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TAC Newsletter 3/24/06


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March 24, 2006


1. PROMISE OF CARE MADE BUT BROKEN - Milwaukee Journal Sentinel, March 20, 2006

November 28, 2005



[Editor’s Note: Deinstitutionalization – the shifting of hundreds of thousands
of people with severe mental illnesses from professional inpatient care in
psychiatric hospitals to the community. Thanks in large part to improvements in
medications and methods of community care, a good portion of those released
during deinstitutionalization have thrived through this transition and achieved
independent lives of a significance impossible to attain in the confinement of
an inpatient institution. For many others, closing hospitals meant being
stripped of vitally needed support while restrictive commitment standards
foreclosed their being rescued from all but the most acute manifestations of
their illness.

In one of the stories in a three-day, exhaustively researched series for the
Milwaukee Journal Sentinel, Meg Kissinger portrays the haphazard and often
squalid fortune of many of those who still suffer in the aftermath of the
dramatic reconfiguration of our framework for the care of people with severe
mental illness. Many other articles have displayed the confounding condition
of those left adrift in the community, but Ms. Kissinger adds something more: a
look at both the previous system and how we came to have the present one.]


By Meg Kissinger

Of all the places where the county sends people who are being released from its
psychiatric hospital, Dawn Powell's houses are four of the worst.

In the past four years, City of Milwaukee building inspectors have found that
her places have:

Backed-up toilets.
Insufficient heat.
Broken smoke detectors.
Dangling electrical wires.
Deteriorating porches.
Filthy carpeting.
A lack of proper exits.
A host of structural defects.

She's been fined $3,520, money she still owes the city. There is a warrant for
her arrest, and she has served time in jail for failing to pay her fines.

Twelve years ago, Milwaukee County signed an agreement in federal court,
promising to ensure that all people with chronic mental illness have proper
living arrangements after being discharged from what was then the Milwaukee
County Mental Health Complex.

So, why does the city allow Powell's group homes to remain open? Why do county
caseworkers still send their clients to her?

Passengers along I-43 can see her wood-frame duplexes on the western side of the
freeway, between Burleigh St. and Keefe Ave. But what they can't see are the
horrifying things that go on inside. The people who live there say mice run up
the walls as they are taking showers, and roaches invade the pantry and climb
over their beds.

Powell, a nursing assistant, solicits clients from the county with the promise
of diligent care. She charges each of her eight tenants $500 a month.

It was at one of her houses, on May 20, 2004, that John Collins, 42, who
suffered from multiple sclerosis, depression and anxiety, fell from his
wheelchair and down the front stairs, cracking his head on the pavement. He died
a month later. For weeks after that, someone used the dead man's food stamp
card. The county has launched a criminal investigation after being told of the
card's use by the Journal Sentinel this month. Powell denied that she was the
one to use the card but added, "I could see why someone would think that."

Powell conceded that her places need work but said she is contributing a
valuable service to those in Milwaukee who suffer from schizophrenia and bipolar
disease, conditions that cloud thinking and can bring on terrifying

"I take the people no one else will take," said Powell, who does not have a
license to operate a group home or a permit to run a rooming house. "This is a
whole lot of work. Believe me, no one is getting rich."

City building inspectors say there are dozens, maybe hundreds, of people like
Powell who are not licensed or regulated but run businesses that provide housing
for people who are disabled by mental illness.

A few weeks ago, a county caseworker moved Bessie Johnson, a 59-year-old woman
with diabetes and schizophrenia, from an illegal rooming house because she
needed more care. A Journal Sentinel reporter and photographer had found Johnson
lying on a bare mattress soaked in her urine. Mounds of spent toilet paper
surrounded her. Johnson was told that she would be moving into a group home.

Where was she placed?

She now lives at one of Powell's homes, a building that has been cited in the
past year for roach infestation and is under investigation of mouse infestation,
filthy conditions, a broken smoke detector and a lack of access to the basement.

On April 23, 2004 - four weeks before Collins fell down the stairs - city
inspectors were given a tip that Powell was running an illegal group home. An
inspector found no violation. The following January -- six months after Collins
died - the city got another call alleging that Powell was running an illegal
group home. This time, the inspector could not get in the house. He wrote a
letter asking Powell to provide a list of all the tenants. She did not comply,
but inspectors failed to follow up.

Todd Weiler, spokesman for the city Department of Neighborhood Services, said
inspectors typically give landlords the benefit of the doubt on a first
complaint. Though this was the second allegation of Powell running an illegal
group home, Weiler said it was treated as though it were the first because the
inspector did not verify the earlier complaint. Apparently, each violation at
Powell's homes was treated as a separate issue.

Ronald Roberts, the city's building inspection supervisor, said homes such as
the ones owned by Powell escape their radar because people rarely complain. Or,
if they do, infractions are hard to verify because owners know how to hide their
tenants when inspectors come to call.


New Era Of Care Fails To Deliver On Promise Of A Better Life

Thirty years ago, a Milwaukee County lawsuit brought by West Allis schoolteacher
Alberta Lessard sparked a revolution in the way the United States cares for
people with mental illness. Thousands of patients who had been committed to
mental institutions were released.

Life for many with mental illness has not gotten easier in the new era. Often,
it got worse; many ended up in jail or homeless.

The Journal Sentinel found hundreds ushered out of hospitals by their
caseworkers and placed in the city's most dangerous neighborhoods and
dilapidated buildings. Hundreds of Milwaukee's most mentally ill people have
been abandoned through bureaucratic neglect, uneven administration of judicial
protections and legislative sleight of hand.

"Basically, they didn't fix a thing," said Diane Greenley, a lawyer for
Disability Rights Wisconsin, when told of the newspaper's findings. Greenley was
one of the many lawyers for advocacy groups that brought the lawsuit against the
county. "The county says they have no choice. That there is no place to put
these people. But, if these dumps were closed, we'd be forced to do something."

Architects of the new system now say they regret how things have turned out.

"We blew it," said Jon Gudeman, who served as medical director at what is now
known as the Behavioral Health Division during the massive downsizing of the
1970s and '80s. He recalls getting a federal directive to shut down wards and
thinking, "Oh, my God, where are they all going to go?"

Sister Lucina Halbur, a nurse who worked in a mental hospital in Winnebago
County beginning in 1961 and led a campaign to close down some of the worst
ones, said: "I naively worked for years to get these people out of those scary
old places, and look what has happened to them. It's pathetic what we have done
to these people. No one can deny that. It's all right there in our face."

Even Tom Zander, the public defender who took up Lessard's groundbreaking case
against her commitment, now says he regrets that so many care facilities have
been shuttered without being replaced by something better. He said he felt
betrayed by cynical policy-makers who wrapped themselves in the cloak of civil
liberties when their real agenda was to trim their budgets.

"People with mental illness have been left out in the cold. Literally. It's
inhumane," Zander said. "I never said, 'Let's close all mental hospitals.' I
said, 'Let's close all the ones with locks on the doors.' "



Milwaukee's first mental hospital, known as the Milwaukee County Asylum for the
Chronic Insane, opened in 1880 on the County Grounds in Wauwatosa. The state
reimbursed the county $1.50 a week for every patient in its care. At the peak of
institutionalization in the 1940s and '50s, Milwaukee County housed some 6,000
people with mental illness in several locations. Accommodations were anything
but lavish, usually two to a room, sleeping on cots and sharing a sink. There
was no psychiatry or meaningful therapy, said Bill Baker, who worked there as an
internist. People were basically drugged and warehoused.

But he remembers lots of camaraderie and the care of capable, if stern, Polish
and German immigrant nurses and aides. Meals were nutritious, if not delicious.
The places were clean and orderly. Patients were taken on outings to events such
as the State Fair and Milwaukee Braves baseball games.

"These were not the snake pits you hear about," said Baker, noting that
Milwaukee was one of the first places to do away with the use of straitjackets.
"The director who ran the place was wise and kind."

By 1955, Wisconsin had more than 14,000 patients in state and county mental

In that same year came the advent of Thorazine, an anti-psychotic drug that
helps organize thinking and reduce delusions. Patients who had been confined to
locked wards were given more freedom. Society as a whole had begun to demand
expansions of civil liberties for women and minorities and, eventually, for
patients locked in asylums. Ken Kesey's 1962 novel, "One Flew Over the Cuckoo's
Nest," detailed the abuses of mental hospitals and furthered the passion for
reform. The book's most infamous character, the sadistic Nurse Ratched, served
as an icon for everything wrong with the system - humiliation, forced
medication, utter intolerance for anyone who dared to stand up to authority.

It was against that backdrop, in October 1971, that West Allis police picked up
Lessard on a reported suicide attempt. Lessard was taken to the Milwaukee County
Mental Health Complex, where she was committed. Indignant, Lessard vowed to take
her case as far as she could to earn back her freedom. She enlisted the help of
Milwaukee Legal Services, and together they took the case all the way to the
U.S. Supreme Court. Lessard and her legal team argued that mental patients
should be afforded the same constitutional protections as criminal defendants.
After all, they risked paying the same price - losing their liberty. Ultimately,
the Supreme Court agreed with the ruling from the federal district court that
the law, as it had been applied, violated constitutional protections.

From then on, the state would have to prove that a person was both mentally ill
and in immediate danger of harming himself or herself or others.

Mental health law had been turned upside down. Commitment became a cumbersome
and expensive ordeal - preliminary hearings, evidence gathering, testimony,
final hearings. In time, the policies of commitment would vary vastly from
county to county. A case that would move easily to a commitment hearing in La
Crosse, for example, might never get to court in Milwaukee, where lawyers,
facing much bigger caseloads, were quicker to work out plea agreements.

Vance Baker, a psychiatrist who practices in Milwaukee and La Crosse, said he
still sees a huge difference in the way patients with the same illness are
treated. "In Milwaukee, the philosophy is to give the people what they want, not
what they need," he said. "It's like a different planet."


Little money, cheap hotels and ever-dwindling options

Federal, state and county policy-makers from all over the nation followed the
Lessard case with keen interest. The court decision to tighten the requirements
for commitment provided an opportunity to reduce spending on mental
institutions. Almost immediately, the federal government, which had begun
funding mental health care in the 1960s, sent directives to mental hospital
administrators to redesign their programs from inpatient to community care.

It was supposed to work like this: Patients released from the hospital would be
put on Social Security disability. They would be given a monthly stipend for
living expenses and be allowed to live where they chose. They would be treated
in clinics that would be scattered around the community.

In 1975, there were 4,000 beds available in Milwaukee County for inpatient
treatment of mental illness. Now there are fewer than 100.

As soon as the mental wards began to empty, E. Michael McCann's phone started to

"I'd get these frantic calls from parents saying, 'They let Johnny out, and he's
going wild, threatening us,' " said McCann, Milwaukee County's district attorney
since 1968. "I'd tell them this: 'Sharpen the stick, and put it to his eye. And
then force him off the property. Tell him that, if he comes back, you'll call
the cops. And they can either charge him criminally or commit him civilly.' "

That worked for a time, said McCann, until the police learned that they had no
power to get people committed, either.

With their income below the poverty level and their ability to hold a steady job
compromised, the legions of former mental patients had few places where they
could afford to live. The sickest headed to rooming houses and cheaper hotels
that dotted downtown and the immediate surrounding area - places such as the
Antler Hotel, the Randolph Hotel and Hotel Wisconsin. Diners and inexpensive
chain restaurants, such as Lenrak's on Old World 3rd St. and George Webb, became
their new dining rooms. The waitresses were no replacement for the aides of the
old asylum days, but the good ones knew to remind their favorite customers to
change their socks every once in a while and, hey, it wouldn't hurt to take a
shower, either.

Suddenly, people with obvious mental illness turned up all over the city - among
the stacks at the downtown library, in the hallways of the county courthouse, in
the atrium at the Grand Avenue mall, on the sidewalks at Rainbow Summer along
the Milwaukee River. Some started living on the sidewalks and under bridges.

Then came the bulldozers. Milwaukee began to gentrify downtown in the late 1980s
and early '90s. The ratty rooming houses and seedy hotels closed or were
renovated. The diaspora of Milwaukee's mental patients continued; the number of
legal rooming houses in the city dropped from 1,500 in 1985 to 172 in 2005.

Holly Gardenier, who ran a homeless shelter in Milwaukee called the Guest House,
saw the number of homeless people with mental illness spike.

"They slipped through a widening abyss," Gardenier said. "There was a whole
underbelly of people that was simply forgotten in these grand plans."

Jails and prisons, too, began to fill with people with mental illness. The
state's prison population tripled in the decade beginning in 1980, largely with
prisoners who were mentally ill and in the past would have been in mental
hospitals. The Legislative Audit Bureau estimates that one-fourth of all prison
inmates have a form of mental illness, from depression to severe, chronic
diseases such as schizophrenia. Of 18,634 prisoners counted in a 2003 census,
4,610 had a diagnosed mental illness, including about 1,500 with serious
disorders, according to prison officials.


People With Mental Illness Pushed From Public Housing

Not even the city's public housing, designated for poor people, would provide
relief to the severe mentally ill. With demand so much greater than supply, the
waiting list for public housing was five or six years by the early 1990s.
Exacerbating the problem was then-Mayor John O. Norquist's decision to expel
people with mental illness from much of the city's public housing. There had
been episodes in the city's high-rise housing complexes - suicides, a shooting
and reports of older residents who had been harassed by drug dealers. Older
residents were frightened and lobbying hard for reform. People with mental
illness were labeled troublemakers.

The Norquist administration made a choice: Half of the city's 14 public housing
facilities would be classified as "elderly only." Everyone else, regardless of
disability, would have to leave those seven buildings. Federal housing officials
were furious and threatened to sue the city for discrimination. Norquist didn't

"We knew that the decision would cause problems elsewhere in other systems -
that it would increase homelessness and impact the mental health system,"
recalled Ricardo Diaz, housing authority director under Norquist. "But we had to
keep in mind what our job was - to provide safe and sanitary housing."

Jim Hill, now administrator of Milwaukee County's Behavioral Health Division,
was working for the city housing division at the time of Norquist's showdown
with the federal government. He recalls the rift and cringes to think how much
goodwill was spent and funding lost.

"The city left a lot of (federal) money on the table - money that could have
been spent on our people," Hill said, referring to housing subsidies that could
have come to Milwaukee.

With no other place to go, people like Collins and Johnson ended up in places
like Powell's homes.

Johnny Collins grimaces when he thinks of his son's last weeks and how he died.

"He was paying for someone to watch out for him, and no one did," Collins said.
"That wasn't right."


CANTON REPOSITORY (OH), November 28, 2005

[Editor’s Note: If you wish to know how completely the symptoms of an illness
like schizophrenia can control one’s actions, look to the Matt Morgan of
fourteen years ago. And to see how effectively medication can treat those
symptoms, turn to the Matt Morgan of today.

No pharmaceutical, however, can eliminate the pulsing guilt from the devastation
caused by his untreated illness. Neither are we aware of any treatment that
will alleviate what must be the immense burden carried by the doctor who decided
to “wean” Matt Morgan off of psychotropic medications.]


By Encarnacion Pyle

COLUMBUS, Ohio (AP) — Matt Morgan invites friends over after work for chicken
casserole and spaghetti dinners.

He and his girlfriend curl up on the couch to watch Days of Our Lives.

He goes to dollar-movie theaters, plays Scrabble and sings karaoke.

This is his life, one so ordinary it’s indistinguishable in his working-class
neighborhood on the Far West Side, where everyone knows everyone else by name.

But his life defies his history, the dark times that his neighbors couldn’t

They don’t know that schizophrenic visions and voices once controlled him.

They don’t know he spent nine years in a state psychiatric hospital.

They don’t know what he’s done and how hard he’s worked the past 14 years to
become ordinary.

They don’t know he killed his parents.

“I’ve been to hell and back,” said Matt, now 38, “and I still don’t know how I

It started near the end of high school.

Matt began hallucinating, hearing voices and thinking everyone, including
friends and family, wanted to kill him.

He became homeless, drifted across the country and tried to hang himself.

Then, he learned he had schizophrenia.

He received treatment and medication at a mental hospital in Pennsylvania but
was weaned off the drugs once he returned home to Fairfield County.

His parents tried to get him help, but no one would listen.

The pieces were in place for tragedy.

On July 25, 1991, he interrupted a late-night card game at his parents’ house in
Lancaster by shooting his parents and sister Marla.

Jerry and Marlene Morgan died; Marla was severely wounded.

“I can still hear the voices telling me, ’Shoot them and it will all be over.
The pain will go away. You’ll no longer be mentally ill,”’ Matt said, forcing
back tears.

“I was so delirious.”

A year later, he was found not guilty by reason of insanity after psychiatrists
testified that he had become dangerous because he had been taken off his

Matt knows some people think he got off easy and should be sitting in a cell —
even though he’s subject to court-ordered monitoring and rules that are stricter
than if he were on parole from prison.

But they don’t see how haunted he is.

He has had chest pains, nightmares, trouble breathing and uncontrollable crying

“I feel this deep regret, like I’ve robbed so many friends and family, and even
myself, of these wonderful, important people,” Matt said.

Though proud of his recovery, Matt is anxious about slipping up.

But his doctors, friends and loved ones say he’s proof that treatment works, so
long as he sticks to it.

“I feel very comfortable it won’t happen again,” said Marla, 44, who still has a
bullet lodged in her brain.

“Matt wants to get better, has worked hard to get better and will have to face a
lot of issues the rest of his life because of what he has done.

“But as long as he continues with his therapy and medication and people are
watching him, he’ll be all right. We all will.”

The youngest of six children, Matt likens his childhood to the idyllic, 1950s
world of Leave It to Beaver.

“We lived in a neighborhood of manicured lawns, perfect trees and children
riding bicycles,” he said.

His father, a retired police officer, spent nearly three decades with the
Lancaster Fire Department before starting a real-estate business with his wife.

His mother watched the children until they were in school.

She later became a real-estate agent and opened Morgan Realty in their home.

Matt’s life began unraveling in 1985, his senior year.

He skipped school, his grades fell and he had to attend summer classes to

Matt enlisted in the Marine Corps but was medically discharged two months later
because he had flat feet.

He drifted from job to job over the next several years, always struggling with
distorted perceptions.

“I saw dragons flying through the air. I believed radio DJs and TV characters
were talking to me. And I thought everyone was out to get me,” he said.

“I couldn’t tell what was real and what wasn’t.”

Matt planned to hang himself from a tree along a country road in the winter of
1989. But his car became stuck in snow and he fell asleep.

Deputy sheriffs found him and sent him home after determining he wasn’t a

The next year, the Morgans kicked him out after Matt tried to punch his father.

He lived with a friend for three days but decided he had to leave, so he began
hitchhiking to Key West, Fla.

“I had to be alone. I couldn’t control myself,” he said.

He slept under bridges, wandered around drunk and went for days without eating.
His family didn’t know what had happened to him.

“He just disappeared,” said his oldest brother, Jay, of Marion.

Two months later, Matt tried to hang himself again, this time from the rafters
of an abandoned building in Key West. But he changed his mind and cut himself
down, suffering only minor rope burns.

Instead he went to Philadelphia, where he walked into the emergency room at
Thomas Jefferson University Hospital.

“I told them I was having a nervous breakdown,” he said.

Doctors said he had “schizophreniform disorder,” which essentially has the same
symptoms as schizophrenia but lasts less than six months.

He ultimately was transferred to a respite facility where Dr. Miles Landenheim
determined that Matt had developed a paranoid delusional system. It was only a
matter of time before he would have full-blown schizophrenia.

During his 12 weeks at the center, Matt received intensive therapy and
medication, including the powerful antipsychotic Navane and antidepressant
Elavil. His paranoia decreased, and he started to understand his illness.

Landenheim decided Matt should return to his parents, but only if he continued
treatment. He returned to Ohio on June 22, 1990.

Three weeks later, he went to the Fairfield Family Counseling Center, where Dr.
Harold Brown spent 30 minutes evaluating him.

A month later, after receiving Matt’s records from Pennsylvania and meeting with
him for another 15 minutes, Brown began reducing his medication because he
thought Matt was faking his symptoms to qualify for Social Security benefits.

In October, Brown cut Matt’s medication again and told him he would be weaned
off it entirely. Mrs. Morgan begged the center to resume his prescription
because she was worried about him.

Among other things, Matt pounded telephone poles with baseball bats and cried
about an aerial attack on his head.

His parents tried to get him hospitalized through probate court. Mrs. Morgan
told the deputy clerk “she hoped this didn’t blow up in our faces.”

About a week later, Matt pointed his finger at his father’s head while they were
watching TV and said, “I’m going to blow your brains out.”

Frightened, the Morgans sent a letter to a psychologist at Fairfield Family
Counseling Center.

“Matt has slipped both mentally and physically, and he refuses medication. ...
Can you help us?”

The day Matt shot his parents, he couldn’t stop fidgeting at lunch. Marla and
other relatives noticed he was walking around the house, talking nonsense.

He went upstairs into his room, came down agitated and stormed onto the back

“My father told me, ’Don’t do anything to set him off,”’ Marla said.

But things seemed to have blown over by 10 p.m. when Marla, Matt and their
parents decided to play cards.

At one point, Matt accused his sister of changing the face of the cards, but
Marla laughed it off.

About 20 minutes later, Matt excused himself to use the upstairs bathroom.
Instead, he pulled a .22-caliber gun from his bedroom.

“My head was spinning,” Matt said. “I thought the government had replaced my
parents and sister with people who wanted to hurt me.”

He said voices told him to kill them.

“It wasn’t a matter of knowing right from wrong,” he said. “There was only one
way to survive, one way to get relief.”

No one noticed the gun until he put it to his father’s head.

Marla’s memory of the event remains fuzzy. She thought Matt had a cap gun until
he told their father something like, “This is for all the pain you’ve put me
through the past year.”

Mr. Morgan, 60, crumpled to the floor in a pool of blood as Marlene, 58, and
Marla, then 29, screamed.

Matt, then 24, walked around the table and shot his mother, who fell at her
husband’s feet.

Marla jumped out of her chair and threw her hands in the air, screaming, “Don’t

She passed out as Matt pointed the gun at her.

When she came to, she thought she had bumped her head on the table. She pulled
herself up the hallway wall as Matt ran out the door. She dialed 911, saying,
“I’m just real sick.”

Her mother stirred, gasping for air.

Firefighters found Marla standing in the front entrance in shock, blood
spattered on her white sweat shirt. She found out at the hospital that she had
been shot.

The next thing Matt remembers is calling 911 from a pay phone. He didn’t say who
he was or what he had done, only that shots had been fired at their Briarwood
Court home. He then walked nearly 3 miles to the police station and turned
himself in.

He told officers his head hurt.

“I have so much head pain. I couldn’t take it no more, I couldn’t take it no
more,” he said.

“I know I gotta be sick, I know I gotta be sick. Oh God, please forgive me.”

Mr. Morgan died in the house. Mrs. Morgan died two days later at Grant Medical

Marla spent a month in the hospital and underwent months of rehabilitation to
regain her balance and coordination. She still has no peripheral vision in her
left eye.

“I’ve worked through my recovery. I’m now trying to help Matt,” Marla said.
“That’s what my parents would have wanted.”

After the shootings, it wasn’t clear whether Matt ever would be free again. He
was charged with murder and admitted to the Central Ohio Psychiatric Hospital,
now called Twin Valley Behavioral Healthcare, in October 1991 to restore his
competency so he could stand trial.

Psychiatrists noted he had a “glued-on smile,” showed no emotion while
discussing the tragedy and whispered to himself, all signs of his illness.

Eight months later, in June 1992, he was found not guilty by reason of insanity
on two counts of aggravated murder and one count each of attempted murder and
felonious assault.

The insanity defense is raised in less than 1 percent of felony cases nationwide
and succeeds in only a quarter of those cases.

“There’s a public perception that lots of people plead not guilty by reason of
insanity, but it’s the exception,” said Doug DeVoe, executive director of Ohio
Advocates for Mental Health.

Studies show defendants found not guilty by reason of insanity are likely to
spend as much, if not more, time confined to a mental hospital and monitored by
the courts if released as if they were sentenced to prison.

If Matt had been convicted, he could have faced 15 years in prison, with an
additional nine years for using a gun.

Matt lived in the maximum security unit of the hospital for 3 1/2 years before
being moved to a less-restrictive, but still locked ward after proving he was no
longer dangerous. He attended individual and group therapy, continued taking
antipsychotic medication and participated in Alcoholics Anonymous meetings. He
kept a journal, learned about his illness and relapse-prevention techniques, and
talked about the guilt, loss and loneliness he felt.

“What struck me about Matt was how well he was and his degree of concern that he
do what he could to prevent his symptoms from returning,” said Dr. Christopher
Kovell, a former staff psychiatrist at Twin Valley who worked with Matt in his
eventual release from the hospital.

Kovell, who now is medical director for the Franklin County Alcohol, Drug and
Mental Health board, agreed to discuss the case only after Matt signed a consent

“We know that schizophrenia is a treatable illness,” Kovell said. “Matt is one
of those people who has a particularly good response to medication. While not
all schizophrenics experience total remission of symptoms, Matt is one of them.”

While Matt was hospitalized, his family sued Fairfield Family Counseling for $9

A trial judge ruled in favor of the counseling center, but the Ohio Supreme
Court overturned the decision in January 1997, saying Dr. Brown should have
monitored Matt for at least six months and reinstated his medication. The case
ultimately was settled out of court, and Matt’s family is under a gag order not
to discuss details.

The Supreme Court’s decision led lawmakers to clarify that mental-health
professionals must report a patient who could be dangerous.

Matt was released from Twin Valley on June 13, 2000, with a long list of
conditions. He must take his daily medication, as well as mandatory injections
of a long-acting antipsychotic as insurance. He has to check in with his case
manager on weekdays and regularly meet with his psychologist and psychiatrist
for counseling. He can’t buy a gun and is prohibited from going to Fairfield
County, where most of his family still lives, except to visit his parents’
graves when accompanied by a caseworker.

Matt is enjoying the freedom, despite the restrictions.

“It was like going from breathing pollution to breathing fresh air again,” he

He met his girlfriend, Beverly Smith, 43, at a support group for people with
mental illness. (She suffered a fractured brain stem when a drunken driver hit
her at age 17.)

They moved in together two years ago and live with their cat, Otis, and
cockatiels, Denny and Kato.

“Denny has a crippled leg,” Beverly said with a laugh. “He’s one of us.”

Friends describe the couple as caring people.

“You can call Matt and Bev at 4 in the morning and they’ll be there, no angry
looks, no questions asked,” said Claire Higdon, who teaches art for Partners in
Active Living through Socialization.

Matt worked at the agency before being hired on contract at Twin Valley in
October 2004 to help run the hospital’s patient-satisfaction survey.

Matt regrets his past and is optimistic about the future.

He hopes people will stop looking at what he did and see who he is.

“Not a day goes by that I don’t think about my parents and that terrible night,”
he said.

“My parents died because they loved me. I have to find a way to live because I
love them.”


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Saturday, March 18, 2006


TAC Newsletter 3/17/06


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March 17, 2006


1. WHY DID NICHOLAS DIE? - South Bend Tribune, February 24, 2006


3. VIOLENCE AGAINST HOMELESS TARGETED - Morning Sentinel, March 10, 2006

4. MISSING SANTA MARIA WOMAN FOUND - Santa Maria Times, February 28, 2006

MEDICINE - The Miami Herald, March 14, 2006


1. SOUTH BEND TRIBUNE (IN), February 24, 2006

[Editor’s Note: We previously shared another article from the excellent
investigative series “Out of Sight,” by Alicia Gallegos, which detailed how
Nicholas Rice became trapped in the criminal justice system because of actions
caused by untreated schizophrenia.

In the final installment of the series, we see how he died – died from the
intensified symptoms of his illness, a lack of treatment for them, and – perhaps
most of all – unthinking neglect.]


By Alicia Gallegos, Tribune Staff Writer

When the first Elkhart County autopsy report surfaced months after Nicholas Rice
died, Coroner Jeff Landrum refused to sign the death certificate.

The pathologist had listed "diffuse acute pulmonary edema" as the initial cause
of death for Nicholas, an inmate found dead in his jail cell a week before

But the coroner had questions about the report from the beginning, he says now,
and "respectfully disagreed" with the pathologist's conclusion.

Pulmonary edema is a condition where fluid fills a person's lungs, leading to
heart failure.

Landrum, after talking with Nicholas' family and researching his background,
believed they should dig deeper.

He would also have been a fool, he admits, not to take into consideration the
private autopsy results by Dr. Werner Spitz, a Michigan forensic pathologist and
toxicology consultant who has worked on high-profile cases around the country,
such as those involving JonBenet Ramsey and Nicole Simpson.

When examining Nicholas' body, Spitz saw the young man's visibly sunken eyes and
cheeks. He noted how much weight he'd lost.

In Spitz's opinion, malnutrition and dehydration caused Nicholas' death. His
report was based on the inmate's past diagnosis of undifferentiated
schizophrenia with "untreated anorexia, refusal to eat, drink, and take
medication, severe progressive weight loss" and no evidence of disease or

Even for Spitz, the finding was rare.

"You don't usually (get) dehydrated when you are in jail," Spitz says. "You
don't usually die of the condition that Nicholas Rice did."

The famous pathologist concluded that "pulmonary edema" was the result of the
process of dying, not its cause.


It's hard to believe her son would starve himself to death, Diane Waldrop says.

When Nicholas was younger, he loved to devour any greasy, fatty food in sight.
He was in good health when he went to the Elkhart County Jail on the attempted
bank robbery charge, she says.

The county's second autopsy was completed in March 2005, and Nicholas' death
certificate was signed. The final findings included schizophrenia, malnutrition,
and dehydration.

Although mental illness is frequently a factor in deaths, Landrum says that in
his experience of more than 1,000 death investigations, it is rarely listed as a
direct cause. And malnutrition is certainly unusual in a 22-year-old man.


The words "forever in our hearts" are etched into the back of the gray stone.
The front reads:

Nicholas Dale Rice

July 17, 1982

December 18, 2004

His parents finally laid their oldest son to rest in July 2005, right before
what would have been his 23rd birthday.

The spot in Spring Run Cemetery in Stevensville is next to the grave of his
grandfather, who died during the 16 months Nicholas was in jail.

Diane hopes her father is looking after her son.

It feels like more than just a year since Nicholas has been gone, she says. He
was in jail for so long.

It's not the same seeing someone behind glass. The last time Diane hugged her
son was almost two years ago inside a Michigan psychiatric hospital.

She remembers early December 2004 and how she fixed up his old room, buying
brown curtains and throw pillows for his bed, so excited Nicholas was about to
find psychiatric help.

She thought he was strong enough to hold on, she says as the tears come.

She thought he would make it home.


In his one-bedroom apartment on Third Street in Goshen, manila folders are
stacked on Rick Rice's coffee table and lie in groups on his hardwood floor.
Piles of medical records, jail logs and research articles are spread around his

Some of the papers are coffee-stained, their corners dog-eared. He often turns
to one document dated Oct. 5, 2004, an emergency detention form for his son
signed by a jail psychiatrist.

It is a warning that went unheeded, Rick says, and the message continues to
plague him.

"Patient is dying from malnourishment," the form reads. "Applicant believes that
if the person named above is not restrained immediately he will die."

Nicholas was taken from the jail and treated for dehydration at a local hospital
two months before he was found dead.

Rick didn't find out about the visit until it was too late.

"There's so many things that could've been done that they didn't do," he says.
"They all dropped the ball. This was such a mess."

Rick and Diane plan legal action against Elkhart County, the sheriff's
department and the company that provides medical services to jail inmates. A
tort claim has been filed.

Elkhart County Sheriff Michael Books declined to comment about the case. But
police attorney Michael DeBoni says Nicholas did not die because of lack of
medical care by the police department.

Officers rely on the professional judgment of medical providers, he says, and
the sheriff does everything in his power to ensure inmates receive necessary


After logging many hours at the public library, poring through research manuals
on dehydration and reading papers on mental illness during his lunch hour at the
RV plant, Rick seems to know every symptom, sign and definition.

If he had known his son was in danger, he says, he would have known to do
something to save Nicholas.

"I would've camped out on the lawn of the courthouse," he says.

The Elkhart County Jail, where his son literally starved himself to death, is
blocks away from his home. He passes the courthouse every day. Ambulance sirens
blaring down the road remind him.

But he also remembers before Nicholas was locked away, the summer barbecues the
father and son enjoyed beside the river years ago.

Nicholas always talked about being famous, moving to California to be a movie
star like his idol, George Clooney.

"I'll probably make it as an actor someday," he used to say. He wanted to be

Maybe his son's death will bring attention to mental illness, Rick says.

Maybe Nicholas will be noticed now.


2. ASBURY PARK PRESS (NJ), February 23, 2006

[Editor’s Note: When the media considers people with severe mental illnesses
and what can be done to help them, the most common reason is that the symptoms
of a psychiatric disorder have caused someone to harm himself or another in
dramatic, and seemingly nonsensical, fashion.

Many of the items that we feature in the E-News include or even focus on such a
tragedy. We do not select such items to highlight these tragedies, but rather in
spite of them. For instance, we present the item below not for you to consider
how Rosario Miraglia took two lives, but instead to point out the reason he did
so. He thought he would save mankind. What better evidence could there be that
the only way in which to prevent future such horrors is to bring treatment to
people lost to illnesses like schizophrenia?]


By Erik Larsen, Staff Writer

FREEHOLD — A jailed man awaiting trial in the murders of his grandmother and
ex-girlfriend two years ago has been indicted, charged with aggravated assault
against a Monmouth County corrections officer.

Rosario "Russell" Miraglia, 33, of Newark was charged with swinging his fist at
a jail guard's head and neck area on Oct. 28. At the time of the assault, the
officer was investigating a report that Miraglia had contraband in his cell,
according to the Monmouth County Prosecutor's Office.

Miraglia was being held in the Monmouth County Jail in Freehold Township in lieu
of $2 million bail. As a result of this new indictment, an additional $6,000 has
been added to his bail amount, the Prosecutor's Office said.

An arraignment will be scheduled within the next 45 days before Superior Court
Judge Bette E. Urhmacher. The case is being handled by Assistant Prosecutor
Michael Costanzo.

Aggravated assault is a crime that carries a sentence of up to 18 months in
state prison.

Miraglia is charged with the murders of Julia Miraglia, 88, and Leigh Martinez,
31, on June 8, 2004, in Ocean Township. He decapitated both victims, then
severed their hands and feet, according to prosecutors, who are seeking the
death penalty in the case.

Last month, Miraglia told a judge he would present a "justifiable use of force"
defense to charges that he killed his grandmother and ex-girlfriend.

When asked why, Miraglia responded: "She cut a deal with the devil to give birth
to a dragon — something more superior to the human race. It would wipe us out. .
. . Technically, I saved mankind so it's a "justifiable use of force' defense."

Superior Court Judge Paul F. Chaiet ruled in November that while he believed
Miraglia suffered from paranoid schizophrenia, he was competent to stand trial.


3. MORNING SENTINEL (Waterville, ME), March 10, 2006

[Editor’s Note: Below others debate whether crimes against those who are
homeless should be punished differently than criminal actions against others. We
remind you that there is another way to reduce the amount of violence against
homeless individuals. One-third of the chronic homeless have a serious mental
illness. For many of them, treatment can lead to finding or accepting housing
and a lessened vulnerability to the criminal aggression of others.]


By Susan M. Cover, Staff Writer

AUGUSTA -- Homeless advocates were cheered Thursday after a legislative
committee gave a positive vote to a bill that they hope could help reduce
violence against homeless persons.

The bill, sponsored by Rep. Patricia Blanchette, D-Bangor, makes homelessness a
factor to be considered by judges and district attorneys when determining

It does not mandate a specific sentence if a victim is homeless. But it is
designed to raise awareness of what supporters describe as a growing trend of
violence against the homeless.

The four members of the Criminal Justice and Public Safety Committee who were
absent for Wednesday's vote on the bill registered their opinions with the
committee clerk, changing the committee recommendation from 5-4 against, to 8-5
in favor.

All four who were absent -- Rep. Kimberly Davis, R-Augusta; Sen. John Nutting,
D-Leeds; Rep. Christian Greeley, R-Levant; and Rep. Stan Gerzofsky, D-Brunswick
-- voted in favor of the bill.

Steven Huston of the Preble Street Consumer Advocacy Project said he's glad the
bill will move forward to the House and Senate with a positive recommendation.

"Even a homeless person can go to Augusta and show their cause is important," he
said. "It's a clear picture you can go and speak-up."

Those who voted against the bill said they aren't convinced that the homeless
are victimized simply because they are homeless.

They also suggested that the state should spend time and resources tackling the
problems that cause homelessness, rather than pass new laws regarding

Supporters, including Attorney General Steven Rowe, said it's important to make
it clear that violence against the homeless, who are particularly vulnerable, is
not acceptable in Maine. Recent videos and movies have encouraged what's known
as "bumfighting," in which teens beat-up people who are homeless.

The proposed state law now moves forward to the House of Representatives for


4. SANTA MARIA TIMES (CA), February 28, 2006

[Editor’s Note: An untreated mental illness can compromise a person’s ability
to perceive the reality around them. Yet symptoms can also confound with equal
devastation by inserting false perceptions into a person’s comprehension that
seem as certain – or even more certain – than what is actually happening.

A person can believe that they are a government agent, a famous author, or a
tycoon. Tiffani Burger’s symptoms endowed her with the absolute certainty that
she is married to one of America’s most successful rap stars, a man she has
never met.]


By Quintin Cushner / Senior Staff Writer

A Santa Maria woman who went missing six months ago has been found at a homeless
shelter in Detroit -- the hometown of the rap star she believed was her husband.

Tiffani Burger, 29, still faces the consequences of crossing state lines while
on probation. But her family is thrilled that the woman, who has battled
schizophrenia and drug addiction, is alive.

"I was just in shock," said Burger's mother, Karin Cushaway, of learning last
week that her daughter had been found. "I was just ecstatic. I started shaking."

Cushaway, of Sisquoc, reported her daughter missing Sept. 4. She has driven the
streets of Santa Maria every few days since then hoping to find her.

Santa Barbara County Sheriff's detectives investigated several reported
sightings of women who resembled Burger but all turned into dead ends. Her
information was entered into the national database of missing persons, according
to sheriff's spokesman Erik Raney.

Cushaway looks forward to reuniting with her daughter once Burger begins
treatment for schizophrenia.

"We're trying to get her the help she needs," Cushaway said, "get her on her

Burger has signed extradition papers, and is expected to be transported to Santa
Barbara County Jail in the next two weeks, Cushaway said.

Apparently, Burger's attempt to get Michigan identification papers led to her
discovery. A social worker seeking to verify her identity called the woman's
grandfather, Ron Parke of Orcutt.

Parke said the phone call came as a terrific surprise.

"Our whole family was under a lot of stress wondering what had happened," Parke
said. "We were sure she was going to contact us during the holidays because she
loved the Christmas season. But we never heard from her."

Burger's family then alerted the Santa Barbara County Sheriff's Department, who
arranged for Detroit police to take her into custody on an outstanding warrant,
Raney said.

Cushaway has not spoken with her daughter since she was found. The concerned
mother fears her daughter is angry at her for notifying police.

Cushaway had an inkling that her daughter had gone searching for the rap
musician Eminem, whose given name is Marshall Mathers, because the woman had
been obsessed with him during the past year.

"She had told me she was married to him and that they had a baby together,"
Cushaway said. "She said they had a telekinetic relationship."

However, Burger had never been east of Arizona, and Cushaway said she was
surprised that her daughter's delusions would carry her so far.

There's no indication that Burger ever knew the rapper. Cushaway said her
daughter would get belligerent if pressed on the issue.

Burger disappeared in August shortly after being released from Santa Barbara
County Jail and is believed to have been in Detroit since December. She had been
incarcerated for attacking a man with pepper spray while on probation for drugs.

Shortly before that jail stint, Burger had packed most of her possessions into
boxes and had announced to her family that her husband, Marshall Mathers, would
be picking her up soon.


5. THE MIAMI HERALD, March 14, 2006

[Editor’s Note: This excellent profile of a mother, her two sons, and their
travails because of bipolar disorder includes insight from Treatment Advocacy
Center President Dr. E. Fuller Torrey, one of America’s leading experts on
bipolar disorder. The article also includes some excellent and realistic
information for those with a loved one who has a severe mental illness.]


By Desonta Holder

Despite years of therapy, despite knowing that guilt and self-blame are futile,
that what happened to one son, what still is happening to another, can only be
explained by the stark vocabulary of a medical diagnosis, Linda Pardo wrestles
always with a mother's grief, remembers with a mother's heart.

''I would lay in bed at night, and I would imagine these horrible things
happening,'' she says. ``Somebody stabbing Aaron, somebody raping Aaron. . . .
None of that happened, but he still died a worse death.''

On a summer day in 1994, Pardo's 23-year-old younger son, soaring on an arc of
manic euphoria, climbed up a pole on an Amtrak platform in Philadelphia and,
with emergency personnel hovering and news cameras whirring, inexplicably
reached out and grabbed a power line. He was badly shocked. Still, says Pardo,
''somehow he stood up and took the fireman's hand, and they helped him down and
got him on the stretcher.'' Aaron hovered at the dim edges of life for 10
agonizing days, his skin seared black, his ears burned away. At 15, he had been
diagnosed with bipolar disorder, a long-term brain illness that causes unusual,
severe shifts in mood, energy and ability to function.

The disorder, which affects more than 2 million U.S. adults, must be carefully
managed. When it is not, or when it cannot be because, as often happens,
patients do not take the medicine that helps smooth their emotional peaks and
valleys, families unravel, careers implode and life may turn violent, even

Bipolar patient Rigoberto Alpizar had not been taking his medicine last December
when he allegedly made bomb threats aboard a plane. Federal air marshals shot
him to death on the plane at Miami International Airport. In January, another
bipolar patient, Troy Anthony Rigby, jumped from the cabin door of a plane in
Fort Lauderdale and ran toward a terminal. Authorities stopped him with a Taser
gun. He later died after a heart attack. Rigby's sister said he had not been
taking his medicine.

''It's a very sad disease,'' says Pardo, 57, an addictions counselor who lives
in Kendall. The Miami Herald has written about her before, in a 1995 story that
chronicled the impossible choices and conflicting emotions of her doomed
struggle to keep her family, and her sanity, intact, to save her children and,
finally, when she eased away from them and moved to Miami in 1993, to save

A petite woman with short, red-streaked hair who projects a compelling, often
amazing sense of calm, Pardo is a recovering alcoholic who has been dry for two
decades, and a two-time divorcée after marriages riddled with physical abuse and
emotional instability. It took her years, she says, to understand that the
definition of her life was ''trauma all the time,'' to reach ``a point where I
knew I couldn't make it better.''

Pardo's older son, Eric, now 36, was diagnosed with bipolar disorder when he was
19. He now lives in a facility in Miami. The condition often develops in the
late teens or early 20s, occurring equally in men and women. ''Many of us have
different ideas about the cause,'' says Dr. E. Fuller Torrey, a psychiatrist and
board president of the Arlington, Va.-based Treatment Advocacy Center, whose
mission is to help people get treatment. The disorder's hereditary basis --
Aaron and Eric's paternal grandmother also was affected -- ''is still very much
in dispute,'' Torrey says. But, he adds, ``None of us doubts there is a genetic

Diagnosis usually follows at least one episode of mania or hypomania, which is
accompanied by a range of symptoms: insomnia that lasts for several days; a
tendency to think and speak much more quickly and erratically than usual; a
spate of irrational extravagance, buying things one cannot afford or does not
need. The disorder has levels of intensity, and manic episodes may be framed by
periods of severe depression.

Aaron and Eric, with four suicide attempts each, were regarded by their
physicians as ''severely bipolar,'' an unofficial category Torrey says ``usually
means bipolar disorder with psychotic features and reasonably resistant to

Torrey, who has been researching the condition for 35 years, says the vast
majority of bipolar cases manage quite well: ``I know successful people who stay
on their lithium, and they're doing beautifully.''

But Pardo's sons did not stay on their medicine. Its side-effects were
unpleasant. It tamped their moods and impressions; it made their hands tremble.

''Medication compliance is a huge problem,'' Torrey says. ``Being manic can be
very pleasant. You think you're the smartest person in the world. You don't need
sleep. . . .''

At 17, Aaron enlisted in the Air Force only to receive a medical discharge six
weeks later. Shortly before his 21st birthday, he cut up all his ID cards and
left home. Police found him in Indiana three months later. As for Eric, Pardo
will never forget the day they were driving in the car, and she pulled over to
buy him ice cream. ''He takes the car and puts it in drive,'' she says, ''and
he's laughing . . . , and he slammed into [another] car that was parked there,
still laughing.'' At home, the young men would chain-smoke and gulp down cups
and cups of coffee, cans and more cans of soda.

''They always felt like hell, so why not?'' Pardo says.

She suffered for them and for herself. She came down with severe headaches; she
tried to ignore the weakness gnawing at her legs. So many bad things happened,
in fact, that she no longer can accurately chart their chronology. ''I remember
times being horrific, but I couldn't tell you what happened in what
succession,'' she says.

And what was she to do about protecting the boys' sister, her youngest child,
her Lola, now 27? How to keep things as normal as possible for her? ''I went to
every PTA meeting,'' Pardo says. ''I even had her in gymnastics.'' Pardo refused
to accept that ``I was the mother who couldn't fix it. When you're a counselor,
and when it's your own blood, it's two different ball games.''

So she tried and tried. She hoped and hoped that things would get better. They
did not.

One day, around 1990, Eric phoned her from a motel to say he had overdosed on
his mood stabilizing medication. Pardo called for emergency help and then
'started screaming, `Hang on, Linda! Hang on, Linda!' . . . I felt my whole self
disconnect. . . . The next day I was completely curling in a ball, screaming.
'Make me safe! Make me safe!' Couldn't stop sobbing. Went to the mirror, thought
it was two-way, started ducking. I knew I was in a psychotic state. . . . My
mind said, 'You had a breakdown.' '' It was six months before Pardo would rouse
herself enough to put on lipstick.

It took her even longer to rouse herself enough to leave, to realize that she
could not determine what happened to her sons, to settle them into an apartment
and head for the sprawling anonymity of South Dade. Within months, Aaron had
burned the apartment down. Then he burned up maybe the only thing he had left:
himself. ''It never mattered how much you did or how much you tried,'' Pardo

After Aaron's death, Pardo returned to Miami, again alone.

Emotionally destroyed by the way her brother had died, Lola stayed behind with
her father. Eric was living in a facility in Philadelphia.

''I couldn't bring Eric down,'' Pardo says. ``I was in survival mode. . . .
Everybody was in such pain.''

The pain had not eased much two years later when Pardo checked Eric into a
facility in Boca Raton. ''I really knew it was not a good idea, nor was I
ready,'' she says. Eric was not ready either. He ''really never took to the
therapy, was very defiant.'' Then he ran away. The police found him in
Jacksonville. Pardo returned him to Philadelphia, sending him money and keeping
in touch by phone.

''It was so painful to listen to him,'' she says ' . . . And he was always
freezing. . . . I sent him a beautiful suede coat one time. Two days later he
said, `I don't want you to get mad. It was stolen.' ''

In the fall of 2004, after Eric almost burned down the Philadelphia facility in
which he was staying, his mother bought him a ticket to Miami and found a place
that he would accept.

''To have him live with me, . . . it wouldn't work because it would end up being
a yelling match over things he would want and I would want,'' she says. ''He's
6-foot-3, about 275 pounds.'' In October, Pardo went back to Philadelphia to
visit Lola, who is working through her pain.
Pardo sees Eric every two or three weeks. They go out shopping and to the
movies. For Christmas, she bought him a TV, a DVD player, movies and curtains
for his room.

''It feels so much better having him here. He'll stand like this'' -- legs
spread, leaning from side to side -- ''and do like this dance, going back and
forth from one leg to the other,'' she says. She pays for his dental care, and
''I give him $30, $40. Of course, it's gone in 10 minutes, but I feel like I'm
trying.'' They call each other often, spending a lot of time on the phone. For
years, after phone calls Pardo would hang up and sob for hours.

She doesn't do that anymore. ``Now I just pray.''



SYMPTOMS: Dr. Jorge I. Casariego, head of Mercy Hospital's department of
psychiatry, says these include extreme energy, sleeping very little,
overspending, extreme sexual promiscuity and severe episodes of depression. The
manic phase can occur much later than the depression phase, fooling a lot of
people. ''People sometimes drink a lot to sedate themselves when they're
manic.'' The younger the patient, the more severe the disorder.

CYCLES: The mania and depression cycles are unpredictable. Some can last for
weeks; others for months. ''There's no limit, no minimum to cycles,'' Casariego
says, which often occur every year or every two years. ``But some people are
rapid cyclers with multiple cycles a year.''

TREATMENT: The patient must maintain adequate treatment. ''Lithium is extremely
effective in controlling moods,'' Casariego says, and the patient should have
his blood tested often in case the doctor needs to adjust his dose. (More
information about lithium, page 12) ''Lamictal is wonderful, effective in
controlling the cycles, particularly depression.'' Psychotherapy helps with
stress, which may trigger cycles. Before modern drugs and therapy, Casariego
says, stress was so severe that patients died of the sheer exhaustion of being

CAREGIVERS: ''You have to use good judgment,'' Casariego says. If a patient
refuses to take medication, ''don't provoke them, because rage is a major
problem.'' Stay calm, and try to get them into treatment. If there is immediate
danger, call 911; specify you are trying to have a patient admitted to care
under the Baker Act. If the patient is behaving bizarrely but seems not to be in
immediate danger, ask a judge for an ex parte order, for hospital admission for

RESOURCES: The University of Miami Psychological Services Center, 5665 Ponce de
Leon Blvd., Coral Gables, holds a monthly Bipolar Family Workshop


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Arlington, VA 22203
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703-294-6010 (fax)

Monday, March 13, 2006


Visit our web site
March 10, 2006


1. OUTPATIENT COMMITMENT OVERVIEW - Harvard Mental Health Letter, March 2006

2. STATE PSYCHIATRIC HOSPITALS DWINDLE - South Bend Tribune, February 20, 2006

Journal Sentinel, January 17, 2006

January 9, 2006



[Editor’s Note: This month’s Harvard Mental Health Letter offers an overview of
assisted outpatient treatment. It is a balanced and, given its length,
insightful summary of the treatment mechanism.

In noting that it “included only a small number of patients, none of whom were
violent, and there was no effective enforcement mechanism,” the newsletter
accurately describes some of the limitations of the Bellevue Study – one of the
very few (of many) examinations to find no statistically significant beneficial
effect of AOT. It does not mention, however, that members of the control group
were hospitalized for a median 101 days in 11 months while the median person
under an AOT order experienced only 43 days of hospitalization. Because of the
small size of the study, this seemingly dramatic result did not reach the level
of statistical significance; as it stands, it was certainly significant for the

Outpatient Commitment.

The emptying of mental hospitals began a half-century ago with the hope that
effective treatment would be available on the outside, and patients would be
willing to accept it. But for many neither of those conditions has been met.
Many thousands of so-called revolving-door patients consume a disproportionate
share of the resources of the health care and criminal justice systems as they
move between jails, prisons, emergency rooms, psychiatric hospitals, rented
rooms, group homes, and the street.

At any given time, a third to half of people with schizophrenia or bipolar
disorder are not receiving treatment, and a third of the homeless are mentally
ill. Many are too discouraged or disorganized to take any initiative. Some will
not agree to treatment because they are isolated and withdrawn, or paranoid and
suspicious. Others refuse help because they wrongly believe they are doing well
enough without it. Court-ordered treatment -- known as outpatient commitment,
mandatory outpatient treatment, or assisted outpatient treatment -- has been
proposed as a partial solution to this problem.

What Are The Standards?

The laws of more than 40 states permit outpatient commitment, mainly for
patients who are actually or potentially dangerous to themselves or others. The
best-known state law is Kendra’s Law, passed in New York in 1999 after a woman
was pushed under a subway train by a man with schizophrenia. Under the New York
law, which is fairly typical, assisted outpatient treatment is authorized for
people who, because of failure to comply with treatment, have been in a mental
hospital, prison, or jail within the last three years or have committed an act
of violence in the last four years. To be committed, they have to be in danger
of relapse or deterioration that would result in physical harm to themselves or

Many mental health professionals believe the standards should be less strict,
with a focus on deterioration alone. A study group appointed by the American
Psychiatric Association issued a report in 1999 recommending outpatient
commitment to prevent relapse or severe deterioration that would make patients
either dangerous or unable to care for themselves.

It’s much simpler to require mandatory treatment for the mentally ill if they
use illicit drugs or (less often) commit other minor crimes. No formal judgments
about dangerousness or deterioration are necessary. Addicts can be sentenced to
drug treatment in lieu of or in addition to imprisonment. In some places, courts
arrange to provide treatment for mentally ill lawbreakers. In mental health
courts, defendants who plead guilty are assigned to outpatient treatment instead
of prison.

The Debate

Critics say that outpatient commitment is an attack on privacy, autonomy, and
the right to travel. They also say that it undermines the therapeutic
relationship, reduces the long-term potential for independent living, drives
patients away from seeking treatment, and diverts resources from voluntary
patients. They insist that the dragnet of outpatient commitment will entrap
people who don’t need it.

Defenders of mandatory outpatient treatment say that it promotes compliance,
especially regular use of medications; mobilizes support services; lowers the
risk of homelessness, psychiatric hospitalization, and substance abuse; and
makes it less likely that patients will be victims or perpetrators of violence.
They say there is no evidence that people are prevented from seeking treatment
and point out that patients and their families rarely raise objections. They say
outpatient commitment will not divert resources as long as extra funding is
supplied. It will not be authorized for people who don’t need it if they have
legal representation, regularly scheduled reviews, and the right to appeal
decisions. In response to the argument that outpatient commitment infringes on
civil liberties, its defenders argue that people are not free when their minds
are in thrall to illness.

Apart from these issues, enforcement is a problem. In some states, patients who
do not comply can be brought to a clinic by police. Some think this should be
allowed when it is authorized by a judge based on evidence presented by a
clinician; others think there should be a formal hearing. Involuntary
hospitalization is a solution only for patients who present an imminent danger.
Telling them that they will be hospitalized unless they take their medications
may sometimes be impractical because resources are limited.

What The Studies Show

The New York State Office of Mental Health issued a report on Kendra’s Law in
2005 and pronounced it a success. From 1999 to 2004, nearly 4,000 court orders
were issued, usually for six months, and in two-thirds of cases the orders were
renewed. About 70% of the patients committed under the statute had schizophrenia
and 13% had bipolar disorder. The report found that after commitment these
patients were more likely to take their medications and less likely to be
homeless, arrested, or hospitalized. In interviews, nearly two-thirds of the
patients said they thought that the court order had been good for them.

There are other favorable reports about outpatient commitment but only two
controlled studies. In a trial conducted at Duke University, patients discharged
from a psychiatric hospital were assigned at random to community treatment alone
or to outpatient commitment with community treatment. The researchers found that
after a year, patients assigned to outpatient commitment had a better quality of
life because they were more likely to comply with treatment and less likely to
be victims of violence. The rate of psychiatric hospitalization was the same in
both groups under the original three-month commitment order. Most of the
advantage for outpatient commitment arose after that three-month period, when
the study was no longer controlled.

The second controlled study, a three-year pilot project at Bellevue Hospital in
New York City, found that outpatient commitment made no difference in the
effectiveness of intensive community treatment. The study included only a small
number of patients, none of whom were violent, and there was no effective
enforcement mechanism.

In an independent analysis for the Cochrane Collaboration, reviewers in 2005
concluded that the only strong evidence for the value of outpatient commitment
came from the findings of the Duke study on the risk of criminal victimization.

Willingness to accept treatment is only one side of the problem that has led to
calls for outpatient commitment; the availability of treatment is the other
side. Everyone agrees that mandatory outpatient treatment requires a plan that
includes intensive services. But often those services are not available because
the public mental health system is poorly organized and underfunded. Mandatory
treatment laws, taken seriously, could be an incentive to provide the needed
organization and funding. But it’s also possible that if better services were
available, outpatient commitment would become a less important issue.


American Psychiatric Association Council on Psychiatry and Law. Mandatory
Outpatient Treatment Resource Document. American Psychiatric Association,
December 1999.

Cornwell JK, et al. "Exposing the Myths Surrounding Preventive Outpatient
Commitment for Individuals with Chronic Mental Illness," Psychology, Public
Policy, and Law (March-June 2003): Vol. 9, No. 1-2, pp. 209-32.

Hiday VA. "Outpatient Commitment: The State of Empirical Research on Its
Outcomes," Psychology, Public Policy, and Law (March-June 2003): Vol. 9, No.
1-2, pp. 8-32.

New York State Office of Mental Health. Kendra’s Law: Final Report on the Status
of Assisted Outpatient Treatment, March 2005.

Torrey EF, et al. "Outpatient Commitment: What, Why, and for Whom," Psychiatric
Services (March 2001): Vol. 52, No. 3, pp. 337-41


2. SOUTH BEND TRIBUNE (IN), February 20, 2006

[Editor’s Note: Whether for long-term care or a shorter period after an acute
episode, people overcome by severe mental illnesses can need placement in a
secure setting – for their own welfare and, at times, for that of those around
them. While improvements in outpatient care can mitigate that need, modalities
for secure inpatient care remain essential and will be long into the foreseeable

Currently, there are two types of inpatient facilities available for people with
serious psychiatric disorders – psychiatric and correctional. Psychiatric care
should be supervised by mental health professionals rather than correctional
ones, whether this goal is fostered through rational commitment standards that
permit treatment interventions before the symptoms of an untreated illness lead
to a criminal act or by programs like mental health courts that offer diversion
once the person has entered the criminal system.

Yet, before a person in crisis because of a mental illness can receive care in a
hospital bed rather than a jail cell, there must be a hospital bed available.]


Fewer Options Left For Housing The Mentally Ill.

By Alicia Gallegos

It's 10 p.m. on a Tuesday night.

Someone is standing in the middle of a busy road, careening in and out of
traffic, mumbling incoherently.

A "10-96" goes over the radio, police code for a "mental subject." Officers
arrive and usher the person away from the street.

Police then have three choices, according to a 2000 report from the National
Institute of Justice journal: arrest the person, take him or her to a mental
hospital, or resolve the matter informally.

But officers know that in reality, their alternatives are even more limited,
says Maj. Sam Cochran with the Memphis Police Department. Officers can wait
hours trying to have a person admitted to an area mental health facility, he
explains, only to find the subject doesn't meet commitment standards or must
voluntarily enter the facility.

Throw in unruly, violent behavior, and their options dwindle further.

"Arrest often was the only step available to the officer in situations where
individuals were not sufficiently disturbed to be accepted by the hospital but
were too public in their deviance to be ignored," professor Linda A. Teplin
writes in the NJI article.

For the many untreated mentally ill, the criminal justice system now becomes the
entry point into the mental health system.

"We don't want to put people in jail," says Elkhart County Sheriff Michael
Books. "(But) we have a responsibility to deal with those folks, (especially) if
we have a violent person." The majority of mentally ill offenders are in jail or
on probation for a property or public-order offense, according to a recent study
by the Bureau of Justice Statistics.

The study also found a high rate of homelessness for mentally ill inmates, along
with unemployment, alcohol and drug use and physical and sexual abuse before
their incarcerations.

A lack of state psychiatric hospital beds contributes to the problem, experts

From 1972 to 1990, available beds decreased by more than 70 percent because of
hospital closures, according to the National Association of State Mental Health
Program Directors Research Institute.

In the 1990s, 44 hospitals closed nationwide. From 2000 to 2003, two state
hospitals closed, and a report cited five states that planned to close hospitals
in 2004 and 2005. In Indiana, the last state hospital to close was Central
Indianapolis Hospital 11 years ago, according to Indiana Family and Social
Services Administration.

Indiana was actually the only state listed that planned to increase the size of
one of its hospitals when the closure report came out in 2004.

A new unit was created at Logansport State Hospital this past summer,
specifically designed for patients involved in the criminal justice system, said
Dennis Rosebrough, FSSA communications director. The hospital also has a new
wing in the works that will open even more beds.

Nationwide, general hospital specialty unit psychiatric beds also have
decreased, according to the report. From 1998 to 2003, 23 of 38 states have
experienced declines in their specialty beds.

The reason for the shortages is multifaceted, says Mary Zdanowicz, executive
director of the Treatment Advocacy Center, a national nonprofit agency dedicated
to helping Americans with severe mental illness. Of course, one major reason is
money, she says.

The Institutions with Mental Disease exclusion was implemented in 1965 by
Congress and prevents state psychiatric hospitals from receiving federal
Medicaid funding.

Without that money, many hospitals have closed.

Although the push of mental health care into more community-based solutions is
well-meaning, she says, it doesn't work for everyone.

Some people with mental illness need long-term, structured care. Others have a
harder time being admitted to area mental health facilities without insurance."
The one alternative they can always count on is jail," she says.

And jails and prisons are often the worst place for mentally ill people to be,
experts say, because offenders are sometimes punished for symptoms of their
illness -- being noisy, refusing orders -- and end up staying longer.

"Mentally ill prisoners are more likely than others to end up housed in
especially harsh conditions, such as isolation," according to a recent study by
Human Rights Watch. "That can push them over the edge into acute psychosis."



[Editor’s Note: One way in which to help ensure that those in need of
psychiatric care stay in the mental health system is to increase the skills and
awareness of the gatekeepers of the criminal justice one, i.e., police officers
and sheriff’s deputies.]


Empathy Seen As Key To Defusing Violent Situations

By Annysa Johnson

Earl Ingram gets angry when he thinks about the day he drove his son to a
Milwaukee police station, hoping officers would take him for commitment to the
Milwaukee County Mental Health Complex.

Diagnosed at 24 with bipolar disorder, Ingram's son, now 28, had been setting
fires at his mother's house, and Ingram feared for the safety of the young man
and others.

Rather than let him bring his son in, Ingram said, four officers with billy
clubs went out to the car, handcuffed his son and hauled him in.

And instead of being taken to the Mental Health Complex, Ingram said, his son
was arrested on an outstanding warrant for driving after revocation and booked
into the jail, where he sat for two weeks without his court-ordered medications.

"It was overkill . . . one of the coldest responses I've ever seen," said
Ingram, a radio talk show host who will share his family's experiences as part
of a new Milwaukee police training program that started this month.

The Crisis Intervention Team program is designed to give police officers the
information and skills they need to improve their responses to situations
involving people with mental illness. That's of grave importance, say mental
health professionals, who voiced outrage in recent years over fatal police
shootings of individuals in mental health crises.

"It doesn't eliminate all tragedies," said Sandy Pasch, former president of the
National Alliance for the Mentally Ill of Greater Milwaukee, who helped bring
the program to the city. "But it greatly reduces them."

Thirty Milwaukee police officers have volunteered to take the 40 hours of
training, after which they'll be dispatched as first responders on calls
involving mental health issues. The goal, said Lt. Carianne Yerkes, is to have
at least a quarter of the department's 1,800 officers participate in the

'The Importance of Empathy'

The weeklong program, offered at no cost by local mental health professionals
and advocates, will cover a host of issues - from the types of disorders and the
drugs used to treat them to community resources and techniques for de-escalating
potentially violent situations.

"That is a major component," said Pasch, who rode along with officers last year
in Memphis, where the program was developed in the 1980s.

"They learn the value of talking to people - what questions to ask, the
importance of empathy," she said. "When you show you're a human being responding
to them, instead of an officer, it takes the fear level down."

The crisis intervention program, or some variation, has been implemented in a
number of cities around the country, including Denver, Indianapolis, and
Appleton, Wis.

The Milwaukee program is taking elements from all those but will most resemble
Memphis' effort in that it's voluntary. In addition, Pasch said, Milwaukee's
program will attempt to address the cultural component - how different ethnic
groups tend to deal with mental health issues - a topic most communities have
avoided because of its complexity.

Pasch said she hopes to see the training expanded to other police departments -
the Milwaukee County Sheriff's Department and some suburban departments have
shown interest - and hospital emergency room personnel.

Yerkes, speaking with the volunteer presenters recently, said she was encouraged
by the comments of officers who applied for the first round of training.

"Many of them have family members or friends who suffer from mental illness, and
have seen the system break down in how they're handled," she said.

Giving Officers Options

The new training comes as many of the resources available for people with mental
illness have shut down or scaled back their services.

As a result, "so many officers believe there are only two options out there: I
can do nothing or take them in for an involuntary commitment," said Steve
Dykstra, a psychologist in the Milwaukee County Behavioral Health System.

"We need to do a better job of developing those options, and letting police know
what else is out there," he said.

Already in place are programs such as Our Space, in which individuals with
mental illness help others work through crises or maneuver through the system,
and mobile teams of mental health professionals who can be called in as needed.

But advocates are hoping to create a crisis resource center where individuals
who are not a danger to themselves or others can go for help.

"In most cases, people don't need hospitalization," Pasch said. "They need
someone to talk to, who can hook them up with services or medication, or just
listen to them. It would be the equivalent of an urgent care center in



[Editor’s Note: It happened in most states sometime in the 1970’s, as
commitment standards were vastly restricted to require that a person must be an
immediate and demonstrable physical danger to himself or others before being
placed in a treatment facility. That legal change left law enforcement officers
powerless to help thousands of individuals who were psychotic and obviously in
need of care in a psychiatric facility. To protect and help such individuals,
some officers decided it was wiser to bring them to jail than to allow them to
remain on the streets. The term “mercy booking” was thus born.

Reflecting North Carolina’s shrinking inpatient capacity and some apparently
laggardly processes, officers in Asheboro were spending an average of five hours
on each commitment. And that did not even include the time needed for
transportation to a psychiatric hospital. We can’t help but wonder how many
people with a severe mental illness in Asheboro were brought to a booking room
rather than a treatment facility mainly because of time considerations. In many
parts of our nation a new term may now be applicable – “convenience booking.”]


By Mark Brumley -- Staff Writer, The Courier-Tribune

ASHEBORO — Several weeks ago, Asheboro police were called to a home in the city
where a 22-year-old man had gotten drunk and cut his left wrist.

The man was passed out when officers arrived early that Saturday morning, a
report stated. But by the time an ambulance got him to Randolph Hospital for an
involuntary mental commitment, he was combative.

It took four officers to control the man, who later that day was sent to another
hospital for treatment. All told, the reporting officer spent 11 1/2 hours on
the case, records showed.

Such involuntary mental commitments are a common, time-consuming, disturbing and
sometimes dangerous aspect of a law enforcement officer’s job, but it’s not one
that gets much attention. They frequently involve alcohol and drugs, which
complicates and extends the process for police, mental health counselors and
health-care workers.

“We’re all concerned about the time that it’s taking for commitments,” said
Bonita Porter, the Randolph access manager for the Sandhills Center for Mental
Health, Development Disabilities and Substance Abuse Services in Asheboro.

Asheboro Police Chief Gary Mason said his officers are averaging 20 involuntary
commitments per month, according to a recent analysis conducted by the
department. The average length of time for each call is five hours, which is
almost half of an officer’s 12-hour shift. But Mason said it’s not unusual for
calls to take 11 or 12 hours. And one recent commitment took 21 hours.

“It is certainly a big weight around our necks,” Mason said. “What that does is
it takes an officer off of the street and takes them away from being able to
answer calls.”

The burden of involuntary commitments is not just a local issue, Mason said.

“The commitment problem is really growing, and it’s not just here, it’s all over
the state,” said Mason, who has discussed the issue with other law enforcement
officials at professional conferences. “It’s a problem we’re all facing.”

With the average length of time that officers spend on involuntary commitment
calls expected to increase, Mason said his department sat down last summer and
came up with a new system to keep officers on the streets rather than in a chair
waiting while involuntary commitments take place.

“We’ve had to strategize and try to do some different things,” Mason said. “It’s
really helping us. We feel like it is utilizing our personnel to the best of our

The Process

Porter said involuntary commitments get started in a number of different ways.

In some cases, she said, a mental client comes in for a routine counseling
session and it becomes obvious to the case worker that the individual has become
“psychiatrically debilitated.” If the client is still fairly clear headed, the
counselor might be able to talk the patient into going voluntarily to a hospital
for treatment.

Family members, neighbors or friends might also bring involuntary commitments to
the attention of police or mental health workers by reporting that an individual
is acting strangely, Porter said. In other cases, police may encounter mentally
or emotionally imbalanced people as a result of attempted suicide and armed
standoff calls.

Regardless of the circumstances, the involuntary commitment process is basically
the same.

If it comes up during business hours, the person is taken to the mental center.
If it’s after hours or on weekends, the person is taken to the Randolph Hospital
emergency room.

During those times, counselors are paged through Moses Cone Memorial Hospital in
Greensboro under a contract with Sandhills Center. If the counselors do not live
in the area, their travel time to Asheboro extends involuntary commitments for
police. During a 21-hour involuntary commitment last year, a counselor took 12
hours to arrive from Greensboro to do the evaluation, Mason said.

The first step is an assessment by counselors who try to determine if
individuals need to be committed. Porter said counselors typically look for any
significant changes that have occurred in people’s lives, whether or not they
are oriented to time and place and if they are at risk of harming themselves or
others. If the people have been drinking or taking drugs, the assessments can be
more difficult and take longer, Porter said. She said family members, if they
are available, can often give counselors valuable information for their

If a counselor determines that a person needs to be committed, the next step is
getting a psychiatrist, a psychologist with a Ph.D. or a medical doctor to
approve the commitment. Porter said they will typically go along with the
counselor’s assessment, and the next step is to ask a magistrate for a
transportation order to send the person to a mental hospital or a substance
abuse treatment facility.

“It’s interesting that, really, the last word is sort of left with the
magistrate,” Porter said. “He or she could say I disagree. ... It happens very
rarely, but it has happened.”

Finding A Hospital

Porter said the next step is usually the most time consuming: Finding a hospital
that will accept the patient for a stay of three-seven days.

“That waiting time begins to extend because we’re now dealing with something out
of our control that’s beyond us,” Porter said. “That’s typically where the clock
goes longest.”

On good days, when everything “clicks,” Porter said, the entire process of
finding a hospital takes three to five hours. On other days, it can take much
longer, occupying not only police officers but also mental health workers.

“It’s a domino effect that goes beyond your local community,” Porter said. “Of
course, we are majority affected by that.”

Committing a patient is not as easy as just shipping the person off to Dorothea
Dix Hospital, the state mental hospital in Raleigh. Porter said Dix is usually
“on diversion” on weekends, which means the hospital won’t accept new patients.
During those times, the patients may be sent to private facilities that have
contracts with Dix, including Holly Hill Hospital in Raleigh and Bryn-Mar
Hospital in Jacksonville.

If Dix is accepting patients, Porter said the hospital requires them to sober up
before being admitted, due to health risks. That means officers often must wait
until a patient’s blood alcohol content drops below .08, the state level for a
driving while impaired charge.

Dix is usually the only option for uninsured patients with no money, Porter
said. Even if patients have insurance, a hospital might not accept them if they
are too unstable or violent, Porter said. She said the hospital might already
have a high number of problem patients, making the unit more difficult to

If a patient has insurance, Porter said, Dix requires mental health workers to
call at least five other centers before checking for a bed there. She said
mental health workers usually check with nearby hospitals offering with
in-patient psychiatric services before calling outside the area. Those hospitals
include Moses Cone Memorial Hospital in Greensboro, High Point Regional
Hospital, FirstHealth Moore Regional in Pinehurst, Alamance Regional Medical
Center in Burlington and Stanly Memorial Hospital in Albemarle.

“They (Dix) want to know that all of those hospitals said ‘no’ to us,” Porter
said. “That takes time.”

Placing a patient in an area hospital might not be possible, Porter said. In
those cases, mental health workers start to look outside the area to facilities
such as Holly Hill, Bryn-Mar and Coastal Plains Hospital in Rocky Mount.

“They’re not very close to Randolph County at all,” Porter said.

Fewer Hospital Beds

Also making it more difficult to place mental patients has been the declining
number of private hospital beds set aside for them. Porter said there just isn’t
a lot of money for hospitals in mental health and substance abuse treatment. The
services are costly, she said, and the insurance services are relatively low.

“Many of them have just cut back on the number of beds that they have,” Porter
said. “We saw that trend happening a lot five or six years ago.”

Porter said mental health advocates are working to reverse that trend, but
another change on the way is the pending merger of Dix with John Umstead
Hospital, a state mental facility in Butner.

“A lot of beds are going to be depleted because of that,” Porter said.

That’s one reason police expect their average wait on involuntary commitment
calls to increase to six or seven hours in coming years.

As mental health workers make calls to try to find a hospital, the clock ticks
away for police, and the risk that some patients will become violent increases.

“We’re concerned that this may escalate while we’re waiting to get to that ...
psychiatric evaluation, getting papers over to the magistrate and so forth,”
Porter said.

Mason said he’s had firsthand experience with such cases.

“You’ll have some people that can get very violent and will fight you or could
hurt you and might not even be aware of their behavior,” Mason said. “It can be
very dangerous. Over the years, we’ve had several instances where it could have
been a very bad situation.”

He remembered on one call at a local doctor’s office where he found himself in a
struggle for his life with a mental patient who seemed to have “amazing
strength.” Mason said the man had already assaulted one of his parents and torn
up the doctor’s office by the time police were dispatched. He said he ended up
on the floor wrestling with the man and trying to keep him from taking his
handgun. Eventually, the man was placed in handcuffs and leg irons and taken to
mental health.

“That could have been a life-or-death situation that was a commitment order,”
Mason said. “You have to go in knowing that you may get hold of someone who is
very unstable, somebody that could be very strong that could not be thinking
with a rational mind and could hurt you and others.”

In extreme cases, Porter said, counselors can ask for an emergency certificate,
which allows a patient to be committed more quickly.

Impact On Law Enforcement

Asheboro police officials already knew that patrolmen were spending an
extraordinary amount of time on involuntary commitment calls when they sat down
in June 2005 to analyze the numbers. But even they were surprised at some of
their findings.

In addition to determining that they were averaging 20 involuntary commitment
calls per month at five hours per call, Mason said, they learned that 75 percent
of those calls came in during the peak hours of 11 a.m.-11 p.m. That’s when
officers get 65 percent of their daily 911 calls for service.

And about three times per month, Mason said, officers have two or more
involuntary commitments taking place at the same time. Days like that can cut a
five-officer patrol team’s effectiveness in half, Mason said. And if an officer
is standing by with an involuntary commitment at the end of his or her shift,
and officer from the next shift must take over regardless of whether the team is
already shorthanded, Mason said.

“That’s where it’s hitting us, and it’s really straining our manpower, “ Mason
said. “What that does is it takes an officer off of the street and takes them
away from being able to answer calls.”

Involuntary commitments also take a toll on the Randolph County Sheriff’s
Office, where deputies are responsible for driving patients to mental health and
substance abuse treatment facilities all over the state after magistrates issue
transportation orders.

Maj. Allen McNeill said deputies transported patients 457 times in 2004. He said
that doesn’t include the times that the patients got weekend passes from the
facilities where they were being treated and deputies were required to drive
them home and then return them to the facilities.

The state recommends that sheriffs transport involuntary commitments in unmarked
cars driven by plain-clothes officers to avoid the appearance that mental health
patients are criminals, but that’s not always possible, McNeill said. He said
the sheriff’s office has to give the assignments to whoever is available for
them. McNeill said patrol deputies, civil deputies and jailers all do the
transports, depending on the time of day.

McNeill said sheriff’s officials agree that most mental health patients aren’t
criminals, and that’s why they do not believe that deputies should have to
transport them. It shouldn’t be a law enforcement responsibility, he said.

“That’s just part of our job that we get stuck with,” McNeill said.

No Cutting And Running

The quickest way to reduce the amount of time police officers spend on
involuntary commitment calls would be to no longer require them to stand by
while the process take place.

Some departments around the state have already started allowing officers to walk
away from involuntary commitments after picking up the patients and taking them
to a mental health center or hospital, Mason said. That may save officers’ time,
but it could also put counselors and health-care workers in danger if a patient
becomes violent. It could also expose the police department to greater

So cutting and running is not an option for Asheboro police officers, Mason

“There’s a growing number of departments across the state that are doing that,”
he said. “However, we feel like, based on the legal advice that we’ve got and
from the opinions given by the Attorney General’s Office ... we just don’t feel
like legally that’s the proper thing for us to do. So we keep our people with
the commitments until we feel like our duty and obligation have been fulfilled.”

But Mason said the department had to find a way to keep patrol officers from
spending hours on involuntary commitment calls.

“We just felt like it was getting to the point that we had to look at doing to
some different things because it’s absolutely killing us out in the field,” he

Coming Up With An Answer

With the city’s approval, Asheboro police devised a plan last summer to handle
lengthy involuntary commitment calls.

The plan involved establishing a roster of officers willing to come in to work
on their days off to standby at mental health or the hospital to relieve on-duty
officers so they can get back on the streets. Supervisors begin calling officers
on the roster only if it appears that a commitment will take longer than a few
hours. The officers aren’t required to come in to work, but if they do they
receive overtime pay. Mason said the money comes out of the department’s special
assignments budget, which is typically used for license checks and other

“This gets an officer back in the field,” Mason said. “We feel like it’s good
utilization of the taxpayers’ money and the money that’s been allocated to our
department. It is relieving officers and getting them back into their cars.”

After implementing the system, police officials studied it in July 2005 to see
how it worked, Mason said.

That month, the department responded to 15 involuntary commitment calls. Six of
those did not require an off-duty officer to be called out. The total amount of
time that officers spent on those calls was 16 hours, 10 minutes.

The total time spent on the other nine calls was 56 hours, 30 minutes. On-call
officers stood by for a total of 46 hours, 15 minutes, on those calls. They were
paid a total of $1,300 for overtime.

“So far it is really helping us,” Mason said. “What it’s done is it has relieved
us of our manpower being tied up as much. We’re still have a lot of commitments
that we’re dealing with but it is giving us some help in keeping sufficient
numbers of officers out in the field.”


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