Jails, prisons, and preventable tragedies

Approximately 218,000 individuals with severe psychiatric disorders are incarcerated in the nation’s jails and prisons at any given time. That means, sadly, stories like the one below are not as uncommon as we might think.

In Auburn, California near Sacramento, 46-year -old Herman "Tim" Van Bragt, fatally stabbed his mother’s friend earlier this week.

Van Bragt had dreamed his mother’s friend Robert Haggquist was going to kill his mother. When Van Bragt was home alone with Haggquist he fatally stabbed the 72-year-old.

Van Bragt’s mother said he had stopped taking medication for bipolar disorder:

She said her son subsequently stopped taking medication for his bipolar condition and crashed his vehicle.

"I'll never get over it. My son is very sick with bipolar disorder."

An ounce of prevention

Three weeks ago, Derek Johnson was shot to death by police in Flowood Mississippi.

Johnson was suffering from severe mental illness and engaged in bizarre behavior. A neighbor observed Johnson naked and screaming that Armageddon was coming. When the police arrived, Johnson came at them wielding a boxcutter. Johnson was shot and killed.

The brother of Derek Johnson claims the Flowood police overreacted and should have been more sensitive to his mental illness. A representative for the police claims that the responding officers felt their lives were in danger and made a reasonable choice to use deadly force. The courts will inevitably sort out this particular tragedy.

In the meantime, the overall factual pattern and its tragic consequences are far too common. Every year, an alarming number of people struggling with mental illnesses and dedicated police officers lose their lives in altercations similar to this one.

The most important question to ask when we read stories about people such as Derek Johnson is not whether or not the police acted properly. Rather we should be asking why a person like Derek Johnson with such a severe mental illness was not being properly treated in the first place.

The best solution to address this national problem is to ensure better treatment for all people overcome with severe mental illnesses.

Imprisoned because of psychosis

After stealing a car in 1995 and violating parole by making harassing phone calls in 1998, Carl Scherer was sent to prison for seven years. Not surprisingly, the symptoms of his paranoid schizophrenia worsened while in prison.

His records indicate that the medications were constantly being adjusted or changed, such that at no time was he stable for any lengthy period of time," Gottlieb wrote. He also reported that Carl often refused his medication, which led to repeated cycles of psychotic behavior.

Just before Carl was released on parole in 2001 he became so ill he was sent to Cresson State Correctional Institute. Shortly after, Carl’s parole was revoked. Carl was to be kept in prison- a place never meant as a treatment facility- to get treatment for his schizophrenia.

"They took away his only opportunity to get the care he needed and left him in there, not because he didn't meet the criteria for being paroled, but because he has a mental illness. I mean, it's outrageous in my mind. …

"That's not the point of the correctional institutions — to house individuals with mental illness."

Shortly after Carl was returned to the general prison population, he was killed by his roommate.

Carl Scherer was apparently too ill to be paroled, but not sick enough to be kept in treatment.

Why are we relying on prisons to provide psychiatric care? Better yet - Why wasn’t Carl getting treatment long before he was entangled in the Pennsylvania prison system in the first place?

Dr. Torrey in New York Post

David Tarloff, accused of killing psychologist Kathryn Faughey and trying to kill psychiatrist Kent Shinbach, was known by his neighbors as "the crazy guy." He'd been "in and out of mental hospitals more than 20 times," says his brother, but "they kept releasing him." He did reasonably well when maintaining treatment, but he "frequently went off his medication."

Off medication, in these stories, is when the trouble usually starts...


Violence committed by seriously mentally-ill individuals who are not being treated are merely one manifestation of our egregiously failed mental-health-treatment system...

And there is abundant evidence that all of these problems are getting worse.

We know what to do, of course. Most individuals like Tarloff do very well if they are properly followed up and treated. Kathryn Faughey's killing is a failure not only of the treatment system but also of every New Yorker for not demanding a system that works - first and foremost, by holding hospital and mental-health accountable.

Until we start doing that, each mind-numbing tragedy will keep on being followed by another.

- TAC president, Dr. E Fuller Torrey in an op-ed in today's New York Post

Washington state continues to fail

Anthony Williams refused to take medication for his paranoid schizophrenia. He had been evaluated by mental health workers at least three times in the last year, but Williams wasn’t deemed an imminent risk to himself or others, so wasn’t ordered to treatment.

So, why do county designated mental health professionals insist that someone be "imminently" dangerous when the word "imminent" doesn't even appear in the Washington standard? Forty-one other states let families directly petition a court to get treatment for a loved one in crisis. Why does Washington State require county designated mental health professionals to be the “middle man” in their process?

In the past Williams had threatened to kill a community corrections officer and had told a psychiatric social worked that “God told him to "shoot bad people" and that he carried a knife to protect himself from both God and the devil.” But Williams wasn’t deemed dangerous enough for treatment.

In September Williams threatened the landlord at his apartment. Police said he was a “a threat to the safety of officers and those around him," and found an 8-inch butcher knife in his sweat-shirt pocket. Williams was found guilty of harassment, but wasn’t deemed dangerous enough to be committed into treatment.

Williams was considered high risk by police, the Department of Corrections and community health staff, and the DOC had logged 50 contacts with him in the past six months.
Yet- King County mental health workers said Williams still didn’t meet the threshold to be committed to treatment.

On New Year’s Eve, Williams fatally stabbed 31- year-old Shannon Harps outside her house. Now will Williams get treatment?

A horrific ending

A few weeks ago a homeless man in Fairfax County, Virginia was shot and killed by police officers after he lunged at them with a knife. As the public railed against the officer for using lethal force, one blog comment added a bit of perspective.

However, this incident just highlights how poorly we treat the mentally ill in this country. This homeless man was clearly not of a sound mind. If he were cognizant of reality, he would not have been jabbing anyone, much less a cop, with a knife, totally at random. This man (and literally thousands of more like him) should be in hospitals, receiving treatment.

Yet, because over 70% of all state mental facilities were closed in the late 70’s to early 90’s, we have no place to house these broken people. Many end up in jail. Many more end up on the street. Far too many end up dead.

We cried at the last spring's tragedy at Virginia Tech. We point fingers at ineffective police reactions. Yet, we don’t want to do anything to fix our mental health situation.

If we don’t push for change, what happened at the Rose Hill Shopping Center on Friday will become more common than rare.

There’s no doubt this story had a horrific ending. Rather than be horrified by the police perhaps the horror should be pointed at the mental health system.

What it takes...

"At one point I stood up in court and said, 'What is it going to take for him to get some help?'" Barbara Strandberg said during a recent interview. "I think I've got my answer now."

The spoils of psychosis

Joshua Hoge is confined at Western State Hospital after being found not guilty by reason of insanity for murdering his mother. He is now trying to claim all or part of his late mother's estate, despite a Washington State law that prevents someone from profiting from killing someone else.

The bulk of the estate that he is trying to claim - $800,000 - came from a lawsuit filed against the clinic that kept Joshua from getting the treatment he needed for his schizophrenia - treatment that might have prevented him from stabbing his mother and brother to death with a butcher knife in the first place.

There's a great deal of gnashing of teeth over the possibility of Joshua "winning" this money - which would likely be used to support him if and when he is ever permitted to transition into a group home and back into society.

While Seattle University law professor John Strait acknowledges that this is "nutty logic," he agrees that Hoge may very well be entitled to the money. "For all intents and purposes, there is no crime," he says. "We don't punish people for being really sick."

Unless you count forcing them to remain psychotic, stab their family members, and spend their lives in a forensic facility ...

Is a double homicide a requirement for getting treatment?

Lizards and frogs were reading his lips, CSPAN newscasters were calling him a terrorist, he was the target of a conspiracy involving the KKK and the CIA, and comedians on BET were making jokes about him, but Franklyn "Frankie" Duzant wasn’t getting treatment for his mental illness.

There was no treatment until -19 months ago -Duzant slashed his son and wife to death with a sword because he believed his wife was going to be kidnapped and his son was going to be tortured by dogs.

Now, Duzant is getting treatment. Since the killing he’s been restored to competency and is ready to stand trial. All it took to get there was a double murder.

Freezing with his rights on

As reported by WLBZ of Bangor, Reid Emery, a 61 year old man, was released from the Down East Community Hospital in Machias Maine last Tuesday night. The following morning, he was found dead in a snowdrift just a few hundred feet from the hospital’s entrance.

When Mr. Emery walked out of the hospital, he was reportedly delusional. He was wearing a light jacket and slippers. He left against the advice of doctors. And he walked out into the height of a brutal January snowstorm. Weather records for East Machias show that the low temperature that night dropped to four degrees.

Nevertheless, a hospital administrator, Ann Marie Knowles, explained that there was nothing that could be done to stop Mr. Emery. “Patients have the right to leave against medical advice.”

In Maine, a person may be admitted on an emergency basis for the treatment of mental illness upon a showing that this person suffers from a mental illness and poses a likelihood of serious harm to himself or others.

We know no details about Mr. Emery’s history of mental illness. We also do not know why hospital personnel deemed themselves unable to intervene on Mr. Emery’ behalf. What we do know is that hospital personnel did nothing to stop an elderly, delusional, and under clothed man from stepping out into subfreezing temperatures and a raging snowstorm.

Any caring and reasonable person should have been motivated under these circumstances to take some action to intervene on behalf of Mr. Emery. Instead, we find a hospital trying to justify the practices and procedures that resulted in this tragic and unnecessary death. What is wrong with this picture?

At least those who champion the civil liberties of the mentally ill can take some comfort in knowing that Reid Emery froze to death with his rights on.

Wall Street Journal: "Free to Die in Iowa"

In today's Wall Street Journal, Michael Judge has a powerful piece about the Sonny Iovino case in Iowa:

After Iovino's death, a spokesman for the VA Medical Center told the Cedar Rapids Gazette, "If somebody doesn't want to be treated, you can't treat them." This is simply not the case. Given his debilitated state, the VA psychiatrist on duty could have forced Iovino to receive the treatment that might have saved his life ...

In fact, Iowa's commitment standard is better than many states', which demand that a person be an "imminent" danger to himself or others. In Iowa, however, to be eligible for AOT a person must lack sufficient judgment to make responsible decisions concerning treatment; and be either (1) a danger to self/others or (2) unable to satisfy the need for "nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death."

When Iovino was picked up by police just two days prior to his death, he was digging up the earth with his bare hands, talking to himself, barefoot in frigid weather, and huddling near a building's exhaust vent to stay warm. He was at the very least a danger to himself ...

Getting messages from the TV

Jeffrey Arenburg is in the news again; this time facing charges for punching an officer in the face.

Twelve years ago, Arenburg killed Ottawa sports broadcaster and former hockey pro, Brian Smith after he finished his 6 p.m. sports show. Police said Arenburg, who had worked as a fisherman, had made complaints in the past that TV stations were broadcasting messages into his head.

According to Canadian media reports, Arenburg was later diagnosed as a paranoid schizophrenic and was found by a judge to be “not criminally responsible” for the death of Smith.

In a terrible irony, after Arenburg killed Brian Smith, Ontario passed “Brian’s Law,” in his name – a bill that allows for court-ordered community treatment.

Unfortunately, threats to local TV and radio personnel by people with untreated mental illnesses are more common than many realize.

In a questionnaire answered by 259 radio and TV stations:

• 123 stations (47.5 percent) reported having at some time received a telephone call, letter, fax, or e-mail from an individual asking the station to stop talking about them or sending voices to their head.
• The stations had received a total of 3,155 such communications from 284 separate individuals in the past year, with one station reporting having received 1,500 communications.
• 43 stations reported that an individual had at some time personally come to their station to ask them to stop talking about them or to stop sending voices to their head. The stations reported having received a total of 150 such visits from 61 different individuals in the past year.

You shouldn’t have to strap a bomb to your body to get someone to help you

Leeland Eisenberg purportedly tried to get help before taking hostages in a dramatic scene on Friday at Hillary Clinton’s campaign office in New Hampshire.

Eisenberg was known for his erratic behavior and for drawing law enforcement’s attention, and yet when he was taking medication, he was a different person.

Family members and friends said that Eisenberg could be a funny and sweet man when he took his medication.

"When he was on his medication he was always making me laugh. He spoiled me. It was perfect in my eyes," Lisa Eisenberg told "GMA." "Without the medication and with alcohol, he turned into a different person."

The Eisenberg case is another in a long line of examples of why our country needs to recognize the importance of early and timely treatment for severe mental illnesses.

The Nation had this:

Without appearing to capitalize on the situation, Clinton, and all elected officials, can and should take this incident as an opportunity to emphasize the importance of mental health services in any health care package, criminal justice reform, and indeed, in any vision of what a more caring, safer America looks like.

One thing a more caring, safer America needs is more inpatient beds and better systems for the sickest people to access those beds. The number of available inpatient psychiatric beds in New Hampshire has dropped dramatically. In May of last year, the Concord Monitor reported on the crisis.

In the past 20 years, alternatives to New Hampshire Hospital, which cares for patients who are a danger to themselves or others, have dwindled.

Lakeshore Hospital closed. Portsmouth Pavilion downsized. The number of beds outside New Hampshire Hospital for patients who need to be involuntarily committed shrunk from 101 in 1998 to 22 in 2002, the report said. In residential acute psychiatric programs, the number of beds plummeted from 52 to 17 between 2000 and 2003 because the reimbursement doesn't cover costs.

Leeland Eisenberg – if he doesn’t land in prison – will likely now qualify for one of those beds. Which is ironic considering the undercurrent of desperation in this story – and of many like it. You shouldn’t have to strap a bomb to your body to get someone to help you.

The family says earlier last week Eisenberg, seeking mental health help, was turned away from a hospital because he had no money or insurance.

Eisenberg apparently went to the Clinton office because he saw an ad on television, in which a New Hampshire man said Clinton helped him get health insurance.

Eisenberg told a family member he was going to do something to get in the hospital. The next day witnesses say he walked into the Clinton office, wearing what he said was a bomb, demanding to speak to the senator. [Good Morning America, December 3, 2007]

It isn’t news that we need more psychiatric hospital beds and better overall systems to care for those who need it. Mr. Eisenberg may sadly have done more than secure treatment for himself – he may have secured some attention for these issues from those who are campaigning to be president.

"Residentially challenged"

When you have a home but refuse to live in it, can you really be called "homeless"?

William Royce had a home, and a loving family. But he died in the elements after mental illness robbed him of his ability to make informed choices. A local police department spokesperson called Royce "residentially challenged,' which many, including one letter-writer, called "a new low in political correctness."

But might that actually be the most accurate way to describe someone like William Royce?

In a response via a letter to the editor in the Tallahassee Democrat, William Royce’s father Charles makes this unique argument.

I thought "residentially challenged" was a very correct way to describe the situation, and our family appreciated its use in the newspaper.

This was a young man who wasn't homeless, but he was residentially challenged, and he chose to live where he was found. He was also mentally challenged. He had been diagnosed with schizophrenia and he periodically was affected by that. Whoever coined that phrase, or opted to use that phrase, was very kind in his choice of words and the family appreciated that.

Iowa’s cold-hearted system leads to hypothermia

Photo from Gazette.com: "Personal items and trash are strewn about the homeless camp under Iowa City's Benton Street bridge Thursday. Transient Sonny Anthony Iovino, 55, was found dead from hypothermia under the bridge Wednesday."

The cause of death for Sonny Iovino is officially listed as “hypothermia.”

But it is clear he was a victim of something equally as chilling – a system that bounced him around, seemingly unable (or perhaps unwilling) to help him.

Iovino was a familiar face to Iowa City police, and was repeatedly picked up in the past 5 years on charges like disorderly conduct, public intoxication and simple assault. In fact, “In the first seven days of November, he'd had five encounters with police.”

So fittingly, it seems from news stories that it was the police who tried the hardest to get him help. Yet all the doors were closed to him because he was severely mentally ill and belligerent – a combination that too often fails to ignite compassion.

When officers took Iovino to the VA Center, he was turned away because he was uncooperative.

When the doctor asked to take his vital signs, Iovino made what reports called an inappropriate comment. "I take that as a no," UI Police Officer Alton Poole reported the doctor as saying. The doctor released Iovino back to police.

Yet, when officers then transported him to jail, he was turned away because he was too sick.

Johnson County Sheriff Lonny Pulkrabek told The Gazette the jail won't admit anyone with an immediate medical need. He said the doctor's note indicated Iovino needed hospitalization for mental illness.

He was behaving erratically, and was, in fact, nearly naked in a city where the average temperature in November hovers at 31 degrees. Yet he couldn’t get the help he clearly needed.

The spokesperson for the medical center that released him back to police said hospital officials did all they could:

"If somebody doesn't want to be treated, you can't treat them."

Whether officials are ignorant of state law or willfully ignore it, the result is the same. In reality, Iowa has the option of assisted outpatient treatment, and actually uses its law to a certain extent, but not as much as it could, mainly because of its restrictive eligibility standard.

Iowa's commitment standard basically holds that to be eligible for outpatient treatment or hospitalization, the person must lack sufficient judgment to make responsible decisions concerning treatment AND is either (1) a danger to self/others, including that of serious emotional injuries to family members and others OR (2) unable to satisfy need for nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death.

From news reports, it sounds like Mr. Iovino met that criteria. Perhaps everyone was tired of trying to help him. Perhaps his attitude and belligerence made him unpleasant to interact with. Perhaps everyone was busy and didn’t want to take the time.

The end result should shame everyone involved.

Community members call for better treatment in Virginia

The following quotes are from news coverage of the death of Susanne Thompson, who was stabbed while walking her dog Saturday morning. Johnny Hughes, the man charged with her murder, has a history of mental illness.

He's [Richmond Mayor L. Douglas Wilder] concerned that state law doesn't always allow mandatory treatment of mentally ill people with criminal histories.

“… this situation represents a much larger problem. The real question is how many others are similarly situated across the state and the region who need coordinated mental health resources in order to reduce any possibility of this situation recurring.”

Hughes' younger sister, Chesterfield County resident Jackie Lewis, said the killing could have been avoided.

"We are so deeply sorry for this innocent loss," Lewis said on behalf of her family. "I'm sure if my brother was in his right mind, he would feel the same way."

"Somebody dropped the ball in terms of his care," she said.

Richmond Sen. Henry Marsh: "The purpose . . . is to create an assisted outpatient treatment program so that those mentally ill persons who are capable of being maintained safely in the community with the help of such a program can receive those services."

"The things he [Hughes] was saying, he didn't belong here," said [Richmond Sheriff C.T.] Woody, who has complained that the jail does not have the facilities or resources to care for the hundreds of mentally ill men and women doing time there.

A little too late

According to a psychiatrist Elartrice Ingram’s schizophrenia symptoms are now under control. He has been in treatment and he’s no longer a threat to himself or others.

It’s too bad that treatment came AFTER he stabbed eight people.

Suicide at UCLA

In Los Angeles, 19-year-old Simon Latimer committed suicide last Friday by walking off a balcony at a UCLA campus. Latimer’s mother, Dianne Taylor said Simon had schizophrenia, and toward the end of his life heard voices from God and wandered around LA looking for God.

Like so many other parents whose grown children have a severe mental illness, Simon’s parents tried to get him help.

“He did well in school, got awards, and then about a year ago, he started hearing voices and became schizophrenic. His personality changed, and he refused treatment,” Taylor said.

Though his parents tried to get him into programs, Simon declined. Since he was over 18, his parents had no choice but to let him go his own way.

“Because he wasn’t considered ‘bad enough’ by the authorities, I couldn’t get him into a hospital,” Taylor said.

She added that this was especially hard since refusing treatment is a common symptom of schizophrenia.

What assisted outpatient treatment can... and can't... do

Last Saturday, Lee Coleman evaded his family’s attempts to have him hospitalized and went on a rampage – stabbing two people with knives he stole from a Manhattan restaurant before being shot by an off-duty police officer who had just paid his check.

It is the type of gripping tragedy that leads to unfortunate, big-lettered headlines in a city’s papers, such as PSYCHO STABBER from the New York Post, as well as editorial pleas with titles like Stop The Insanity On The Streets. And when the general community peers into the most often ignored world of severe mental illnesses, the possibility of reform emerges. On Monday, Governor Eliot Spitzer expressed his support for creating a panel tasked with investigating how to treat the most severely ill and thereby protect the public from those in that group whose symptoms would otherwise escalate to violence. New York is home to Kendra’s Law, the best-known and most thoroughly documented assisted outpatient treatment (AOT) law in the United States. Yet despite the availability and success of Kendra’s Law, tragedies intertwined with non-treatment continue in New York. Does that mean Kendra’s Law has failed? Hardly.

Kendra’s Law neither is nor is purported to be a cure-all.

For starters, an AOT program cannot help someone who is not in it. As is appropriate with any form of court-ordered treatment, the eligibility standard for Kendra’s Law is targeted at those incapable of managing and maintaining their own care. And even if Coleman was eligible at some point, the Kendra’s Law program is not tasked with searching out those who are sick and need AOT.

AOT is also not a mechanism designed for times of extreme crisis. The law has no mechanism for immediate intervention other than for those already under AOT orders.

The purpose of Kendra’s Law is to give intensive and sustained outpatient treatment to those that courts order into the program, treatment designed to help some of those most overcome by severe mental illnesses stay out of the hospital, off the streets and away from jail. It does that exceptionally well.

Failure in the case of Lee Coleman can be pinned to New York’s still-restrictive standard for emergency intervention and inpatient hospitalization, which requires immediate and demonstrable physical danger. Coleman’s uncle pled with police for help after his nephew frantically fled attempts for treatment and disappeared. The police told him they were powerless because “there was no history of violence.”

Oprah on bipolar and violence

Andrea Petrosky killed her child. On The Oprah Show today, she talks about it, and about her bipolar disorder.

Petrosky is one in a long line of mothers whose untreated or wrongly treated severe mental illness had such a sickening result. In fact, of children killed by a parent, 15.8 percent of defendants had a history of untreated mental illness.

What she has to say about it sounds very familiar.

Andrea says the person who killed her son "wasn't me. It wasn't the real me. It was a very sick me, because I would never hurt him. Never," she says.

Her voice is an eerie echo of many who have been through similar circumstances. Like Naomi Gaines, who killed her 14-month old twins.

"I know how I was feeling that day. I know I was not the same Naomi who got up with my kids a million times before and fed them and bathed them and walked them and breast-fed them and cared for them," she says. "I wasn't that same person. So I know that I would never hurt them if I had had my sanity."

It isn’t the disease that leads to violence, it is the lack of timely and effective treatment for that disease.

People with severe psychiatric disorders are not more dangerous than the general population - if they are being treated. But without treatment, some commit acts of violence because of their delusions and hallucinations. Many of the cases in the news eventually uncover the fact that the person who killed their child was not taking medication. And research shows that the most common reason that people with severe mental illness refuse treatment is because they are too sick to realize they need treatment.

Don’t believe the hype you will hear today from some in the mental health community – that these cases are extremely rare. In Texas just last week, Alysha Green doused her three-, five-, and seven-year old daughters with gasoline and lit them on fire. The three-year-old has since died. Alysha’s husband says his wife had a history of mental illness with a past diagnosis of bipolar disorder. She was prescribed medication. She stopped taking her medication and, her husband reported, her behavior deteriorated in the three weeks prior to the tragedy. That same week, Helen Kirk was found insane in her murder trial in Massachusetts – she told police she believed her son Justin was “the devil” after she strangled him.

Oprah also talks to General Hospital star Maurice Benard and actress Jenifer Lewis from their perspectives as people with bipolar disorder. Benard returns to the issue of violence when he recounts what happened one evening when he was off medication.

“I started yelling. And I told [my wife] if she didn't stop [crying], that I was going to kill her—in my mind I didn't believe I would."

As much as we don’t want it to be true, violent behavior is one of the consequences of failing to treat. Even NIMH gets that now.

Oprah doesn’t delve into the concept of assisted outpatient treatment, which is too bad. The obvious question after a show like this is “how can we help people before they get so sick?” Maybe in a future show, they will include the perspectives of so many who can attest to the importance and value of earlier intervention.

Until then, we call this a good beginning.