.

Once the blue paper is filled out, the person making the request must find a clinician to conduct a certifying examination.

If the clinician determines the person does have a mental illness and poses a risk to himself or others, he or she must get a judge or justice of the peace to approve it.

Arrangements are then made to find the patient a hospital bed. Administrators can admit the patient involuntarily, or voluntarily if the patient agrees.

Pitcher said she first requested a blue paper for her son in July and said he was initially committed to Southern Maine Health Care.

Upon admission after a blue paper, a doctor or psychologist must examine the patient within 24 hours. By law, hospitals can keep patients on a blue paper admission for only three days, not counting the day of admission.

If the hospital believes the patient needs continued hospitalization, it can do one of two things: admit the patient voluntarily or file a court order if the patient fights hospitalization.

The court order for a long-term hospitalization, known as a “white paper,” must be filed in the district court of jurisdiction.

Pitcher said she pushed for the white paper process for her son, but said doctors at Southern Maine Health Care disagreed that Collins posed a serious risk and that a court hearing was never held.

The hospital did keep Collins for a month – much longer than the three days allowed under the blue paper – but he was released on Aug. 28, about three weeks before he allegedly set fire to the apartment building.

Had Pitcher succeeded in getting a court hearing, the court would have notified her with a hearing date no later than 14 days after the order was filed.

At that hearing, two mental health professionals would have presented the findings of their examination of Collins, who would have had the option of choosing one of the examiners.

Collins could have testified and could have called witnesses to testify as well.

Then, a judge would have been asked to decide, based on “clear and convincing evidence,” whether Collins had a mental illness, whether his recent actions and behavior posed a likelihood of serious harm, whether hospitalization was the best available treatment and whether the individualized plan offered by the hospital was adequate.

“What you’re dealing with is a balancing test between protection of society and protection of an individual’s liberty,” said Lee, the Waterville lawyer. “The criteria is strict.”

Although he wouldn’t speak about the specifics of Collins’ case, Lee said people with mental illness, even those who pose a serious threat, can still present as non-threatening.

“How many times do we read about how so-and-so was so normal before they committed a horrific crime?” he said.

PROBLEMS WITH THE SYSTEM

In cases where a judge rules in favor of admission, a patient can be held involuntarily for up to four months per state law. Once that commitment period ends, the hospital can apply to have the patient recommitted for up to one year.

At any point during commitment, however, the hospital must discharge a patient if he or she no longer needs hospitalization.

According to the State of Maine judicial branch, which handles commitment cases, there were 929 requests for involuntary commitment brought before the district court in fiscal year 2014, which ended June 30. The state does not track how many of those led to a commitment order from a judge, according Mary Ann Lynch, spokeswoman for the judicial branch.

The number of commitment requests annually has hovered around 1,000 for the last five years.

Rep. Richard Malaby, R-Hancock, a member of the Health and Human Services Committee, is convinced Maine’s mental health system is failing and that Collins’ case is a tragic reminder.

“The parents are the canaries in the coal mine,” he said. “We’ve got to make it easier for them.”

Malaby wants to sponsor legislation to improve the process by which patients with mental illnesses receive treatment, though he doesn’t know what the ideal solution would be.

“It’s such a complex problem,” he said. “But we can’t keep letting people fall through the cracks, especially when it leads to tragedy.”

Lee believes the greater problem is not in the involuntary commitment process, but in getting proper treatment for those with mental illness.

“That’s how people slip through the cracks,” he said. “But (treatment) is difficult and it costs a lot of money.”

Jeffrey Austin, vice president of the Maine Hospital Association, said the current system for handling mental health patients “does not reflect reality,” and agreed that changes are needed.

“Behavioral health issues in this state are dramatic and rampant,” he said. “It’s probably the thing we hear most about from members.”

Staff Writer Scott Dolan contributed to this report.