"You're doing really well, girl," Cynthia told her one day in March, over lunch at Tiffany's favorite Chinese buffet.

"I'm trying," Tiffany said.

Her bedroom at Royalé, which she shared with a roommate, was immaculate. She kept a Bible on the nightstand. She made friends and started playing billiards in the recreation room.

She became articulate and self-aware, even poking fun at her illness. (One day at an exotic bird store, another favorite haunt, she held a parrot on her arm for a minute, then turned and whispered conspiratorially: "This bird wants to kill me.")

And she began taking responsibility for her troubles. She called her siblings -- Matthew, then 16, and Jessica, then 13 -- and apologized for being a bad role model and sabotaging her treatment.

"I don't want to do this anymore," she said one day. "I'm here because of me."

In June, Tiffany was granted a pass for an overnight home visit. The family gathered in the backyard over steaming bowls of Michael's pasta e fagioli, with kidney beans.

Tiffany excused herself regularly to smoke cigarettes and collect her thoughts on the other side of the yard. But it was a pleasant, normal evening, or as close as the family had come for a long time. They laughed about a relative who used outlandish amounts of rouge. Michael even poked fun at Tiffany's shaved head, and she smiled.

"I've always felt," she said that night, "that my life had a purpose."

There was a part of her, she confessed, that missed the drama of Metro -- the "action," she called it.

Still, she wanted desperately to recapture an independent life, and that drive was paying off. She was placed on the waiting list to move onto the A level of Royalé, reserved for patients nearly ready for release. On Level A, she would attend independent-living classes and prepare for life in a board-and-care facility on the outside.

"I think she's ready for it," Cynthia said in July. "I really do."

The Sittons had been burned by hope plenty of times.

Tiffany's schizophrenia is complicated by her bipolar disorder. Like many schizophrenics, she had also been a serious drug abuser: heroin, Vicodin, by her account just about anything that came along. Each had impeded treatment by mixing poorly with prescribed medications.

"It's like part of me wants to be sick. So I do bad things," she said on a recent afternoon. "I know I do bad things."

But as much as the Sittons seek to hold Tiffany accountable, their odyssey also speaks volumes about the mental health system.

Treatment was laughably poor in some facilities: "exercise" classes consisting of patients walking in a small circle, group therapy sessions offering the same counseling to a schizophrenic, an anorexic and an elderly patient with dementia.

Even in locked facilities, Tiffany managed to get her hands on street drugs like methamphetamine. At one point she had ground up and snorted so many medications prescribed for other patients that her insides were pocked with ulcers.

At each place Tiffany was admitted, the Sittons provided a document detailing her illness and past treatment. But on three occasions, Tiffany was prescribed antidepressants -- despite an explicit warning in the document that such drugs sent her into a manic state because of her bipolar condition. (Tiffany's caretakers declined comment for this article, citing her privacy.)

"They don't look at the history. They just talk to the patient, who is psychotic," Cynthia said. "I'm in there every day, advocating, and she still falls through the cracks. Imagine what happens to the thousands of people who don't have that."