I last saw my sister Susan alive on Dec. 3, 2008. A few days later, curled up on the back porch of a vacant house in Reading where she had once lived, she froze to death.

Though my mother and I had searched for Susan every day in the months after she disappeared, we didn't find out what happened to her until May 2009, when her decomposing body was discovered by a man hired to work on the house. The official cause of death was "hypothermia by psychosis." In other words, my sister died because she was too mentally ill to take the most basic steps necessary to keep herself alive.

Not a day goes by when I don't think of Susan. But some days bring back the tragedy of her death more awfully than others. One of those days was this month, when I learned of the death of Paulette Wilkie of Bucks County.

Paulette, 56, died of exposure in Morrisville on Dec. 5, officials said. Like Susan, she reportedly suffered from schizophrenia. Like Susan, she had lain down outside in a delusional state and had frozen to death as a result. Paulette reportedly had family members who wanted to get her into treatment, too, but, like Susan, she refused offers of help.

Paulette probably had anosognosia, a condition that causes about half of all people with schizophrenia to be unaware that they are sick. Certainly, she needed medical intervention that she didn't get.

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Tragically preventable

Apart from the horrible circumstances, what makes the suffering and deaths of my sister and Paulette Wilkie even more tragic is that they were preventable.

A 1976 Pennsylvania law called the Mental Health Procedures Act is supposed to assure that people with mental illness who can't voluntarily seek psychiatric care get the help they need. It defines the circumstances under which a court can order involuntary treatment, either as an inpatient in a hospital or as an outpatient in the community.

But the law isn't working and needs to be fixed.

For either inpatient or outpatient involuntary care to be ordered, the law requires that a person constitute a "clear and present danger" to herself or others. Most of us would agree that my sister and Paulette were dangerous to themselves when they decided to lay down in freezing temperatures. But as countless preventable tragedies have shown, it's unrealistic to expect authorities to be on the scene and ready to act the moment the danger of a person's mental illness rises to the level of "clear and present."

Training mental-health professionals to use this broken, 35-year-old law - which is the $500,000 "fix" currently being undertaken in Pennsylvania - doesn't change the fact that the law is broken.

It would make far more sense to authorize intervention when it's obvious that a person is on the road to becoming a clear and present danger - that is, when he or she is refusing treatment for severe and chronic mental illness. nolead begins

Commonsense solution

State Sen. Stewart Greenleaf (R., Montgomery) has repeatedly introduced a bill that would really fix Pennsylvania's involuntary-care law. It would not alter the current standard for involuntary commitment to a hospital, but it would make commitment to outpatient care a practical means of preventing psychiatric crises. In the legislative session now ending, Rep. Mario Scavello (R., Monroe) introduced the bill in the state House, and both legislators are expected to submit it again when the legislature reconvenes in January.

The legislation has the support of statewide groups representing people with mental illness, their families, police, and sheriffs. Common sense and multiple studies from other states show that outpatient commitment is a compassionate, cost-effective alternative to criminalization, victimization, homelessness, repeated hospitalization, and death.

Nevertheless, the bill has never gotten out of committee in Harrisburg. Each time it's been introduced, it's been fought by misguided defenders of mentally ill people's "right" to refuse lifesaving treatment.

On the heels of Paulette Wilkie's death, Bucks County issued a "Code Blue," which provides emergency shelter for the homeless on freezing nights. While commendable, however, it won't make a difference for those like my sister and Paulette. People as ill as they were can't accept help, because they don't know they're sick.

These people need more than a shelter. They need lawmakers to understand that, for some severely ill people, involuntary treatment can be the difference between life and death. And without a more humane and effective commitment law, preventable tragedies will continue to occur.

Mark McDonough lives in Reading. He can be reached at rememberingsusan@yahoo.com.