Clifton Perkins Hospital Center, where two patients recently were killed by other patients, is one of several broken mental health facilities in Maryland ("Man indicated on murder charge in Jessup mental hospital death," Nov. 11). People typically wind up there as a result of having committed a violent act stemming from a severe untreated mental illness. Tragically, only by committing violence can they get help.

That's because Maryland has one of the most restrictive civil commitment laws in the nation. People who are so disabled by severe mental illness that they can't seek or accept care don't receive treatment unless they become dangerous. Until then, they're just out of luck.

All but five other states use a different approach to treating people with the most severe mental illnesses. It is called assisted outpatient treatment (AOT), and it makes it possible for people who meet certain criteria to receive court-ordered outpatient treatment either before they are so ill they need to be hospitalized or after they are discharged from a hospital.

This form of treatment commits the community mental health system to monitor, oversee and otherwise be engaged with patients suffering from severe mental illness. AOT stops the revolving door that leaves people with severe mental illness cycling repeatedly through hospitals, jails, prisons and the streets. And it saves lives in the process.

Far too often, the violence that lands a person at Perkins is followed by family members saying they tried to get treatment for the patient but were unable to do so. Until Maryland broadens its civil commitment standard beyond dangerousness and makes treatment available to severely mentally ill people before they commit a violent act, this will continue to happen.

Aileen Kroll, Arlington, Va.

The writer is legislative and policy counsel for the Treatment Advocacy Center.