For Mark McBride, not having the proper access to mental health care caused his life to change completely.

On Sept. 19, 1994 Mark's 26-year-old brother, Matthew, killed his parents, James and Nancy McBride. The St. Louis family had difficulties finding treatment for Matthew, who had been diagnosed with schizophrenia five years prior.

In four years, Matthew went into mental health facilities three times. Thirteen hours prior to the killing, Matthew was released from St. Anthony's Medical Center in St. Louis County.

Present law addresses state facilities, but does not hold private facilities accountable.

"There are plenty of laws on the books that might have prevented the McBride murders," Mark says. "We were failed by a doctor and a hospital."

Presently, the McBride family is seeking a lawsuit against St. Anthony's.

But the lawsuit won't go back and change the past, Mark says. Now Missouri must take preventive measures so that what happened to his family won't happen to others, says the 35-year-old automotive dealer.

That meant going to the state level.

Six months after their murders, Gov. Mel Carnahan appointed a 19-member committee to study Missouri's involuntary commitment laws. After six-months of study and public meetings across the state, the committee made recommendations to change current law, including review of a person's case history rather than depending on the act of "physical" harm to determine involuntary commitment.

That change may have made a difference in the five years prior to his parent's death, says Mark. The family would not have had to struggle to keep Matthew in treatment.

Matthew never physically hurt himself when his schizophrenia set in. He never physically hurt his parents.

But when Matthew went off his medication, the harm began. Thinking his parents were controlling his thoughts, Matthew made threats to kill them. He heard voices. He became homeless. He refused to care for himself.

"Matthew's patterns of behavior were always directed toward my parents," Mark says.

That was harm enough, Mark says.

"Physical harm begins when the medication stops for some people," he says. "Now the taxpayers are going to foot the bill."

"It seems to me that it would have been a whole lot smarter if my parents could have kept my brother on his medication, that would have been a far less costly way of treating this disease."

Matthew was charged with two counts of first degree murder and one count of armed criminal action. He was found permanently incompetent, and the state dropped the charges. He currently lives at Fulton State Hospital.

"The McBride Commission provides the leverage to persons and caregivers like my parents to help their loved ones," Mark says.

That means if a person with a mental illness goes off their medication and begins the same patterns as before, family members would have some way to get treatment for them.

"It's not going to make it easier (to commit someone)," Mark says. "It's going to create an accountability system."

Trying to balance a person's rights with how to be a responsible society, was difficult, says the Commission's chairwoman, Lori DeRosear, who also is the medical director for St. Louis State Hospital.

"It's a fine line between right and wrong," DeRosear says. "The issues we grappled with were moral, ethical issues. Those are hard issues to grapple with."

"There's no intent to hospitalize people and to milk them for their money," DeRosear says. "Our objective is to catch (people with mental illness) before they fall."

Mark agrees. "The way it is now, a person has to get to the edge of the cliff and jump before anybody does anything."

The McBride Commission's recommendations cleared the legislature with almost no opposition. But there have been some concerns expressed about possible unintended effects.

Some warn that changes in mental-health commitment procedures could increase the number of people committed to mental health facilities, they say.

Being required to have out-paitent treatment could be an infringement on rights, says Marsha Richeson, a lobbyist for the American Civil Liberties Union.

"They can tell someone where to live, who to associate with, what medication to take. It's not much different than being on parole," she says. "Certainly it's not as bad as being on a ward, but it's not like a picnic either."

But the Mental Health Department says they don't expect any more people will be committed against their will. The media attention surrounding the McBride incident pushed the numbers up, says Turner.

"According to the numbers I have," he says. "The impact has already happened."

Others say making the private industry answer to the same regulations of the state would increase costs. If private mental health facilities have to set up another independent review board, it's going to create excess burden.

"It's going to make it more costly and more time-consuming," says Tom Anderson, a Columbia private psychiatrist. "Hospitals already have these kinds of procedures in place."

Anderson, former president of the Missouri Psychiatric Association, says he fears a backlog of minor complaints.

"Someone could complain about not liking their food or the way their bed was made," Anderson says.

But he says the good points of the legislation are things he's been wanting for some time. It's about time for the 180-day outpatient treatment alternative, he says.

Out is where Glenn Westphale would like to stay.

He would like to continue canoeing on the weekends, he says. Take his daughter to the park. Continue getting help without being locked up.

Susan agrees. There's a lot of stigma they have to battle, she says. But it all translates.

"They're on the inside looking out," Susan adds. "We're on the inside looking in."