ALBANY - The case of a woman who killed herself and her two daughters soon after her release from psychiatric care highlights limits of institutions, law enforcement and even relatives to intervene and prevent such crimes.
Angela Mtambu gassed herself and the 6- and 9-year-old girls early Tuesday in suburban Albany in the room where her 23-year-old son, an Air Force veteran, committed suicide three months earlier. She locked the door against the girls' uncles sleeping in another room.
The uncles had cared for the children during Mtambu's 22-day inpatient treatment in Pennsylvania. That detention followed a police alert when Mtambu voiced her deadly plan to relatives in Texas, where she and the girls had been living.
Patient advocates said better communication might have helped, but that's unclear. Privacy laws mean many details may never be publicly known. Mental health authorities in Pennsylvania and in Rensselaer County, where Mtambu went after her release, did not immediately reply Thursday to requests for information.
However, the privacy laws don't prohibit doctors and institutions from warning relatives, potential victims and police that a potentially dangerous person has been released and is headed their way. The U.S. Department of Health and Human Services clarified the point last year, following mass shootings by troubled people in Newtown, Connecticut, and Aurora, Colorado.
In New York, when patients pose an imminent threat to themselves or others, therapists are obligated to warn potential victims and should take steps beyond what they do normally, said Dr. Seeth Vivek, president of the state Psychiatric Association.
"The duty to warn, the duty to protect, is part of the obligation of a psychiatrist or institution or psychiatric hospital," he said.
Pennsylvania and many other states require such disclosures, according to the National Conference of State Legislatures.
Vivek said many tragedies have occurred "because we have this false notion of confidentiality."
Mtambu, a single parent and native of Zimbabwe, had been living in Houston the past few years with her daughters and was working as a nurse, said Police Chief Christopher Lavin in East Greenbush, where she died in a home she owned.
Based on a tip from relatives that she discussed taking her daughters and joining her dead son, the East Greenbush police sent out an Amber Alert. Pennsylvania troopers found her car at a motel in Harrisburg. She was taken into protective custody and to a psychiatric facility. An uncle from the Albany area retrieved the girls.
"There are no court orders, no orders of protection, no requirement of any type of compliance on her part or anybody else," Lavin said.
Mtambu rejoined the family, and for a week the uncles wouldn't leave her alone with the girls. Two nights after that, she killed them with nitrogen gas.
The case suggests the need for better communication between agencies in different states about people in distress, said Glenn Liebman, chief executive of the Mental Health Association of New York State. There also needs to be more community-based services for parents with psychiatric disabilities. More than half the women in the public mental health system have children, he said.
Vivek cautioned against lumping all patients together. The high-risk patients, a relatively small group primarily diagnosed with schizophrenia or bipolar disorder, have diseases that impair their judgment.
"If I'm hearing voices telling me to kill people, my confidentiality is not more important," he said.
New York law authorizes emergency psychiatric commitments for up to 15 days for people who threaten or attempt suicide or show they're dangerous to others. That can be followed by up to 60 days' involuntary commitment certified by two doctors, and after that by court order.
Lavin said when his officers take people for psychiatric evaluation or protective custody, they don't hear back about the diagnosis, length of stay or release.
"You can't get a confirmation the person was seen," he said.