In June 2005, Terrence Andrews told staff at a psychiatric hospital that he felt homicidal toward everyone he saw.

"The mailman would come by, and I would want to kill him," he confided, three years before he attacked and killed his Shadyside neighbor with scissors and a steak knife on May 29, 2008, according to prosecutors.

Before and after that 2005 hospitalization, Mr. Andrews showed up at mental health clinics dozens of times threatening to harm himself and others, jurors in his trial heard Wednesday.

"If I can't come in here, I'll go across the street and kill someone so I can just go to jail, where I can get the death sentence and die," he told medical personnel in January 2008.

Months later, 18-year-old Lisa Maas was dead. Mr. Andrews, 41, charged with homicide for her slaying, faces life in prison if convicted of first-degree murder. His trial began Tuesday before Allegheny County Common Pleas Judge Edward Borkowski.

Mr. Andrews' lawyer, Lisa Middleman, plans to argue that her client is so mentally ill he was unable to form the specific intent to kill. She started presenting her case Wednesday.

During 4.5 hours of psychiatric testimony, jurors learned that Mr. Andrews told medical personnel on various occasions that he wanted to kill his neighbors and landlord, that he was sleepwalking with a butcher knife, and that he desperately wanted to be hospitalized. They also learned that Mr. Andrews had tried to kill himself repeatedly by choking himself and slitting his wrists.

Still, in May 2008, staff at Oakland's Western Psychiatric Institute and Clinic formulated a new treatment plan for Mr. Andrews, said Barbara Ziv, a Philadelphia psychiatrist testifying for the defense. They told him they would give him food vouchers and a bus pass if he stayed out of their "emergency room" for two weeks, she testified.

"Patient has clearly not benefited from multiple inpatient hospitalizations and has not followed through on chronic threats to harm himself and others," Dr. Ziv said, reading from a Western Psych report. "CTT does not feel that this patient is at risk to harm himself or others and recommends patient continue with outpatient treatments."

A spokeswoman for Western Psych has declined repeatedly to comment on the case. The hospital faces a lawsuit initiated last year by Ms. Maas' mother.

Wednesday, as Mr. Andrews sat quietly through his trial, head drooping, he was on three anti-psychotic medications, an anti-depressant and a mood stabilizer, Dr. Ziv testified.

"Mr. Andrews needed that [medication] and a contained environment to keep himself and society safe," she said.

If successful, Ms. Middleman's defense could lead to a lesser conviction, such as third-degree murder. But during his tense cross-examination, prosecutor Daniel Fitzsimmons tore into numerous aspects of Dr. Ziv's testimony, questioning her diagnoses.

Mr. Fitzsimmons contended that Mr. Andrews was so "desperately trying to get into the hospital" that he exaggerated his symptoms, and that he was relatively lucid when he confessed to police his intent to kill Ms. Maas.

"He made a specific plan to stab her and disarm her," Mr. Fitzsimmons said.

First Published: March 24, 2011, 8:00 a.m.