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David Baxter

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Why I Can't Save My Brother?
Sunday, September 10, 2006
By Joan Mitric, Washington Post

My brother BJ has not killed anyone. Not yet. And I hope he never will. But in various disturbed, hyper-vigilant and paranoid states over the past 30 years, he has slashed screen doors, severed phone wires at the family home, tossed scalding coffee at our now-deceased mother, left bizarre or menacing messages on his siblings' phones and otherwise exhibited behavior that screams: "I am a danger to myself and others."

BJ also drinks or drugs himself into a stupor countless times a year and has spent the greater part of the past two decades in jail for drunken, disorderly or disruptive conduct. Two years ago, he created an hours-long hostage situation in the Southern California beach town where we grew up after threatening someone in a motel with a pellet gun. For this, he was thrown into Wasco State Prison near Bakersfield and charged with the felony of "threatening a crime with intent to terrorize," as well as several misdemeanors.

BJ is clearly ill. Yet the exact nature of his illness remains undiagnosed because in the decades that he has waged war against his demons, he has never had a full psychiatric workup.

That's right. Months, even years of jail time, all of it at taxpayers' expense, and not a single mandatory referral to a drug rehab or residential program with a strong mental health component. Sadly, BJ's experience reflects the true state of our country's health care system, especially as it relates to adults who are mentally ill and repeatedly incarcerated. It says even more about our society's unwillingness to provide the resources to diagnose and treat mentall illness.

This truth hit me again with the recent news of the death of Bethesda psychiatrist Wayne S. Fenton, whose body was found in his office on Labor Day weekend shortly after he had met with a severely troubled patient. It will probably be months before a clearer picture emerges -- if one ever does -- of what may have gone wrong with the fragile psyche of Vitali Davydov, the 19-year-old charged in the death. But the case is merely the latest tragedy involving individuals with a history of mental illness to scar the Washington area in recent years -- in May, a disturbed young man fatally shot two Fairfax County police officers before killing himself. And unless something changes in the way our society deals with the severely mentally ill, it won't be the last.

By all accounts, Davydov's family was trying desperately to get him the medical support he needed. But caring relatives often are not enough. Even if a family knows that one of its own is in dire need of medication or talk therapy or both, it is frustratingly difficult to get help for a mentally ill adult, especially one who refuses it. I know, because I have tried -- and failed.

My middle brother, BJ -- a bright and sensitive soul drawn to poetry and philosophy -- was the one most affected when our parents abruptly divorced in 1974, breaking up a 32-year marriage and the family we knew. BJ was a college graduate, but over time, his once erudite, witty letters became increasingly incoherent, tinted with delusions and paranoia. He held jobs irregularly while living with our mother: He fought forest fires, was a landscaper, a breadmaker, a beekeeper, a liquor store clerk. He even helped manage a shellfish company. But these jobs all ended suddenly, usually because BJ became abusive, picked a fight or inflated a perceived slight into an imaginary threat.

Like many people with undiagnosed mental illness, he self-medicated with alcohol and drugs to ease his anxiety and to quell his inner torment.

Over the years, my sister and I have tried to get BJ the help he needs: doctor's appointments, a place to sleep, rehab programs. We pleaded with him to take advantage of one of the good residential programs in California. All to no avail. Every time BJ is arrested, I write or call the presiding judge and beg him to remand my brother to a treatment center. If I find out BJ has been incarcerated, I call the jail's psych ward and have the same frustrating, ultimately futile conversation with staff counselors there. I urge them to do a psychiatric workup or to insist that BJ at least attend substance-abuse sessions while he is in jail and sober. I reason that even if he is not an active participant, a seed may be planted. I hope that BJ may see that he needs medical help and finally seek it.

Unfortunately, in California, as in many other states, even recalcitrant inmates cannot be forced to see a doctor, take antipsychotic drugs or attend individual or group therapy sessions, unless they consent to it. Yet once BJ is released, attendance at AA meetings is often a condition of BJ's parole; not surprisingly, his attendance is sporadic, half-hearted at best. Soon he is back in jail, on the public dole.

Prison counselors in California know that the current system is dysfunctional. The state prison at Wasco, one told me, is "nothing but a gigantic warehouse." He added that a typical counselor supervises at least 200 inmates and hence spends little time with any of them, and that the prison has many violent felons with "obvious mental health issues" who have never had a psychiatric write-up even after five or 10 years in the system. He said a rapid return to a life of crime and prison is typical of drug offenders or people with alcohol or substance-abuse issues with undiagnosed mental disorders.

"They do fine in our strict routine," he said. "We tell them when to get up, when to shower, exercise, what they can eat, even when to brush their teeth. But when they get out of here, many do not have the skills or the mental stability to function on their own in society, to hold down a job, to take care of themselves, to set up a support group they can call on."

This certainly is the case with my brother. Once on the outside, he haunts libraries, pesters friends, lives in cheap motels, rummages in dumpsters. Or he camps on the streets until he's locked up again. Lack of structure plays havoc with his mind.

When my mother was hospitalized with severe emphysema several years ago, BJ -- who had been living with her for years -- spiraled rapidly downward. In the month she spent in a pulmonary rehab facility, he trashed the home they shared, almost setting it on fire, and became increasingly distraught and violent. He showed up at the hospital agitated or drunk. He frightened the nurses, rearranged oxygen tubes, stole car keys and made it impossible for me to hire anyone so that Mom could continue her recovery at home. Despite numerous calls to police and mental health providers, no solution was found. In California, as in many other places, a court must declare someone mentally incompetent before authorities, or families, can act.

After weeks of attempted interventions with counselors, friends and other failed strategies, my sister and I persuaded Mom to get a restraining order. With help from social workers and a mental health counselor, we encouraged her to evict her son so that she could go home with a caregiver. It was a devil's bargain.

Since then, BJ's rap sheet has grown, mostly for drunken and disorderly conduct or for scaring people with his bizarre behavior. If he does not receive serious help soon, I fear the episodes will only escalate. I worry that the hostage incident with the pellet gun -- where thankfully no one was hurt -- could easily morph into a crime in which people are injured, or killed.

Maybe even my brother.


Joan Mitric, a writer who divides her time between Washington, California and the Balkans, writes often about health issues.
 

ThatLady

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What was that old byline that used to proceed the TV program, The Naked City? "There are a million stories in the naked city. This is but one of them." (Something like that)

It's sad to hear of things like this and realize how little we, as individuals, can do to help people like Ms Mitric's brother. They're difficult cases, at best, since they really aren't able to cooperate with therapy or rehab. They require such a highly structured environment just to survive that it's a real problem to develop something that will work for them. Without their cooperation, and understanding, therapy is probably a nightmare for the therapist (probably, for the patient, as well).
 

David Baxter

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"There are 8 million stories in the Naked City. This has been one of them."
 
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so in what cases can do they an involuntary admission to a hospital? how severe does the situation need to be? i know of someone who was suicidal but refused to get help and there was nothing her family could do to have her get help. they were turned away.
 

David Baxter

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The criteria are imminent danger to self or others and/or mental incompetence (e.g., actively psychotic).

Someone who is voicing suicidal thoughts but denies a specific plan or specific imminent intent may not meet the criteria.
 

ThatLady

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so in what cases can do they an involuntary admission to a hospital? how severe does the situation need to be? i know of someone who was suicidal but refused to get help and there was nothing her family could do to have her get help. they were turned away.

Here, if a person presents to a hospital ER and the doctor feels that patient is a true danger to him/herself or others, that person can be involuntarily committed after being reviewed by a psychiatrist who agrees with the ER doctor's concerns.
 

Halo

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So here if a person is suicidal but does not say that they have a specific plan than they are not considered an imminent threat to themselves and will not be involuntarily committed?

Am I interpreting this correctly?
 

David Baxter

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Not necessarily, Nancy. It's a judgement call, really. What I was saying is that if the person did not admit to or expressly denied a specific or immediate plan, s/he MIGHT not be seen to meet the criteria for involuntary admission.
 

ThatLady

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That's how I understand it, as well, Nancy. I think the psychiatrist looks for certain criteria when evaluating the level of danger to self/others that the patient may be exhibiting. If those criteria are met, the patient can be involuntarily committed. If they are not met, the patient may be encouraged to accept voluntary committment, or may be sent home with an appointment for follow-up. Whether or not they keep that appointment is up to the patient if they are not found to be committable.
 

Halo

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Oh okay. I guess I was a little confused. I was thinking that you could go to the hospital/doctor and say that you suicidal but as long as you didn't say that you had a plan that you couldn't be committed unvoluntarily. Good thing to know. I guess it would be left up to the individual doing the evaluation as to whether they felt it necessary for the patient to be committed. Can you tell this is a huge fear of mine :eek::

Thanks again for the information
 

ThatLady

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Heh. Yeah, Nancy, I think I can understand your fears. I will say this: the time I spent in the hospital was difficult. I think my daughter would say the same thing. I also think she would agree with me that it was time well spent, and difficulty well endured. We've come out the other side much improved over what we were when we entered the hospital. :)
 

Halo

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All I can say is that the hospital was the most horrifying digusting useless time of my life and I intend to never return. It was a waste of my time and for very specific reasons that will remain with me the rest of my life I will forever hate that place. Unfortunately I think for me it did more harm than good. :(
 

ThatLady

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That's really sad to hear, Nancy. I wish your experience could have ended up being the help to you that it was to my daughter, and to me. While it was unpleasant to be hospitalized, and I hated the thought of it, the end result was a good one. I just wish it could have been the same for you. :(
 

stargazer

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In California, it's called a 5150, meaning "a danger to oneself or others." I was granted a 5150 twice in 2004, when it was determined that I was so disoriented (from mania and lack of sleep) as to be a danger to myself. That leads to a mandatory 72-hour hold in a psych ward, involving med checks, attendance in groups, and so forth. In the first case, I was released after the 72 hours; in the second case, they kept me in for 6 more days.

I think it's odd, though, that rehabilitative programs and counseling groups don't exist in prisons. If I read the article right, California prisons are basically restricted to incarceration. I suppose it would cost even more money to bring in doctors and counselors, but I still think it's a sad state of affairs.
 

Danny Boy

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Speaking for New York; New York prisons do have special cell blocks for the mentally ill and treatment. I believe most states do. The problem is the corrections counselors, correctional officers, and doctors whom are supposed to be on the lookout for behavior pattern rarely care enough to fill out the request for psychological evaluation from.

On another note if you're mentally ill, in prison, and have half of brain in your head you would be very wise to stay out of the "psych blocks" as the living conditions are often worse than general population.
 

stargazer

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I would think California does as well. It was late at night, and I might have mis-interpreted the article. But I think the thrust of it is that funding isn't available to provide *true* help for the multitudes in State prisons.
 

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