Scott Harlan Thorpe’s precarious mental state had deteriorated recently, prompting his policeman brother to try to notify Thorpe’s psychiatrist in Nevada County with a phone call that was not returned, according to his mother.

That psychiatrist, whose phone number is unlisted, could not be contacted Friday. A spokesman for the county’s Behavioral Health Department did not return The Bee’s calls.

Marilyn Thorpe, speaking in a telephone interview from her Nebraska home, said her son was frustrated by the care he was receiving at the clinic.

Prosecutors say that Wednesday’s rampage started when Thorpe stormed into the Nevada County mental health facility looking to kill his psychiatrist, Dr. George Heitzman, who was not there.

Thorpe, who was arraigned Friday, is charged with killing two women who happened to be in the mental health office, and the manager of a nearby restaurant after that. Authorities say Thorpe believed the restaurant was trying to poison him.

He was taken into custody after his brother, Sacramento Police Sgt. Kent Thorpe, notified Nevada County authorities and assisted them in getting his brother to surrender. Kent Thorpe has declined to be interviewed.

Scott Thorpe, 40, who did not enter a plea, is also charged with three counts of attempted murder.

Marilyn Thorpe said her son suffered from depression, paranoia, anxiety and a fear of public places. He has been treated with a variety of psychiatric drugs since 1996.

But managing his illness grew more and more difficult, she said, and the professionals responsible for his care apparently did not respond to pleas for help.

Advocates for the mentally ill said the Nevada County mental health system is underfunded and lacks leadership.

“They are doing the best they can,” said Lael Walz, president of the National Alliance for the Mentally Ill in Nevada County. “They don’t have sufficient resources ... The system is overwhelmed.”

Marilyn Thorpe said that her family feels sick about the shooting and is at a loss for words of comfort for the victims’ families.

“It’s unreal,” she said. “What do you say?”

She said she first noticed the deterioration in her son’s mental health in February 1996, during a visit after his father died.

“He was real anxious and beside himself, so I took him in to get help,” she said.

She said he would often talk about the FBI being after him and believed restaurant workers poisoned his food. He also was becoming frustrated that no one believed him.

“The trouble is that all of this was so real to him,” she said.

Dr. Joseph Sison, a staff psychiatrist at the Sacramento County Mental Health Treatment Center and an assistant clinical professor of psychiatry at UC Davis Medical School, didn’t treat Thorpe but said Marilyn Thorpe’s description of her son suggests a dangerous combination of symptoms. “Anxiety combined with depression leads to a more agitated state,” he said, adding that the delusions of being poisoned signal psychosis, in which the lines between fantasy and reality are blurred.

“It sounds like he began to resent that no one believed him,” he said. Patients like that “are angry and paranoid, and some, if left unchecked, can become more and more delusional.”

People who are psychotic experience a change in their brain chemistry that can be corrected with anti-psychotic medicine, Sison said.

“If you can treat these psychotic behaviors with medicines, you have a chance of improving their insight and judgment.”

It is unclear when a psychiatrist last saw Thorpe. But his mother said that in a recent conversation he had told her he was going to quit his monthly visits with the doctor.

She said she advised him to continue the visits, if only to continue getting his prescriptions, which she said he had been taking meticulously as recently as December.

Marilyn Thorpe said her older son, Sgt. Kent Thorpe, called his brother’s psychiatrist sometime in the last month, concerned about Scott’s worsening condition. The doctor never returned the call, she said.

If presented with a patient in such a state, said psychiatrist Sison, he would first try to determine if he was taking his medications.

“If not, and you are really becoming more concerned about psychotic behavior, you have to talk him into going into the hospital or to come into care more frequently until the delusions are under control,” Sison said. If that failed — and if the patient was clearly a danger or could be considered “gravely disabled” — involuntary hospitalization would be in order, Sison said.

Nevada County has no inpatient mental treatment facility. Acutely mentally ill patients are taken to the local hospital emergency room, where county mental health workers assess them, according to an unidentified receptionist at the Nevada County Behavioral Health Center.

If hospitalization is warranted, the patients are transported to the nearest inpatient unit with an available bed. Since the closure of Roseville’s Charter Hospital last year, that can be as far away as the Bay Area, the receptionist said.

“We all recognize there are tremendous gaps in service,” said Walz, the mental health advocate. “The demand far exceeds the services available.”

Walz said the Nevada County Board of Supervisors began over the last year to address the concerns, particularly in regard to mental health help for patients who commit crimes and supportive housing for the mentally ill.

The Nevada County Behavioral Health Department has also been without a director since August, and the first round of interviews yielded no appropriate candidates; more interviews are scheduled next week, she said.

An answering machine in the office of retired Behavioral Health director Diane Chenoweth said that she had retired and that no messages would be picked up on that line. Acting director Doug Bond referred calls to Pat Ward, an analyst to the Board of Supervisors. Ward did not return calls.

In the wake of the shootings, mental health advocates and experts stressed that most mentally ill people are not violent.

“The huge majority of the mentally ill are nonviolent and in some ways less violent than the rest of us,” said Tom Sullivan, director of the Sacramento County Department of Mental Health.

Added Rusty Selix, executive director of the California Mental Health Association: “In my 14 years of advocacy in mental health, this is the first time I have ever heard of someone dissatisfied with their mental health treatment who goes and shoots up a mental health facility.”

Selix said when someone with a mental illness becomes violent it typically means the patient was much sicker than anyone realized.