Two deadly attacks in the past month have put a spotlight on Minnesota's system for those with serious mental illness, where the common refrain from those involved with the work is that there's "not enough."

Not enough workers. Not enough early intervention. Not enough treatment facility or group home beds. Not enough services after someone leaves treatment.

"There's just a real dire shortage of what is needed to help this portion of the population," said Doug McGuire, who coordinates the Hennepin County Commitment Defense Project, where attorneys represent people facing potential court-ordered treatment.

The first killing occurred the day before Thanksgiving, when police say a man with a lengthy criminal and mental illness history stabbed a man to death at an Edina bus stop. Two weeks later, the Loring Park neighborhood was rocked after another man impaled a grocery store clerk with a golf club, according to charges in the case.

Both of the suspects had been civilly committed to involuntary treatment within the past few years, after they were found to be at risk of harm due to their mental illness.

Other states and cities besieged by mental health crises — including California, Oregon and New York City — recently have been re-examining their civil commitment laws or taking controversial steps toward involuntarily hospitalizing more people with serious mental illness.

While Minnesota is short on services, the state has long had a robust system for involuntarily committing people who pose a danger to themselves or others. The Treatment Advocacy Center, which pushes for wider national use of such practices and grades states' commitment laws, gave Minnesota an A+, the highest score of any state.

Call for more services

Only a very small fraction of people with serious mental illness ever commit violent acts. There's no single answer to prevent such unpredictable, tragic cases, said court, hospital, county and state officials.

Instead, they pointed to a multitude of inadequacies they said need to addressed, starting with catching conditions early and reducing the stigma that prevents people from seeking treatment.

"These kinds of rare but very serious situations, we have to figure out how can we intervene earlier," said Sue Abderholden, executive director of the National Alliance on Mental Illness Minnesota.

She said she hears over and over from people who have a family member experiencing symptoms, like hallucinations or delusions, but the person won't voluntarily seek treatment.

"If they call the county, basically what they're told is, 'Until they're a danger to themselves or others ... There's nothing we can do,' " she said. "And we're like, come on, really?"

Her organization wants state funding for programs where people concerned about someone's mental health could ask county workers to help encourage that person to voluntarily enter treatment. They also want an expansion of First Episode Psychosis pilot programs, where teams try to intervene after someone first experiences symptoms to increase their chances of recovery.

Such upstream efforts attempt to stave off bottlenecks have become common at hospitals like Hennepin Healthcare, where people are stuck in emergency rooms because mental health treatment programs don't have room for them, said Dr. Eduardo Colón Navarro, chief of the Department of Psychiatry.

Minnesota's mental health system involves a mix of state facilitates and private hospitals, centers and group homes. Legislators devoted about $200 million to mental health over the past couple of years. But Rep. Peter Fischer, DFL-Maplewood, said they aren't sure about the impact of dollars because they don't have a good analysis of existing gaps and the number of beds needed for different types of care.

"It's been left to the free market to decide where we're going to build and what we're going to do, based on what reimbursement rates are going to be," said Fischer, who leads the House Human Services Policy Committee. "Maybe if we would have had a built-out system these two individuals might have gotten help earlier and not ended up in the situation they ended up in."

What comes after commitment?

An initial court-ordered commitment to treatment lasts up to six months, then another order is needed to extend it. Treatment facility staff determine whether someone no longer poses a risk of harm and can be released.

County case managers are responsible for arranging the next placement of someone who doesn't need hospital-level care, according to the Department of Human Services, and counties are responsible for supervising people who are provisionally discharged from commitment. Often, under a provisional discharge, a patient must follow requirements like taking prescribed medication, not using illegal substances and staying in contact with a case manager.

When someone is fully discharged from commitment in Minnesota, they are often connected with services and can continue to voluntarily receive those. But people are not required to continue their treatment and there is no mandated follow-up.

For Adam Jami Garcia, 32, symptoms of schizophrenia and other mental disorders date back at least several years, court records show. Garcia was charged with second-degree intentional murder in what appeared to be a random bus stop stabbing of Christian Lundegaard in November.

Garcia was civilly committed for chemical dependency and mental illness in 2020, and he was recommitted the following year. An initial order for commitment noted habitual and excessive use of methamphetamine, opiates and cannabis and that he had schizophrenia spectrum disorder and a history of psychosis symptoms when using meth.

His address at the time of the stabbing was listed as the site of Hennepin County's Behavioral Health Center in Minneapolis, according to court documents.

He has a lengthy criminal history, including stabbing a man in the leg who had been studying in a University of Minnesota library in 2019.

Taylor Schulz, 44, who is charged with impaling Robert Skafte at the Oak Grove Grocery in Loring Park, had a limited criminal history in Minnesota. He was convicted for drunk driving in 2000. Court records show he had been evicted from his Loring Park apartment shortly before the killing.

Schulz was civilly committed in 2021, with the commitment order listing diagnoses of schizoaffective disorder and self-reported PTSD. The order quotes a doctor who said his delusions would likely follow him if he didn't get adequate treatment, noting that he was at "unacceptably high risk of further psychiatric deterioration unless strong support is given."

'A really hard issue'

Hennepin County Judge Michael Browne sees four to seven civil commitment cases every day. He said tragic situations involving someone with mental illness don't necessarily indicate a systemic issue.

"This is a super hard thing to have the kind of control over that we think should be in place. We think, 'Yeah we ought to be able to handle this.' But the truth of the matter is compliance is a really hard issue to control," he said.

But Browne also stressed that Minnesota needs more secure treatment facilities, noting, "People are in the jail because there isn't anywhere else for folks to go."