Teenager Samson Berhe was twice taken to Harborview Medical Center in the span of four days last month when he exhibited violent and threatening behavior, police said.

But his stay in the hospital was brief both times and he was deemed "not in need of treatment," according to police.

Days later, according to King County prosecutors, Berhe fatally shot high-school tennis coach Mike Robb in West Seattle in what is believed to have been a random slaying.

The revelation of Berhe's two visits to Harborview leading up to the June 26 slaying has raised questions about the intervention of mental-health officials in cases when people exhibit alarming and self-destructive behavior. At one point, police said, the 18-year-old's family members refused to pick him up from Harborview because they feared him, an account his mother confirmed yesterday.

But experts say having someone committed for treatment at a mental-health facility against the person's will is complicated and difficult.

Mental-health experts and police officers said that, in general, it's not enough for someone to be showing signs of mental illness, or even hollering and making threats, as was the case with Berhe. There has to be evidence that such people are in immediate danger of hurting themselves, hurting others or destroying things, before they can be involuntarily committed for even a short time, experts said.

"It's not enough for somebody to be acting, for lack of a better word, crazy," said Suzanne Parton, an officer with the Seattle Police Department's Crisis Intervention Unit.

Washington state has one of the nation's most stringent laws protecting the rights of the mentally ill, or those suspected of being mentally ill, according to police, mental-health experts and attorneys.

"It's very hard to detain somebody against their will in this state," Parton said. "The state is trying to protect the civil rights of the mentally ill person, and I understand that, but at the same time we have a lot of really sick people that are not getting the treatment they need."

Indeed, cases of individuals who are not committed for treatment and then turn around and carry out crimes or harm themselves are not unusual.

While mental-health officials are barred by confidentiality laws from speaking specifically about Berhe's case, they say there may have been no reason to hold him unless he was violent or threatening while at Harborview.

Berhe was sent to Harborview on June 19 after his mother called police and reported he was suicidal, possibly because his doctor had taken him off his mental-health medication.

Berhe's mother, Zewdie, said yesterday she is unsure what type of medication her son was taking and couldn't explain how her son came to be on such drugs in the first place.

Three days later, he was returned to the medical center after he struck his brother's friend and said that "all confused people should be killed." Police said Berhe's family refused to pick him up from Harborview the next day.

Zewdie Berhe said the family didn't want him to come home until he had been helped. But a caseworker for Child Protective Services returned Samson Berhe to the home.

Berhe's mother said her son left and that was the last time his family saw him before his arrest. Berhe is now being held in lieu of $1 million bail and is to be arraigned Thursday in the slaying of Robb.

Police said they have, essentially, two options in dealing with people who exhibit signs of a dangerous mental disorder. They can arrest that person if they can show probable cause that he or she committed a crime. Or, they can send the person to a hospital for mental-health evaluation.

Once at Harborview, the person is evaluated under the supervision of a staff psychiatrist, said Edward Dwyer-O'Connor, manager of the Psychiatric Emergency Services at Harborview, which screens about 8,500 such individuals each year.

Several issues are addressed at that point, Dwyer-O'Connor said. Among them is whether the person needs to go to the hospital and if he or she wants to go. If the hospital thinks the person might need to be hospitalized, but the person doesn't want to be hospitalized, then King County's mental-health evaluators are called.

"We refer them, they come investigate personally and make their own decision," Dwyer-O'Connor said.

Last year, the King County Mental Health, Chemical Abuse and Dependency Services had more than 7,000 referrals for evaluations. Of those, more than 5,000 people were evaluated face to face and 1,972 people were involuntarily detained for 72 hours, according to Amnon Shoenfeld, director of the division.

"We are required to have evidence, and just the fact that someone is mentally ill is not enough," Shoenfeld said.

Parton, the police officer, said that another factor that can influence the hospital's decision about whether to treat a person is a toxicology screening.

She said the hospital may be loath to call in the evaluators if a person tests positive for drugs or alcohol.

"They can't call every time a drunk feels suicidal," she said.

In charging documents, prosecutors acknowledged that Berhe had a history of both mental instability and substance abuse.

"This is a tragedy and everybody who deals with these issues gets frustrated," Parton said.

"There are some very real problems with the system, but we're doing the best we can."

Christine Clarridge: 206-464-8983 or cclarridge@seattletimes.com

Seattle Times staff reporter Mike Carter contributed to this report.