Some who work with mentally ill people say civil commitment laws - the statutes that allow the government to order a person into psychiatric care - are too weak. They say the laws are created that way because of a lack of respect for therapists, counselors and other professionals.

"There's definitely a stigma," said Cindee Davis, a counselor at Mental Health and Assessment Services in Des Moines. "At parties, I tell people I'm in the mental-health field, and they step back like I can read their mind. There's just a fundamental misunderstanding of how the science works."

Others say a handful of violent incidents is not enough reason to risk trampling individual civil rights and turning psychiatric hospitals into jail annexes.

Jeffrey Schaler, an adjunct professor of justice, law and society at American University in Washington, D.C., doesn't trust mental-health professionals and believes commitment laws deprive people of due process.

"We just can't simply lock people up because, one, they act peculiar and, two, they think about killing people," Schaler said.

The difficulty of the debate has played out in public in recent weeks. Last week, a Humboldt man just released from court-ordered psychiatric care took five people hostage with a shotgun on Des Moines' east side. He told police he planned to kill his wife and commit suicide.

Two weeks ago, a Council Bluffs woman with a history of severe depression drove her pickup truck into the Missouri River, killing herself and her three sons. She had been released from a mental hospital despite the protests of her family.

If the laws had been stronger, those people might have gotten help they needed, said Margaret Stout, executive director of the Alliance for the Mentally Ill of Iowa. The alliance seeks to change the civil commitment law to make it easier for the courts to force mentally ill people to seek treatment and take medicine.

"If someone has a heart attack, we call 911. We do something about it," Stout said. "But when someone exhibits symptoms of mental illness, oftentimes we say that there's nothing that can be done. That's simply not true, but the backing from society has to be there."

Opponents say those measures go too far. They believe mental-health treatment is subjective and often ineffective, and some patients balk at the side effects of psychiatric drugs.

"Changing the laws to make it easier to put people away is an affront to justice," Schaler said. "You simply can't accurately predict future dangerous behavior."

Predicting the dangerous intentions of patients became acute in two recent stories.

In Council Bluffs, Karen Duncan killed herself and three children by driving a pickup into the river on July 11. Duncan struggled with deep depression for months. She was twice involuntarily committed by the courts and had sought help on her own, relatives have said. She once attempted suicide by unhooking the gas valve in her home.

Duncan's family argued she had been released too early from stays at Jennie Edmundson Hospital in Council Bluffs and at Cherokee Mental Health Institution. Her husband, Chris Duncan, argued unsuccessfully for an extension in his wife's last stay in treatment.

In Des Moines on July 15, Jimmy Gordon of Humboldt, armed with a shotgun, sought out his estranged wife at the East Ovid Avenue home she where was staying. He took five hostages and held police in a standoff for seven hours before surrendering.

A member of Gordon's family told police during the siege that Gordon had been been released from a court-ordered stay in a psychiatric hospital, police said.

During the standoff, Gordon told police he was suicidal and wanted to kill himself and his wife, police said. After his arrest, he immediately requested a psychiatric evaluation.

What, if anything, the mental-health system could do to prevent such incidents is unknown. Civil commitment hearings are private by law. The mental-health professionals who treated Duncan and Gordon are prohibited from commenting on their cases. To get a civil commitment, the state must prove a person is a "current danger to self or others."

Sometimes, mental health professionals admit, the most important factor is a patient's willingness to change.

"The patient has to want to do the necessary work," Davis said. "You can lock them up for years, but in some cases, if they aren't willing to change, it won't matter."