Shootings expose flaws in mental health system

But just getting patients diagnosed or enrolled in treatment often isn't enough. Virginia Tech gunman Seung-Hui Cho was ordered into outpatient treatment before he killed 32 people in 2007.

This summer, prosecutors say, James Holmes killed 12 people at a midnight premiere of a new Batman movie in Colorado. His attorneys say he had an undisclosed mental illness, and his psychiatrist tried to report him to a campus behavioral and security committee.

Experts say it can take years before patients agree to stick with a prescribed treatment. Elyn Saks, a law professor at the University of Southern California, has schizophrenia and, without medication, starts to believe she can kill hundreds of thousands of people with her thoughts. Until the mid-1990s, when she was in her 40s, Saks tried periodically to skip her drugs.

"I felt so ashamed," said Saks, a MacArthur Foundation "genius grant" winner for her contributions to mental health law. "It's an internalized stigma. I wanted to be whole, I wanted to be well. Each time I tried to get off medication, I did it with great gusto and failed miserably." Now, she takes her pills. "Frankly, I'm sorry I wasn't smarter sooner."

Earley initially didn't stick with treatment after his father lied to get him into a hospital. He became violent — he was shot with a Taser by a police officer at one point — and was hospitalized five times before he realized he couldn't live without his medication.

"I know I have a mental illness and if I leave it untreated it will destroy me," said Earley, who now works full time as a peer counselor in Fairfax County, Va., helping others with severe mental illnesses. With treatment, he said, "I have my own apartment, a car ... I'm able to do things with friends and family. I have a job I can go to that gives me pride."