Here is the most heartwarming hope-and-love-saturated video I have ever seen from the annals of mental illness. Ray Weaver is an American singer-songwriter living in Denmark. His gifted daughter Savannah Esperson Weaver, living in America, has for years struggled with afflictions variously diagnosed as bipolar disorder; borderline personality disorder; and, ultimately, schizophrenia. Ray made many trips from Europe to America to visit and support his valiant daughter. Just a few weeks ago, consummating months of treatment and medications, Savannah’s doctors approved her request to be with her beloved father. Here they are, reunited in song: the Townes Van Zandt ballad, “If I Needed You, Would You Come to Me?”
via The Oregonian
By Aimee Green | The Oregonian/OregonLive firstname.lastname@example.org
The Oregon Court of Appeals on Wednesday reversed a southern Oregon judge’s decision to commit a man to the state psychiatric hospital and revoke his gun ownership rights after he’d threatened to kill strangers who he believed were watching him through power lines and robotic birds.
The man’s case illustrates Oregon’s high legal bar for forcing people with mental illness into receiving treatment and forbidding them from having guns.
The case also highlights battling ideologies: One argues that people who have been diagnosed with mental illness and have threatened to kill others should be sent to the state hospital for involuntary treatment for up to 180 days. The other argues that forcing vulnerable people to receive treatment without significant evidence they’re truly a danger violates their civil liberties and can have devastating effects on them.
The man in this case was identified in court papers only as 43-year-old “J.P.”
Alexander Cambier, a Portland public defender who represented J.P.’s interests before the Appeals Court, said committing someone for up to six months represents a significant “deprivation of liberty” that must be backed up by evidence of the person’s future dangerousness.
“In a case like this the state is seeking to put someone in a hospital room — which can look a lot like a jail cell, i.e. locked doors and bars over the windows — not because they have actually hurt someone but because the state is predicting that they will hurt someone in the future,” Cambier told The Oregonian/OregonLive.
The Appeals Court said prosecutors didn’t legal justify the case against J.P. because he didn’t have the means to actually acquire a gun and probably didn’t have the physical strength to hang people as he had threatened.
J.P. had been diagnosed with schizophrenia and a supervisor at a mental health clinic was worried he’d act on his delusions to “kill” or “hang” strangers who he thought were members of the mafia, according to an Appeals Court summary of the case.
J.P.’s encounter with the mental health system began after his mother became gravely concerned when he sent her photos he took of a man at a bus stop and people in cars because he thought they were monitoring him, according to the summary. He also said he thought the roofers working on the house across the street from his grown daughter’s home were in on it, too.
Within a few weeks, he called his mother and announced he was ready to act, stating: “I’m ready to get these people. Whatever means necessary, I need to do this today,” according to the summary.
He added: “I don’t care how I have to do it. I’ll kill them. I’ll hang them. I’ll do whatever I have to. I need to deal with this.”
During a hearing, Douglas County Circuit Judge William Marshall said he considered J.P. a “real danger … to other people,” in part because he’d at one point successfully convinced his daughter to briefly loan him an unloaded shotgun.
“This illness is long-term,” Marshall said. “It’s not disappearing. It’s continuing to invade him.”
But in reversing Marshall’s ruling, the Appeals Court noted there was no evidence that J.P. followed his “verbal threats” with an “overt act” that indicated he was “highly likely” to end someone’s life.
“There was no evidence in the record … that the threat was anything more than the result of his delusions and agitation,” the Appeals Court wrote.
The court noted several other cases in which other people didn’t meet that bar, including a woman who had made threats to kill her neighbor’s children and put their heads on her fence and a man who threatened to kill a police officer by telling him he was a “dead man walking.”
It also noted the case of a woman who it determined had been lawfully committed: She fired a bullet into the wall dividing her apartment from her neighbor’s. That proved she was highly likely to be dangerous in the future, the Appeals Court said.
J.P., the man at the center of Wednesday’s ruling, was civilly committed in October 2017. He has long since left the state hospital. But the ruling has the effect of restoring his right to possess or own guns. Such a prohibition would have lasted indefinitely unless he successfully convinced the state’s Psychiatric Security Review Board to restore those rights.
The opinion was made by a three-judge panel of the Appeals Court: Rex Armstrong, Douglas Tookey and Scott Shorr. Read the opinion here.
— Aimee Green
MY TALK AT AUSTIN
I was honored to deliver this talk on November 4 at Austin, at the annual meeting of the American Association of Medical Colleges. AAMC is a 142-year-old organization dedicated to improving American health care through educational initiatives and state-of-the-art medical research. My invitation signaled that the AAMC has recognized mental healthcare as an essential part of their outreach.
I feel grateful to the distinguished outgoing president of AAMC, Darrell G. Kirch, MD, for his warm introduction, and to Stacia Gueriguian of the AAMC for her superb stewardship of the technical production. If you find the talk useful, I urge you to repost it on the web, and perhaps to recommend it to a university, public-school system, or community-access channel in your area.
I have written about the state-enforced incarceration, torture (via solitary confinement), and medical and inhumane neglect of young Tyler West of Fruitport, Michigan, since I began this blog nearly two years ago.
I have included mention of this mentally ill, ridiculously over-prosecuted victim’s plight in nearly every talk I have given. I’ve contacted journalists, advocates, and elected federal and state officials in and around Michigan. (Senator from the neighboring state of Minnesota, sometime mental health reform advocate, and perhaps presidential hopeful Amy Klobuchar, I am looking at you. https://twitter.com/amyklobuchar/status/705052728171634688
Progressive Senator Debbie Stabenow of Tyler’s home state, Michigan, https://www.
No one answers. Silence prevails among people in a position to rescue Tyler and elevate him to a national symbol of our debased mental healthcare systems: a silence as absolute as that which surrounds Tyler when he is repeatedly thrown into solitary confinement for reasons undisclosed to his parents.
No one. No one. No one, on the evidence, cares about crazy people.
It causes me lacerating psychic pain to think about Tyler West and his inexplicable Bedlam-like imprisonment. (For details, see my other blogs about Tyler on this site.) My helplessness, and his family’s helplessness, in seeking justice for him exhaust and infuriate me no end. I no longer write about him as much as I used to, as much as I should.
The one person in this world who sustains any shred of hope within me, and who inspires me to speak about about Tyler yet again, is his courageous mother, Kimberlee Cooper-West. Kimberlee is a religious and civic-minded woman; and although struggling with her own grief, she has never given up on her violated adopted son. I have quoted many times from her impassioned writing. And today, reading through the Facebook file of my colleague in advocacy Dee Dee Moon Ranahan, I came upon her latest cry from the heart. It follows below. Ms. Stabenow? Ms. Klobuchar? Detroit Free Press? National NAMI? In this season of love and charity and reverence and soul-reclamation, to paraphrase Atticus Finch: “For God’s sake . . . do your duty!”
Wish I had good news to share with ya all.
November 8 was our son Tyler’s 20th birthday. We were unable to say “Happy Birthday” as he was in lock down for five days. Days later, we drove a little over an hour to Richard Handlon Correctional Prison in Ionia, Michigan. (Tyler is number #113697.) We had cake with him. He made a cake from two honeybuns, smashed peanut M&M’s, and a melted Snickers bar on top. He’s inventive. We sang “Happy Birthday” to him.
He’s still our boy. Few mention him. Our heart breaks for what we’ve lost. This is Tyler’s third year away for his birthday. Next, he will miss Thanksgiving and Christmas. He hasn’t been given counseling, education, training, or the proper medications. He’s been beaten up four times since he was incarcerated.
Why couldn’t mental health professionals keep him in an inpatient psychiatric hospital? For the love of God there was no good reason to release our son from the hospital. His safety was compromised. No one was responsible. He was nearly shot at for trespassing. He was an inpatient five days prior to his arrest. He was delusional and hearing voices. What is wrong with this country? Why is there no long-term treatment?
This is a brain disease, ya all. Maybe we should start locking up every grandma and grandpa who is violent or disorderly from Alzheimer’s. Serious mental illness is a disease. It is prodromal to Alzheimer’s. Prisons are corporations. Their goal is money. They need prisoners. Caught up in the system — it’s a real thing.
We are receiving a criminal justice system education. Months are now years. One caseworker, Ms. Williams, calls many people names like dumb, retarded, idiots and pedophiles. Everyone in Ty’s facility is either mentally ill or autistic. She told Tyler, a 19-year-old kid who was only supposed to be in prison for two months, “You’re doing 15 years.” It leaves me to wonder how many have given up from her words.
Ty’s not even provided an inhaler for asthma and chronic lung disease. He has autism and a serious mental illness. When he was in school he was never suspended. He was a target for bullies which was our main concern. Incarceration never crossed our minds. On his birthday, I sent his appeal papers certified to a judge. Hopefully, he will give him an appellate lawyer.
Tyler West is in a prisoner in the Richard Handlon Correctional Prison in Ionia, Michigan. Mark Rippee, blind and severely disabled, as well as severely mentally ill, is at large on the streets of Vacaville, California, where he has somehow survived for twelve years. He is regularly beaten up and tormented by street punks. His sister Linda Privette told me that in addition to food and clothing, she recently provided him with his eighth walking cane in a twelve-month period–the other seven had been taken from him.
You may read about Tyler and Mark, and the grossly inhumane reasons for their medieval persecution, elsewhere on this blog. In brief, each is an unconscionable victim of an American state’s official contempt for the mentally ill, contempt that festers from ignorance, indifference, and a lack of organized public pressure to rescue them and their families from their living hell.
I’m sure that many relatives of the mistreated mentally ill would like to see equal attention devoted to their loved ones. My inadequate response is that there are not enough megabytes in cyberspace to tell the story of every American sufferer of mental illness who has been further victimized by our systems. We need to make mental-health reform a massive civil-rights issue. We need a revolution of conscience.
I am posting below a heartbreaking, eloquent message from Tyler’s adoptive mother, Kimberlee Cooper-West. (She submitted it to the Facebook site Circle of Comfort and Assistance Community, and I reprint it with her permission, and it bears close reading.) You can find comments from Mark Rippee’s sisters, Linda Privette and CJ Hanson, elsewhere on this blog.
Wish I had good news to share with ya all’ Love my CCA family! Some have asked, so here it is! Today is our son Tyler’s 20th birthday! We were unable to say Happy Birthday, as he is in lock down for 5 days. We drove a little over an hour, to Richard Handlon Correctional Prison, in Ionia, Michigan. This was last Monday. He is number #113697. We had cake with him. He made a cake from 2 honeybuns, smashed peanut M&Ms(sprinkles) and a melted Snickers bar on top. He is inventive. We sang Happy Birthday to him. He is still our boy! Few mention him. Our heart breaks for what, we have lost. This Will be his 3rd year, away, for his Birthday. Next he will miss Thanksgiving and Christmas. He hasn’t been given counseling, education, training, or the proper medications. He was beat up 4 times, since he was incarceration. Why, couldn’t these mental health professionals, keep him, in an, inpatient psychiatric hospital? For the love of God, there was no good reason, to release our son. His safety compromised. No one responsible. He was nearly shot at for trespassing. He was inpatient, 5 days prior, to his arrest.. He was delusional and hearing voices. What is wrong with this country? Why is there, no long term treatment? This is a brain disease, ya all’ Maybe we should start locking up every Grandma and Grandpa who is violent, or disorderly from Alzheimer’s. Serious mental illness a disease. It is prodromal to Alzheimer’s. Prisons are corporations. Their goal is money. They need prisoners. Caught up in the system, it is a real thingl. We are receiving, a criminal justice system education. Months are now years. One caseworker, Ms. Williams, calls many people names like dumb, retarded, idiots and pedophiles etc. Everyone in Ty’s facility is either mentally ill or autistic. She told Tyler a 19 year old kid, who was only supposed to be there for 2 months, your doing 15 years. It leaves me to wonder, how many, have given up from her words.. He is not even provided an inhaler for asthma, and chronic lung disease. He has autism and a serious mental illness. When he was in school he was never suspended. He was a target for bullies, which was, Our main concern. Incarceration, never crossed our minds. Today on his birthday, I sent his appeal papers, certified to a judge. Hopefully he will give him an apeallate lawyer.
This Arkansas group, #ARmindsMatter, looks to be a prototype for citizen-based activism in all our states to demand relief from the many failures in America’s systems of mental healthcare.
I would be interested to learn of similar movements in other states. With an active, agenda-driven interlinkage of groups such as #ARmindsMatter, we could forge a powerful watchdog, lobbying, and organizing collective that would establish reform as the civil rights issue of our time and break the inertia that’s destroying the lives of so many mental illness sufferers and their families.
I thank the blogger and advocate Dee Dee Moon Ranahan for drawing my attention to this; it first appeared on her own excellent blog “Sooner Than Tomorrow.”
THE “RIGHT” TO BE SO ILL by Kathy Day
We just had a glaring incident of how untreated serious mental illness impacts the community.
A young homeless man that I know well and love, had an extreme outburst in front of our apartment. I don’t know what set it off. He was eating a box of cereal and drinking some milk. Then I heard him yelling at the top of his lungs. He started chasing another person down the street.
My neighbors across the street called the cops. They were terrified because they have two young boys and they didn’t want them to witness what was going on and they feared the young man could hurt someone.
The officers who came are well trained in crisis intervention. I asked them to try to take him to a hospital. They said they’d try but wanted to let him cool down first.
If he didn’t have the ‘right’ to be so ill, he’d have received the treatment he needs long ago. But the way the system is designed, he’ll have to demonstrate dangerousness, likely in the presence of law enforcement, before he gets any real treatment.
Turns out he was taken to the ER a week ago on a psych hold. The ER discharged him within 24 hours.
If he’s released early again, this family will be afraid of his next incident. It’s not fair that they should have to deal with the failures of the system of mental healthcare.
-Catherine Rippee-Hanson, a sister of James Mark Rippee
Mark Rippee has survived on the streets of Vacaville for nearly twelve years despite being sightless, missing parts of his brain, enduring the pain of an interior metal rod to support his shattered right leg, fifty surgeries—many of them to heal the wounds he has suffered from repeated beatings by passing thugs. . .
. . . And, oh yes: despite his diagnosis of acute schizophrenia (a diagnosis that, weirdly, Mark’s family cannot definitively confirm because of restrictive and nearly useless laws).
Mark Rippee is one of more than one hundred thirty thousand homeless people in California as estimated by the Department of Housing and Urban Development. Most of them are unsheltered. That figure amounts to one-fourth of the national homeless population (553,742). As one legislator wrote,
“Homelessness and homeless encampments have become a part of the permanent landscape of California.”
As hundreds of millions of dollars in new-housing money languish in law-court entanglements, the death toll among California’s homeless has been rising: infections, pneumonia, cancer, cirrhosis, and other treatable diseases claim ever-more victims. In 2017, eight hundred thirty-one street people died in 2017, nearly doubling the count of 458 in 2013.
A Los Angeles County study reported by Politifact reported that more than one-fourth of the homeless are seriously mentally ill. Other estimates place the figure at one third.
The homeless mentally ill (in California and elsewhere) exist under twin, paradoxical curses: they are public eyesores. Pedestrians grimace as they step over their inert forms or cross the street to avoid their wild gestures and ranting.
At the same time, they are invisible: faceless statistics, generic, interchangeable, somehow less than human because of their madness.
Mark Rippee is one of these living paradoxes. Perhaps he should be their national symbol. His nearly faceless face is the face of the faceless: the face of our gravely disabled brothers and sisters who live and suffer and howl and die, bereft of help from government, agencies, and many churches, on the streets of our cities. Force yourself to contemplate what is left of Mark Rippee’s face for as long as you can stand to hold his sightless gaze and think about the obscenity of your country’s mental healthcare system.
This is a man who is severely, gravely disabled, living on the streets for 12 years. –Catherine Rippee-Hanson
Thirty-one years ago, Mark Rippee was a handsome and hopeful young man. At age 23, he was a productive member of the Vacaville community, a robust construction worker with a girlfriend, still mapping his life-plans.
Those plans blew to bits in an instant on the Sunday night of June 21, 1987—Fathers Day. On a dark country road, astride a Harley-Davidson motorcycle that he had owned for only a few days, Mark swerved to avoid an oncoming car that had drifted into his lane and tore through an alfalfa field until the bike ploughed at high speed into a grain harvester.
This is a man who left massive amounts of grey brain matter from his Frontal lobes lying in a dark field. This is a man who paramedics transported without sirens at first, thinking he must be DOA. –Catherine Rippee-Hansen
The impact tore a deep T-shaped gash across Mark’s face, destroying his eyes and exposing his frontal lobe, grey bits of which were found around him. His right leg was ripped open from his crotch to his ankle and broken in several places The EMTs who loaded him into an ambulance assumed he was dead until they noticed movement en route to the hospital.
Mark Rippee survived his shattering injuries. His accident, however, struck hard at his close-knit family. His father James suffered a breakdown soon afterward, entering a state of denial that led him to prohibit Mark’s twin sisters, Linda and Catherine, from securing Mark’s commitment in an institution. Six years later, James Rippee suffered a stroke and died. Mark’s mother, Lou, now 78, also commenced a long, slow decline in her health.
For eighteen years Mark managed to live at the borders of a peaceful and secure life, given the givens. His mother and his twin sisters (both of whom married) threw themselves into his welfare with the aid of a part-time caregiver. At intervals, and with support, Mark could maintain his own apartments.
The three women kept hope alive. They never lost their love for the invisible man beneath the disfigurement and the ravaged brain.
This is a man who was described as sweet, caring, willing to share whatever he has, and intelligent. –Catherine Rippee-Hanson
That hope eroded with each of the twenty-odd operations on Mark’s brain to scoop out abscesses (Mark has undergone more than fifty operations in all). Each brain surgery eliminated more grey matter. Each elimination weakened Mark Rippee’s capacity to think clearly and increased his tendencies to erratic, threatening behavior.
“He lost control of his emotions, his anger management, his reasoning,” said Linda. “There was no filter. Since the accident, he has fought depression, sleep disorder, and chronic unimaginable pain.”
Mark hallucinated. He heard voices, spoke in the personas of three different people.
“He called Travis Air Force Base several times to report that aliens were attacking,” Linda (by then Linda Privatte) said. “A voice told him to take a fork and pluck my daughter’s eyes out. He chased me with a stun gun, he began to have conversations with himself and 2-3 other people in his head.”
Mark’s psychosis deepened. He barred his mother from his apartment, yelling that he would kill her if she came in—he did not believe it was his mother. The sisters feared he would hurt her. His mother stopped caring for him; after twenty years the stress on her was taking a toll. Shortly afterward Mark was evicted for starting a fire outside his apartment door.
“He was suicidal,” Linda continued. “Mom wrestled a loaded gun from him. He has walked into traffic and tried several times to jump from a moving car. He has tried twice to jump off an overpass twice. He hates us all for saving him.”
Mark Rippee clearly was now beyond the family’s control. A few years earlier, a psychiatrist had diagnosed the young man as afflicted with paranoid schizophrenia. But Mark’s delusions had by then swept him well beyond the capacity to assent to therapeutic treatment or medications.
The sisters began to search for a therapeutic sanctuary and psychiatric care. In doing so they entered a labyrinthine world, a world that often mystifies most Americans, including relatives of the mentally ill: a world of bureaucracies piled upon bureaucracies: municipal and state government, psychiatric hospitals, police departments. A world of strange acronyms (CBT, CET, CMHC, AB, ADC, HHRMAC, SB, SHIP, SHOP—the list extends into the hundreds.) Behind the acronyms stretched a thicket of rules, restrictions, policies, protocols—all designed, it seemed, to pass the buck, evade accountability, and keep the mentally ill as far as possible from reclamatory help.
The years pass, and the trail of the sisters’ efforts grows long, convoluted, chockablock with blind alleys, false leads, rebuffs, personal humiliation. Not even Linda or CJ can fully reconstruct its nightmare skein.
Among the most infernal of the acronyms was HIPAA.
HIPAA: the Health Insurance Portability and Accountability Act. Congress created HIPAA in 1996. Essentially, it is a misbegotten tool for ensuring the informational privacy of a patient in the health-care system. In practice, HIPAA has deprived countless thousands of family members from information vital to helping them understand what is wrong with their loved one, and what to do about it. Leading advocates for mental healthcare reform have insisted that HIPAA be either radically reconceived or scrapped.
HIPAA rules prevented the Rippee family even from being able to confirm that diagnosis of Mark as a paranoid schizophrenic. (It was relayed to them by a mutual friend of the psychiatrist.) Nor could they ascertain his medication needs.
Nor could they—can they—even have him removed from the brutal mercies of the Vacaville streets and placed safely in an institution. They were—are—stymied by the monumentally absurd, fatally ambiguous system of state laws that sprang up at mid-century to counter the unintended consequences of deinstitutionalization. These laws awkwardly attempt to protect the civil rights of mentally disabled people on the street (140,000 as of 2015, as estimated by the Department of Housing and Urban Development) against involuntary commitment to therapeutic care: unless, that is, if the individual can be judged “a danger to self or others.”
The absurdity of this standard radiates from its description: how is it possible to prove that someone is a danger to self or others unless that person commits an act that is—well, one can see where one is going with this. Yet even committing such an act is no guarantee that the perpetrator will be taken under care. Consider the case of—oh, James Mark Rippee: the loaded gun. The stun gun. The threats of suicide. The threats on his mother’s life. The fire he set. The attempted jumps from moving cars and overpasses.
Yet as I write these words, James Mark Rippee remains blindly, madly, on his own; a man, in effect, without a country. Certainly without a country that gives a damn whether he lives or dies, as long as he just stays the hell out of sight.
This is a man who has no safety net at all, but has the right to die on the streets, because he can say, “No.” –Catherine Rippee-Hansen
Linda and Catherine—the latter by now suffering from cancer that has been diagnosed as terminal—turned their energies to another strategy that seemed reasonable: securing hospitalization for Mark as “gravely disabled.”
“Gravely disabled” describes one of the several lurching measures to slap a tourniquet over the worst bleeding wounds of deinstitutionalization. Encoded in two similar bills, AB 1971 and AB 2156, “gravely disabled” is the standard for which the state would intervene in an uncooperative homeless victim’s life and usher that person to shelter and treatment. A person is considered gravely disabled if he/she is unable to. provide for basic needs for food, clothing, or shelter because of a mental disorder of impairment such as alcoholism.
That’s the theory, at least.
Linda and Catherine—Linda, after her sister weakened from her cancer—showed up at meetings of the Solano County Board of Supervisors to encourage support passage of AB 1971. They spoke up. They wrote volumes of emails to the committee.
For their troubles, they found that “gravely disabled,” like “danger to self in others,” resides largely in the eye of the beholder: the eye being that of the agency in charge of enforcing it.
“Over the last few weeks alone, I’ve contacted more than forty-five agencies and people, trying to convince them that my brother is the definition of “gravely disabled,” Linda told me recently. “I told them he needs a conservator [a certified adult overseer], based on his family’s situation and the fact that he has been homeless for more than a decade. While I attempted to have patience, I was only told, “Thanks, we’re working on it.”
That was hardly the worst. After one early petitioning visit, Catherine reported that the Board of Supervisors let her know that they consider Mark self-sufficient “if he can eat out of dumpster. They consider him self-reliant if he knows to cover himself with newspapers, or to sleep under a bush to try to stay warm. They consider him self-sufficient if he can panhandle.” (Other relatives of street-people in the state have reported versions of the same response.)
The sisters rejoiced when AB 1971 was passed by the California Assembly, even though it was stipulated only as a five-year pilot program, and only for Los Angeles County, not the entire state.
They rejoiced prematurely. In late August, after a rash of opposition from groups that included, with splendid irony, the California Hospital Association and the Disability Rights Education and Defense Fund, AB 1971’s sponsors pulled the bill. The Rippees, along with tens of thousands of other Californians struggling to reclaim their helpless loved ones from the California streets, are back where they started:
This is a man who is suffering, body and mind, tormented, and in physical and mental pain every day . . . This is a man who hears voices he hates, like a broken record to the point of pure torment . . . This is a man who had medical doctors abandon him for having angry or unacceptable outbursts . . . This is a man who gets robbed of his income by people who he asks for help to use the ATM . . . This is a man who has family members who under current law cannot make decisions for him to help him . . . — Catherine Rippee-Hanson
With Catherine depleted by her disease and Lou Rippee awash in depression, Linda Privatte struggles on alone to reclaim what is left of her brother.
“I have not been able to as much as look at Mark,” she told me a day or two ago. “I’m feeling guilty about that.”
You are entitled to look away from your brother, Linda (though you won’t, not for long). It is the rest of us who are morally obligated to keep looking into James Mark Rippee’s nearly faceless face, until we accept that this man and all his gravely disabled mentally broken brothers and sisters are our brothers and sisters as well, and that we must not look away until we have inspired or shamed our country into facing them and giving them sanctuary.
For God’s sake, this is a man. He is not invisible. He is not expendable. With any humanity left in us, let us help him. This is a man. This is a man. This is my brother.
Note: on Monday, September 10, I invited two members of the Solano County, CA, Board of Supervisors to respond to comments by CJ Hanson and Linda Privatte that addressed their comments and policy positions. At this writing neither has responded. I will post any comments from them should they come in.
I invite and encourage repostings of this blog entry from other sites, from newspapers and magazines, and from other print and online journals. No further permission is required.
This excellent Mother Jones piece by Samantha Michaels pinpoints one of the worst ongoing atrocities in our criminal-justice system–the indefinite pre-trial incarceration of young mentally ill defendants. This broken system cries out for restorative, enlightened oversight at the federal level.
via Mother Jones
By the time he turned 15, Jesus G. was hearing voices and having suicidal thoughts. It was early 2013, and he’d been living at the Central Juvenile Hall in Los Angeles for more than a year, though he’d never been tried or found guilty of a crime.
In late 2011, Jesus’ younger brother accused him of molesting him, but Jesus denied the allegations. The clock stopped on his case months after that, when a doctor decided that, due to his hallucinations and immaturity, he wouldn’t understand what was happening in court.
As with adults, when a kid like Jesus is declared incompetent to stand trial, the state can detain him while trying to improve his mental functioning and knowledge of court procedures. But while California law limits the amount of time adults can be confined—often in hospitals—during this process, no such cap exists for children, who are regularly held in juvenile hall instead. As the months passed, Jesus and his attorneys wondered when he would ever get out.
In California and across much of the country, children with cognitive problems routinely languish in custody for months or years while judges determine whether they’ll be able to pick up the skills needed for a fair trial. Most states don’t have comprehensive programs to help these kids become “competent,” as the courts call it, referring to someone who has the ability to assist their attorney with their defense and possesses a solid understanding of the charges and proceedings against them. In one egregious case, according to a legal director at the National Juvenile Defender Center, children were asked to watch episodes of Law & Order to prepare for their trials.
According to California Assembly member Mark Stone, about 300 of the estimated 7,000 wards in California’s juvenile justice system last year were not getting the help they needed to become competent for trial. Now, lawmakers in Sacramento are considering a bill that would limit how long kids are detained after a judge finds them mentally unfit. And it would spell out the services they can receive to get up to speed. Gov. Jerry Brown vetoed a similar bill last year after critics protested that dangerous, emotionally unstable teens might be let loose.
But this year Stone hopes a compromise will be more palatable: In his new bill, most kids could be detained six months while trying to become mentally competent, but those accused of certain violent crimes could be held for 18 months. Some advocates say a year and a half is still far too long to hold a child without trial, but others say it’s a step in the right direction for a system that often feels haphazard at best and an absolute mess at worst.
Before he got to juvenile hall, Jesus was struggling at home. He’d recently moved to California with his mom and told adults at school he was depressed and wanted to die; he tried cutting his wrist because he claimed his stepdad abused him. At age 14, after he was locked up, a medical examiner found he was functioning in some ways like a six-year-old. “For him to understand the reality of what’s transpiring and understand the process, what people are doing with him and what he needs to do in his own defense…those are going to be difficult things for him,” the doctor told the court.
The fight for better juvenile competency laws has roots back in the 1990s. Across the country, a jump in homicides led to a superpredator panic, and delinquent teens were depicted as dangerous criminals. New laws made it easier for them to be transferred to the adult system, where a third strike could land them in prison for life.
By then, courts already had procedures for dealing with adults who weren’t mentally fit for trial, and many states started to apply the same standards to children. But that hasn’t worked out well, says Thomas Grisso, a psychologist in Massachusetts and a leading expert on these issues. Like adults, kids can struggle to understand court proceedings because of a mental illness or an intellectual disability. But many kids aren’t ready for trial simply because they’re immature. Their brains haven’t developed fully, or they haven’t picked up the average knowledge an adult would have about courts, Grisso says, so they require different types of services to get up to speed.
California does have a separate competency law for juveniles, and back in 2007 it was the first state to acknowledge that immaturity could make someone unfit for court. But since then it has lagged behind. “California ended up with one foot moving forward and the other one stuck in the mud,” says Janet Warren, a psychiatry professor at the University of Virginia who helped develop procedures in her state for juvenile competency that are now hailed as a model.
National guidelines written by Grisso and his colleague Kimberly Larson encourage lawmakers to keep kids in the least restrictive environment possible while they study to become competent—ideally at home. In California, however, “juvenile halls have become an unfortunate default holding place for incompetent youth,” public defenders in Los Angeles wrote in an amicus brief, noting that the state doesn’t use residential group homes enough. And California has no hospital beds for these kids, says Jim Salio, president of the Chief Probation Officers of California. “Because there’s no other place to house them, we end up with these minors in juvenile hall. They really should be in some other place.”
Experts recognize that locking them up can worsen their mental health problems, make them less likely to graduate high school, and boost their odds of committing crimes later. In 1972, the Supreme Court ruled it was unconstitutional to detain anyone indefinitely during treatment for competency problems; a person could not be “held more than the reasonable period of time,” the justices wrote. But what’s reasonable? In California, Salio says, some teens are held two or three years.
According to a study in Virginia, most kids can develop the skills needed for trial within three months by studying court procedures with an expert and receiving treatment for any mental health problems if needed. After six months, if a child has not become competent, it’s unlikely he ever will.
During his year-plus at juvenile hall, Jesus continued his schooling but received no services to prepare him for trial, his attorneys told the court, including no ongoing treatment to deal with his hallucinations, depression, and suicidal thoughts. The probation office explained a committee focused on competency programming was still “in the planning stages” and that Jesus probably couldn’t start until the following year.
Albert C., a 15-year-old accused of assault and gun possession, was also locked up in Los Angeles after a judge found him unfit for trial. His programming, according to an amicus brief, involved just 90 minutes a week of going over worksheets with court vocabulary, followed by a quiz. The person who administered the worksheets hadn’t graduated from college or received much training. “He was essentially warehoused for a year with no therapeutic services or treatment,” wrote the Pacific Juvenile Defender Center and local public defenders, noting that doctors recommended he take medicine for attention deficit hyperactivity disorder.
It doesn’t have to be that way. In Virginia, most kids with cognitive problems stay at home while they prepare for their trials. The state has hundreds of trained forensic evaluators who meet with them there a few times a week, typically over three to four months, using an individualized curriculum with interactive animated software, flashcards, workbooks, coloring books, board games, verbal conversation, and role playing. Florida, Louisiana, and Maryland also have comprehensive, state-wide programs for incompetent kids. But some states like California face pressure to spend their money on more hospital beds for the growing number of incompetent adults left languishing in jails. “To put juvenile competence as a financial burden on top of that makes me pessimistic about a lot of states suddenly getting on board,” Grisso says.
Virginia experts counter that it’s cheaper to do it their way. Warren estimates children in her state become fit for trial at a cost of about $5,000 each, while it takes $200 a day to detain a kid in juvenile hall and $600 a day to keep someone in a psychiatric facility. In other words, a few months of treatment and education could cost three and a half times more in juvie than at a kid’s home.
Jesus and Albert both fought their pretrial detention. Neither kid had much luck. Jesus was held in juvenile hall for about 16 months before he was finally released. Albert stayed for about a year until a judge declared him competent and he pleaded guilty to his crimes. In his case, a judge ruled that although local protocols suggested kids shouldn’t be held for more than about four months during competency treatment, that didn’t carry the force of law in California.
Last year, the California Legislature passed a bill that would have put a six-month cap into law, with support from the Chief Probation Officers of California, but the governor vetoed it amid concerns that kids with aggressive behavior would get out of custody too soon. Assembly member Stone tried to put more teeth into the bill this year, with a six-month cap for most kids and an 18-month cap for those accused of certain violent crimes, including murder and rape as well as certain acts of sexual abuse, like the ones Jesus was accused of.
The new bill would lay out the types of services that courts could consider for incompetent kids, things like therapy and medication instead of just workbooks with court vocabulary. And it would encourage courts to look for options besides juvenile hall while still considering public safety, and require them to dismiss the cases of incompetent kids who are only accused of misdemeanors. Lawmakers have until Friday to vote on the proposal.
In the meantime, children are waiting. Dale Major, an attorney in San Francisco, says one of his teen clients has spent about three years locked up without trial, spread out over multiple arrests, after being declared incompetent because of post-traumatic stress disorder, paranoia, attention deficit disorder, and developmental immaturity. “Even though he’s in juvenile court, he’s now 18, sitting in a county jail, getting no services,” he says. “The kid has had no childhood.”
Further evidence of cluelessness and indifference in too many of our state governments.
Suicide has been a persistent problem in Montana — and it’s getting worse. Now, some who have lost loved ones are mobilizing to stop the deaths.
WOLF POINT, Mont. — Mourners in this small town in northeast Montana, where a strip of appliance shops and bars are dwarfed by vast ranches, packed into a church this month to pray for Michael Lee.
A week earlier, Michael, a 13-year-old who dreamed of playing for the NFL, had killed himself in his family’s red clapboard home. At the funeral on Aug. 3, a row of Michael’s middle-school football teammates sat behind his relatives and friends, wearing maroon jerseys and white armbands with “R.I.P.” handwritten on them. A handful of strangers were there, too; the funeral announcement said anyone affected by suicide was welcome.
That seems to include just about everybody in the state these days.
The church was silent as Colleen Timmins-Lee, Michael’s stepmother and a state trooper, rose to speak, trembling.
“If you or someone you know that you even think might be going through this, then please, please get them the help they need,” she said through tears. “Please, please just reach out and just tell one person and try to prevent another tragedy like this.”
For those who sat in the pews wiping their eyes, or who stood by the entrance of the church, where a table was covered in pamphlets on suicide prevention, the message was both urgent and familiar. Montana has the highest suicide rate of any state in the country, and while people here don’t often speak openly about sadness or loneliness, many have firsthand experience with loss.
That already included Michael’s family. Just over two years ago, his mother, Kimberley Evans, also died of suicide.
Afterward, Michael struggled. He saw counselors at a children’s mental health clinic in rural Wolf Point, but after it burned down last year, the closest available counselor was 50 miles away. Michael’s stepmother and his father, Frederick Lee, a patrol officer with the Montana Department of Transportation, couldn’t afford time off to take him there, and they said the counselors Michael had seen told them that he had improved.
Now, weeks after their son’s funeral, they were left wondering what else they could have done — and what Montana can do — to stop this from happening.
“When it comes to depression and suicide in our community,” Lee said, “it’s out of control.”
A GROWING CRISIS
Suicide has been a persistent problem in Montana — and it’s getting worse. The state saw 25.9 suicides for every 100,000 residents in 2016, nearly double the national average, according to Centers for Disease Control and Prevention data that is age-adjusted. Since 1999, that rate has risen 38 percent, even faster than the 30 percent national rise in suicides.
The challenges Montana faces are many. It’s sparsely populated — the fourth-largest state by area, it’s 44th in population, with just over a million people — and it has less than a quarter of the mental-health care providers required to serve its residents, according to the Health Resources and Services Administration. A strong gun culture and high rate of heavy alcohol consumption fuel the problem, as does lack of daylight in the winter and high altitude, which have both been linked to depression. And then there’s the stigma associated with reaching out for help, which many Montanans see as a sign of weakness.
“We have a perfect storm when it comes to suicide,” said Karl Rosston, suicide prevention coordinator for Montana’s Department of Public Health and Human Services. “We have a lot of factors that are all happening at the same time.”
Then, last year, came another blow: Facing a projected $227 million budget shortfall, Montana’s Republican-led legislature and Democratic governor made cuts to the state’s health department, including to mental health funding. As a result, more than 100 mental health professionals were laid off across the state and 10 rural health care programs were forced to close because they couldn’t afford to pay their employees, according to the Behavioral Health Alliance of Montana, an advocacy group for the state’s mental health providers.
Now, some who have lost loved ones to suicide — frustrated by the budget cuts and driven by the state’s urgent needs — are mobilizing to do whatever they can to stop the deaths. They are veterans and Native Americans, social workers and public health officials. They’re studying suicide prevention and opening clinics and speaking to students. But they still fear that, in many cases, their efforts will not be enough.
‘ONE IS TOO MANY’
When Ryan Ranalli was growing up in Helena, Montana’s capital, there was at least one suicide in his high school each year. Later, after he joined the military and served in Iraq as an Army infantry squad leader, he lost more friends to suicide. More than 200 Montana veterans killed themselves from 2013 to 2016, representing nearly a fifth of the state’s suicides in that time, according to the state Office of Vital Statistics.
“It’s one of those things, especially if you’re a male, not to ask for help,” Ranalli, 39, said. “People I served with, they don’t want to reach out and say ‘Hey, I’m having some problems, and I need to talk to somebody.’”
For Ranalli, the problems started in 2005 after several Army buddies in his unit were killed in Iraq, some by a bomb, others in a firefight. The same year, on his second deployment there, Ranalli was hit by a roadside bomb, ending his dream of a long Army career. He returned home with a traumatic brain injury, stuck in a cycle of nightmares, flashbacks, anger, depression and anxiety. The following year, two more friends died while fighting in Iraq. By 2012, Ranalli was overwhelmed by survivor’s guilt and frustration over his inability to rejoin the Army. One night, his wife found him in their garage, blackout drunk and attempting suicide.
“I felt like a burden,” he said. “I’ve seen what [suicide] does to families, but at the time, you just don’t think about it.”
Ranalli’s wife convinced him to get help, but it eventually became clear that the treatment he needed wasn’t available in Helena. There was a traveling VA clinic that came through once a month, but nothing permanent, so he underwent months of treatment out of state, in San Diego.
After his health improved and he returned home, Ranalli decided to channel his frustration with Montana’s mental health care shortfalls into action. He worked on a letter-writing campaign for a permanent veterans mental health clinic in his hometown, and this spring, the Helena Vet Center held its grand opening. So far, it’s provided over 1,055 mental health visits to nearly 150 veterans and family members. Ranalli is one of them; he receives treatment there for post-traumatic stress disorder.
In the fall, Ranalli, who has six children, plans to begin speaking about suicide prevention in local schools.
“To me, one is too many,” he said, “whether it’s a vet or a high school student.”
‘YOU LOSE A LOT’
At 19, Laurencia Starblanket, a member of the Salish Tribe, has already lost more than half a dozen close friends and relatives to suicide.
Nearly a decade ago, Starblanket’s aunt killed herself. Soon after, Starblanket’s grieving mother became addicted to pills, then heroin and methamphetamine, which has landed her in prison on and off.
Then Starblanket lost three friends, two cousins she called brothers and an uncle she considered a father figure — all died by suicide, all within the past two years.
“It’s hard. You lose a lot. A lot comes out of you,” said Starblanket, who lives in Arlee, a windswept town of about 600 on the Flathead Indian Reservation in the shadow of the Rocky Mountains. “After my [uncle] passed, I was just numb. I didn’t want to go to school. I didn’t want to do anything. I just laid in bed.”
From 2005 to 2014, the suicide rate among the indigenous population in Montana was 22 percent higher than the state’s average, according to the Department of Public Health and Human Services. And youth suicide was more than twice as common in Montana than in the country as a whole during that period.
A little over a year ago, after her cousin died, Starblanket started drinking for the first time and soon began considering suicide herself. Her family sent her to Canada to spend time with relatives, and when she returned home, she decided to go to school to study tribal governance so she could address the high suicide rate among Native Americans.
This year, after Starblanket came home, her younger sister attempted suicide. That only doubled Starblanket’s resolve. This summer, she worked as a camp counselor at a suicide prevention program at the Tribal Health Department in St. Ignatius, Montana.
“Ever since seeing my sister in a hospital bed because she wanted to kill herself,” Starblanket said, “I look at it as: I want to save someone else’s little sister.”
‘WE LITERALLY DON’T HAVE THE CAPACITY’
The mental health clinics serving Montana’s wide-flung communities were already struggling to meet the state’s growing needs. Then, over the course of 2017, the Department of Public Health and Human Services was hit with about $95 million in cuts, which resulted in the loss of at least as much money from federal matching funds, according to the Montana Budget & Policy Center, a nonprofit that analyzes budget issues and advocates for government investment in health care, education and the environment.
State officials declined to say how much of the health department cuts directly affected mental health services. But two cuts hit mental health care providers particularly hard. The state reduced the Medicaid reimbursement rate by 2.99 percent, which meant that clinics received less money when they treated low-income patients. And the state slashed Medicaid reimbursements for case managers by more than half, so that clinics receive $8.19 across the board, rather than $17.38 for children and $18.22 for adults, for every 15 minutes that case managers spend with their clients.
In response to the funding reductions, the Sunburst Community Services Foundation, a Montana nonprofit that offers mental health care as well as arts and education programs, cut anything that could be considered extra, from office supplies to training. Yet the organization is still losing about $60,000 a month and may close two of its six locations.
“They’re my people and I really care about them, but it’s like a fool’s errand,” Megan Bailey, a licensed clinical social worker who leads Sunburst’s program development, said of their clients. “We literally don’t have the capacity to hold this up any longer.”
Gov. Steve Bullock has said mental health is a priority for his administration. His office has released figures showing that mental health funding in the state has increased by millions of dollars since 2011, two years before he took office, even with the recent cuts. Still, Montana’s mental health budget lagged behind states with a comparable population from 2009 to 2015, according to data compiled by the National Alliance on Mental Illness.
Following a public backlash, including a lawsuit by the Montana Health Care Association, Bullock announced plans in July to restore funding for Medicaid reimbursements and partially restore Medicaid case manager funds. Those plans, including details on restoration amounts, will be made public by Sept. 1, the governor’s office said.
“Governor Bullock remains committed to fighting for Montanans and the essential services they deserve,” the governor’s office said in a statement. “He will again propose a budget that invests in mental health and ensures vulnerable Montanans have the health care they need. He will continue to engage in statewide partnerships to implement evidence-based programs aimed at reducing suicide in Montana.”
But struggling mental health care providers say that it may be too little, too late, and it would take years to reopen shuttered clinics and regain the community’s trust. In the meantime, Montana’s suicide toll continues to rise.
‘WE CAN’T WAIT FOR FUNDING’
Libby, Montana, is tucked between the Kaniksu and Kootenai National Forests, surrounded by mountain ranges crisscrossed with trails roamed by moose and bears. Reader’s Digest named it the state’s most charming small town this year.
But beneath the natural beauty is a growing frustration.
Libby is in Lincoln County, which has a population of nearly 20,000 but just one behavioral health employee, Amy Fantozzi, a graduate student who oversees the county’s contracts with medical providers who do mental health assessments.
The town had a clinic run by the nonprofit Western Montana Mental Health Center, the largest service provider in the region, which had 12 clinics serving 15,000 clients across 15 counties. But after the cuts were announced last year, the center laid off more than 60 case managers and shut down three clinics, including the one in Libby. That left hundreds of patients without access to therapy, medication and a case manager to check on them.
Now, when those patients are in crisis, their only option is the emergency room at Lincoln County’s lone hospital. Once they check in, Fantozzi gets a call, and she must decide whether to spend $100 of her $18,500 annual budget on a mental health assessment. Depending on the results, she could then spend an additional $300 to have the patient evaluated and involuntarily committed at the nearest mental institution 90 miles away.
There have yet to be any publicly reported deaths by suicide as a result of the local clinic’s closure, but county officials fear the current system of mental health triage won’t hold up.
“Right now it just feels like a Band-Aid on every patient,” said Jennifer McCully, 32, Lincoln County’s public health manager. “Is it going to work this time? Maybe, but we probably will see them again.”
On a recent Thursday morning, more than a dozen Lincoln County health officials, law enforcement officers, teachers, community leaders and medical providers gathered around a horseshoe of folding tables at Libby’s high school to discuss how to fill the gap left by the budget cuts. One idea was to create a list of people who may be at risk of suicide and deploy volunteers to check on them regularly.
“We can’t wait for funding,” said Liz Erickson, who provides faith-based counseling through the Libby Christian Church. “We cannot wait for the grant. We cannot wait for that help. We just have to start the dang thing ourselves.”
‘WE CAN’T GO BACK’
In Wolf Point, Michael Lee’s father and stepmother are grieving for their son, who would have started high school this fall. They are also urging everyone they know to reach out to those who may need help.
But they are well aware of Montana’s many challenges when it comes to suicide prevention, which Frederick Lee said made the recent mental health funding cuts all the more infuriating. “They’re cutting back things we need,” he said.
Lee hopes to help in any small way he can. He will soon begin a three-year course in a suicide prevention method known as QPR — which teaches participants to question, persuade and refer those thinking of suicide — so that he can train others in northeast Montana. And he plans to leave his job with the Department of Transportation to find work as a deputy in a school. He wants to talk to kids throughout the day and check in on them.
“If we had one more minute to talk to Michael about his depression, if we had one more minute to tell him that we loved him, maybe the depression wouldn’t have taken him,” Lee said, his voice breaking. “But we can’t go back. The problem is we have to go forward.”
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources. Montana residents can find a list of local resources here.
Phil McCausland reported from Helena, Libby and St. Ignacius, Montana; Elizabeth Chuck reported from New York; Annie Flanagan reported from Wolf Point, Montana; and Mariana Keller reported from Missoula, Montana.