I was thinking about a woman I never knew today. Her name was Gloria Leonidas, and she was one of five people killed just over a year ago in what has become known as the Seattle café shooting spree. Gloria was a wife, mother of two daughters and well-known community volunteer. The day she was shot started out just like any other day for her. And then she was gone.

The man responsible for her death, Ian Stawicki, had shown a variety of mental illness symptoms over the years, becoming increasingly violent in the last handful. He’d never been a patient at a psychiatric hospital, but was charged twice with misdemeanor assaults (charges that were later dropped). He owned guns. His family knew something was wrong with Ian, but didn’t know how to get help for him, and Ian wouldn’t seek help on his own.

This isn’t a unique case. Margaret Ryan was killed in Seattle last year, too, by her mentally-ill son, Brodie Lamb. He was also known to have violent outbursts, but unlike Stawicki, he’d previously been both convicted and treated with medication for his illness. He refused to comply with court orders for continued treatment of his mental illness, however. And then he killed his mother.

There are good arguments against involuntary treatment for mental illness, and I agree that no one should be forced to take medication except when they’re a threat to themselves or others. But why aren’t more states willing to put adequate money into funding follow-up outpatient care for a person with a serious mental illness?

According to a recent study on involuntary outpatient treatment, a state’s investment in such programs, where caseworkers visit patients to ensure they stay with their therapy and medication, can lead to lower overall health care costs. Researchers at Duke University found that patients in the program require fewer revolving-door hospital visits and become more productive in society. Here are the stats.

Forty-five of the 50 U.S. states have some form of involuntary outpatient treatment, however the level of states’ investment is so varied that for all intents and purposes, in some places, the program doesn’t exist. Other states, such as New York, have invested heavily. The program took shape there after 32-year-old Kendra Webdale was pushed to her death on the tracks of a New York subway by a man suffering from schizophrenia. But even with New York’s significant investment, it happened there again just last year, when Ki Suk Han was killed.

So where do we go from here? Do we keep trying to build involuntary outpatient programs (and plug the holes in the existing outpatient programs)? And can we do that without stomping all over basic civil rights? Or does the safety of the whole outweigh the rights of the individual in these cases?

What are your views on this issue? All opinions are appreciated.

Note: this post was updated on 08/31/13 to correct references to “involuntary outpatient commitment” where it should have read “involuntary outpatient treatment,” including in the title of the post. D’oh!