Saturday, February 9, 2013

Your Tax Dollars At Work

From the August 16, 2008 Wall Street Journal, a sobering story of a young man with schizophrenia who was released from a mental hospital contrary to medical opinion:
On Christmas Eve, 2003, Joe says William had his first psychotic episode in a Target store, telling his father that the security cameras were monitoring him.

But he refused to seek treatment, and his family couldn't insist. Maine, like many states, requires that the mentally ill pose a substantial risk of harm to themselves or others, based on recent evidence, to be involuntarily committed.

In March 2005, after William threatened two men with a loaded AK-47 assault rifle -- his father is a licensed gun dealer -- William went to a psychiatric facility in Bangor. He was eventually released but stopped taking his medicine.
The next time around through the revolving door:
A few weeks after William Bruce's admission, psychiatrist Jeffrey Fliesser wrote that William was hostile, paranoid and "dangerous to others without additional observation and active attempts to treat him," an opinion he reiterated over the next five weeks. The doctor also wrote that he urged William, now diagnosed with paranoid schizophrenia, to take medication, but William refused. Dr. Fliesser declined to comment about the case for this story.

William began working with advocates employed by the Maine Disability Rights Center, which receives funding from the federal PAIMI program as well as state and private sources.

According to a nurse's treatment record dated March 23, Ms. Bailey, the advocate, told Riverview administrators she saw no documentation showing that William should remain hospitalized. Trish Callahan, another advocate, suggested that William "may actually be getting worse by remaining here," the nurse's record says.
So an advocacy group funded by the federal government got William Bruce released:
William was soon back home. He hid steak and butcher knives in his bedroom and spent hours pacing in the driveway, giggling and babbling unintelligibly to himself. Joe began calling to check on his wife several times a day. "It was the worst we'd ever seen him," he says.

On June 20, two months after his son's release, Joe Bruce returned home from his office to find his wife's battered, bloodied body. William was gone.

"My son has killed my wife," Joe told the 911 dispatcher, later adding that he was arming himself in

According to the medical examiner's report, Amy died of multiple blunt-force trauma and chop injuries to her head. She was 47 years old.
William Bruce is doing much better now.  He is on antipsychotics that allow him to recognize what he did:
William Bruce, now 26, is strikingly handsome, his dark hair slicked back. Sitting in a Riverview conference room on July 23, he spoke courteously but deliberately. It was the first time he has been interviewed about his case.

"I blame the illness, and I blame myself," William said of his mother's death. "The guilt is...," he paused, struggling to find a word "...tough."

William said the first time he came to Riverview, he refused to believe he was mentally ill and approached the advocates because he wanted out.

"They helped me immensely with getting out of the hospital, so I was very happy," he said. He later added, "The advocates didn't protect me from myself, unfortunately."
Unsurprisingly, the advocates for the mentally ill are convinced that they did the right thing.


Gladorn said...

I work corrections and unfortunately I see first hand that the first line of effective treatment starts with incarceration. Even our outside mental health counselor sees this and is sick of it. Law enforcement finds it easier to arrest someone instead of getting a Detainment Order. (Less work for them.)

What is worse is that the mental health agencies that can help will take forever to get to an inmate. Their reasoning is that correctional officers can take steps to protect the inmate from themselves. Of course, these steps often include keeping an inmate in four point restraints, securing them to a concrete bunk, or securing them in a restraint chair. Therefore someone needing treatment can be restrained in some manner for weeks (or months) before they get picked up for treatment. And it's "OK" because they are being "protected."

We don't have the tools to do much else for them, and those with the tools aren't in any hurry to use them. And yet until something terrible happens, it's all logically explained away. (And when something bad does happen, we get the blame because "Hey, Corrections!")

Windy Wilson said...

This came about because the perfect is the enemy of the good (enough).
The process before the 60's was not perfect, but it is better than what Gladorn (and Clayton in his book) describe. But the system as it existed had to be "improved". And now it is worse in ways unimaginable in 1950.

RS said...

We are in the middle of this at the moment. Our son is in acute mental care with schizophrenia. The goal is to get him out as soon as possible.

Is this REALLY the right goal? Shouldn't the goal be to make and keep him WELL as soon as possible?

Clayton Cramer said...

The motivation for getting him out as soon as possible may be financial on the part of the insurer. However: because most of the treatment for schizophrenia now is pharmaceutical (there's no point to psychoanalysis -- it does nothing for schizophrenics), a rapid return to the outside may not be a particular bad thing.

Harsh fact: only about 30% of schizophrenics recover. Some of the 70% can be sufficiently stabilized to return to work (although usually not at the level that they had previously worked); some can be stabilized enough that they aren't a threat to others. Many will be disabled for the rest of their lives.

I wish that I could tell you something more encouraging. This is why I get so upset about the rather relaxed view about alcohol and marijuana (both risk factors for schizophrenia) that has taken over our society.