How to Keep Your Son From Killing Someone
December 9, 2022 10:44 AM Subscribe
This post was deleted for the following reason: Poster's Request -- loup
people with schizophrenia are a) way more likely to be victims of violence than perpetrators
My understanding that this is true of people with mental illness generally, but not for people with psychosis (which is not all people with schizophrenia, of course), though they are nowhere near as likely to be violent as pop culture would have you believe.
I recently read a schizophrenia memoir written by a law professor who had been treated in both the UK and the US and the difference in the degree of physical violence to which she had been subjected in the course of treatment in the two countries was startling, even though she herself would admit that she behaved at times in threatening ways in both countries. I keep thinking about how Eric Adams's half-assed "plan" is going to subject more of the most sick mentally ill people to more violence and incarceration in totally unsuitable places, thus constantly retraumatizing them. If there is a country that has solved the problem of people getting to places like Justin's, I don't know where it is, but I'm sure that more cops dragging more people into windowless vans isn't the way. Barely-trained peer counselors are...better, I guess?
posted by praemunire at 11:30 AM on December 9, 2022 [11 favorites]
My understanding that this is true of people with mental illness generally, but not for people with psychosis (which is not all people with schizophrenia, of course), though they are nowhere near as likely to be violent as pop culture would have you believe.
I recently read a schizophrenia memoir written by a law professor who had been treated in both the UK and the US and the difference in the degree of physical violence to which she had been subjected in the course of treatment in the two countries was startling, even though she herself would admit that she behaved at times in threatening ways in both countries. I keep thinking about how Eric Adams's half-assed "plan" is going to subject more of the most sick mentally ill people to more violence and incarceration in totally unsuitable places, thus constantly retraumatizing them. If there is a country that has solved the problem of people getting to places like Justin's, I don't know where it is, but I'm sure that more cops dragging more people into windowless vans isn't the way. Barely-trained peer counselors are...better, I guess?
posted by praemunire at 11:30 AM on December 9, 2022 [11 favorites]
It blows my mind Britney Spears got a guardianship but this woman who tried to follow all the rules didn't. Mental health court, hotel stays, probation, recordkeeping weren't enough.
God this is bringing back memories of an old friend who bounced in an out of housing and rehab for various drug issues. One of the last times I saw him he had a weird open wound, out of character for a pretty clean cut guy. He was NOT ready to be independent.
I now wish someone had a well-regulated POA over him.
Our mental health system is a processing plant for new prisoners.
posted by Freecola at 11:52 AM on December 9, 2022 [3 favorites]
God this is bringing back memories of an old friend who bounced in an out of housing and rehab for various drug issues. One of the last times I saw him he had a weird open wound, out of character for a pretty clean cut guy. He was NOT ready to be independent.
I now wish someone had a well-regulated POA over him.
Our mental health system is a processing plant for new prisoners.
posted by Freecola at 11:52 AM on December 9, 2022 [3 favorites]
I mean the article says she gave up on trying to get a guardianship because a guardianship could not compel her son to accept treatment, so it wouldn't solve the problems she had, not that she had no chance of getting a guardianship.
The whole article is not actually generalising about what medical treatment you can compel someone to accept when their actions affect others, but it does feel like evidence for a broader article about that!
posted by applesauce at 12:33 PM on December 9, 2022 [3 favorites]
The whole article is not actually generalising about what medical treatment you can compel someone to accept when their actions affect others, but it does feel like evidence for a broader article about that!
posted by applesauce at 12:33 PM on December 9, 2022 [3 favorites]
Article 81 guardians in NY cannot, despite the apparently clear text of the statute, compel either psychiatric treatment or involuntary stay in a psychiatric facility, because the process for appointing Article 81 guardians does not meet the requirements for involuntary treatment generally under the state constitution (particularly the individualized consideration of risks vs. benefits of treatment).
posted by praemunire at 1:02 PM on December 9, 2022
posted by praemunire at 1:02 PM on December 9, 2022
I'm confused. There are multiple points in the article where he is apparently taking medication and it doesn't help, e.g.:
It seems what the article is most concerned about is incarceration of the mentally ill to protect others, framed as a concern for mental health and getting people the treatment they need. But the narrative doesn't seem to actually line up with the framing--though I admit it's hard to tell because it's often sparse on details.
For example, I'd be interested if he's ever been offered therapy instead of just seeing a psychiatrist. The closest I saw in the article was peer counselors, but they aren't trained the way a professional would be. Health psychologists are specifically trained in motivating and helping people to engage in healthy behaviors, including taking medication regularly and communicating with your doctor when the medication isn't working for you. Has he ever received those services? Has any professional even asked him why he won't take his medication? You might assume multiple psychiatrist visits means "of course, SOMEONE would have asked" but let me tell you as someone who struggled to take medication for years, across 6+ specialists that I saw regularly not one of them ever asked me why I wasn't taking my medication as prescribed. They just lectured me on why I should.
posted by brook horse at 2:02 PM on December 9, 2022 [8 favorites]
He prescribed Risperdal and Depakote pills for Campbell to take on his own, plus injections of Risperdal.The article isn't arguing for more effective schizophrenia treatment. On its surface it seems to be arguing to be able to force schizophrenic people to accept psychiatric care so that they will get better. But by its own admission psychiatric care didn't help him. Maybe there's an argument for forced hospitalization? But the article mentioned multiple hospitalizations, so that also didn't help.
Still, Justin’s behavior got more erratic, and more menacing, even to his own mother. “Please call 911 if he seems to be a threat,” one case worker advised in 2014. He raved he was a “little princess” who could just dream and have her “taken out.” That was when she called the cops.
And at times, when Justin’s Medicaid lapsed, Clarissa had to pay the treatment bills herself. “The pharmacy said its $606” she wrote the care coordinator in 2015. “I paid $614 the last time. I can’t do it again.”
It seems what the article is most concerned about is incarceration of the mentally ill to protect others, framed as a concern for mental health and getting people the treatment they need. But the narrative doesn't seem to actually line up with the framing--though I admit it's hard to tell because it's often sparse on details.
For example, I'd be interested if he's ever been offered therapy instead of just seeing a psychiatrist. The closest I saw in the article was peer counselors, but they aren't trained the way a professional would be. Health psychologists are specifically trained in motivating and helping people to engage in healthy behaviors, including taking medication regularly and communicating with your doctor when the medication isn't working for you. Has he ever received those services? Has any professional even asked him why he won't take his medication? You might assume multiple psychiatrist visits means "of course, SOMEONE would have asked" but let me tell you as someone who struggled to take medication for years, across 6+ specialists that I saw regularly not one of them ever asked me why I wasn't taking my medication as prescribed. They just lectured me on why I should.
posted by brook horse at 2:02 PM on December 9, 2022 [8 favorites]
"at what point is it reasonable to pre-emptively take human rights away from this man before he seriously hurts a person who isn't mentally ill and therefore matters?"
Should have read the comments first. This is the weirdness I was picking up on in the framing.
posted by brook horse at 2:08 PM on December 9, 2022 [2 favorites]
Should have read the comments first. This is the weirdness I was picking up on in the framing.
posted by brook horse at 2:08 PM on December 9, 2022 [2 favorites]
I completely empathize with this woman because I too have mentally ill family members and I'm sorry, but you know what? I do bemoan the wear and tear on the caregiver and there hasn't really been any forced treatment or medical interventions for decades. There are no institutions now. I fucking wish there were. It's absolutely great that some severely mentally ill people are high functioning enough to care for themselves but there are a lot who are not and they never will be. As it stands right now there is nothing out there to back up a caregiver who wants their relative to access safe treatment or supportive housing or anything at all, and the gods only help a caregiver who might dare to hope she could have anything resembling a sane life of any kind. There is nothing. There is nobody. There need to be some alternatives in emergency situations and in non emergencies too because right now, there are none.
You get back to me after you've stood there trying as hard as you can to deescalate a 250 pound man who is shouting at the top of his lungs that he killed your aunt and buried her money in Brazil. You can reason with the cops who show up to finger their guns and laugh at him, maybe, and if you succeed at that maybe you can get him into a wildly overcrowded hospital ward for THREE DAYS because oh yeah, he tried to burn the house down - and you can prove it and you have the time and spoons to go from agency to agency to prove it - when he went into full psychosis, but that's all you can do. In three days he's getting out and oh, yeah, he hates you now, more than he did before. Maybe they pumped him full of enough anti psychotics that he'll be calm for a few days or weeks or months but maybe not. It's a crapshoot! You don't know because they don't have to tell you because he can make his own decisions, like burning down the house with you in it!
You can try to figure out what to do with the relative you love with all your heart when they won't come out of their room for days on end and all the plates and spoons are in there along with rotting food and the smell becomes intense and they have graffitied all over the wall and you do not have the kind of money it would take to put them into private care even if you could force a commitment because they are not considered a danger and supposedly they are capable of caring for themselves. They don't even have a diagnosis because you can't make them go to a doctor or a clinic or even make an appointment for them, so all they have are pages and pages of misdemeanor and felony charges and all you have are years of paying for lawyers and bail and $2 a minute jail phone cards and $5 commissary ramen. You don't want them to be homeless but slowly all your friends and relatives back away, one by one, because it's just too much. They can't hold a job for long so you are the sole support while they cycle in and out between rage and catatonia and what exactly are you supposed to do? Tough love, toss them onto the streets to die? Among other things, they know where you live and they will come back, just even angrier and sicker. Call the cops and retraumatize the traumatized? There's nowhere for them to go but jail. They refuse to access any kind of help, and since frankly there is only an infinitesimally small bit of help that might be out there for the lucky few high functioning mentally ill who actually can and will jump through 10,000 hoops you sort of see their point.
As a caregiver, I can't force a diagnosis, or medication, or any treatment, or involuntary commitment or do anything at all until one of my mentally ill relatives literally tries to kill me and by that time, you know, the damage is kinda done. And then the cops will show up and that's a whole other shitshow. I know there were snakepits and I know that forced hospitalization was horribly abused (my own great grandmother spent her life in an asylum while relatives lived well on money that should have been hers) but replacing them with exactly nothing but the jails and a whole cadre of miserable, exhausted, terrified, penniless women has not worked out super well.
posted by mygothlaundry at 2:10 PM on December 9, 2022 [126 favorites]
You get back to me after you've stood there trying as hard as you can to deescalate a 250 pound man who is shouting at the top of his lungs that he killed your aunt and buried her money in Brazil. You can reason with the cops who show up to finger their guns and laugh at him, maybe, and if you succeed at that maybe you can get him into a wildly overcrowded hospital ward for THREE DAYS because oh yeah, he tried to burn the house down - and you can prove it and you have the time and spoons to go from agency to agency to prove it - when he went into full psychosis, but that's all you can do. In three days he's getting out and oh, yeah, he hates you now, more than he did before. Maybe they pumped him full of enough anti psychotics that he'll be calm for a few days or weeks or months but maybe not. It's a crapshoot! You don't know because they don't have to tell you because he can make his own decisions, like burning down the house with you in it!
You can try to figure out what to do with the relative you love with all your heart when they won't come out of their room for days on end and all the plates and spoons are in there along with rotting food and the smell becomes intense and they have graffitied all over the wall and you do not have the kind of money it would take to put them into private care even if you could force a commitment because they are not considered a danger and supposedly they are capable of caring for themselves. They don't even have a diagnosis because you can't make them go to a doctor or a clinic or even make an appointment for them, so all they have are pages and pages of misdemeanor and felony charges and all you have are years of paying for lawyers and bail and $2 a minute jail phone cards and $5 commissary ramen. You don't want them to be homeless but slowly all your friends and relatives back away, one by one, because it's just too much. They can't hold a job for long so you are the sole support while they cycle in and out between rage and catatonia and what exactly are you supposed to do? Tough love, toss them onto the streets to die? Among other things, they know where you live and they will come back, just even angrier and sicker. Call the cops and retraumatize the traumatized? There's nowhere for them to go but jail. They refuse to access any kind of help, and since frankly there is only an infinitesimally small bit of help that might be out there for the lucky few high functioning mentally ill who actually can and will jump through 10,000 hoops you sort of see their point.
As a caregiver, I can't force a diagnosis, or medication, or any treatment, or involuntary commitment or do anything at all until one of my mentally ill relatives literally tries to kill me and by that time, you know, the damage is kinda done. And then the cops will show up and that's a whole other shitshow. I know there were snakepits and I know that forced hospitalization was horribly abused (my own great grandmother spent her life in an asylum while relatives lived well on money that should have been hers) but replacing them with exactly nothing but the jails and a whole cadre of miserable, exhausted, terrified, penniless women has not worked out super well.
posted by mygothlaundry at 2:10 PM on December 9, 2022 [126 favorites]
I mean, what always happens is that no one wants to pay any money. Most of these problems would be semi-solvable if we, as a society, said "we want to help seriously mentally ill people and their families and we will pay whatever it takes via taxes".
Respite care for parents with ill family members at home, in-home paid carers, multiple kinds of supportive housing that don't have to worry about finding funds to repair things that get broken, generous social security benefits for family carers if family want to care for people in-home, social worker teams to help people having episodes, etc. Guaranteed care so that parents can rest easy knowing that someone will take care of their child after they're gone. The health psychologist appointments that brook horse describes.
Honestly a lot of it is housing. Unstable housing exacerbates mental health problems of all kinds. Supported living is going to be best for a lot of people since it takes the pressure off the family relationship.
None of this would solve all problems, but if this poor guy had housing that could support him and his mother wasn't on the hook for all these costs, the remaining problems would be a lot more manageable and both he and she would have more headspace to deal with them.
Obviously at this point our healthcare and social services systems are so deteriorated that there may not be anyone who can support this guy, even if we found the money. Are there health psychologists enough to take on the patients who need their services? Are there respite carers in the quantity needed for everyone who needs a respite? Probably not!
We as a society just want to do whatever is cheapest and gets people out of our line of sight - immigrants, unhoused people, mentally ill people, street level sex workers - oh, just push them away so that no one has to think about them or incur any costs, or at least put them in jail so that the payment for caring for them can flow to prison corporations.
posted by Frowner at 2:11 PM on December 9, 2022 [28 favorites]
Respite care for parents with ill family members at home, in-home paid carers, multiple kinds of supportive housing that don't have to worry about finding funds to repair things that get broken, generous social security benefits for family carers if family want to care for people in-home, social worker teams to help people having episodes, etc. Guaranteed care so that parents can rest easy knowing that someone will take care of their child after they're gone. The health psychologist appointments that brook horse describes.
Honestly a lot of it is housing. Unstable housing exacerbates mental health problems of all kinds. Supported living is going to be best for a lot of people since it takes the pressure off the family relationship.
None of this would solve all problems, but if this poor guy had housing that could support him and his mother wasn't on the hook for all these costs, the remaining problems would be a lot more manageable and both he and she would have more headspace to deal with them.
Obviously at this point our healthcare and social services systems are so deteriorated that there may not be anyone who can support this guy, even if we found the money. Are there health psychologists enough to take on the patients who need their services? Are there respite carers in the quantity needed for everyone who needs a respite? Probably not!
We as a society just want to do whatever is cheapest and gets people out of our line of sight - immigrants, unhoused people, mentally ill people, street level sex workers - oh, just push them away so that no one has to think about them or incur any costs, or at least put them in jail so that the payment for caring for them can flow to prison corporations.
posted by Frowner at 2:11 PM on December 9, 2022 [28 favorites]
mygothlaundry, I hear you. An acquaintance of mine has a brother with schizophrenia. They are living with their parents in a brownstone. The parents and acquaintance are terrified of the brother as he is a danger to himself and others. He has harmed the parents before. They cannot forcibly commit him. They have tried barring/locking him from their home but that leads to more anger and violence. The solution is currently having the parents go on a long/indefinite vacations and the acquaintance is searching for another place to live. There is no solution for them except eventually selling the house and escaping. The brother with schizophrenia had owned a business. Something broke in his mind in his early 20s. He refuses to seek care. Since this man is in his 30s, there is no "respite" care since he refuses all help. The family is wealthy and they have the resources for care. They are in an impossible situation.
posted by ichimunki at 2:35 PM on December 9, 2022 [21 favorites]
posted by ichimunki at 2:35 PM on December 9, 2022 [21 favorites]
And the central question posed by the framework is not "how could we prevent this unquestionably shitty outcome by changing the way we do things" but instead "at what point is it reasonable to pre-emptively take human rights away from this man before he seriously hurts a person who isn't mentally ill and therefore matters?"
With respect, I don't think that's really a fair read of the article, which seems to strongly emphasize throughout how Crader has repeatedly sought resources for her son for 20 years and been railroaded the entire time, compared to one statement where she admits that after so long living with someone who she fears might hurt or kill her, she wishes she could have him committed. The article might not be explicitly asking the question of what can be done to prevent this outcome by changing how we do things, but its repeated description of how the system has failed to provide adequate resources for this very ill man who has already harmed himself and others, and has threatened to do so again, seems like as clear-cut a case as one could want from a story that is focused on describing an individual case rather than systematically investigating the larger mental health and social support system.
posted by biogeo at 4:11 PM on December 9, 2022 [22 favorites]
replacing them with exactly nothing but the jails and a whole cadre of miserable, exhausted, terrified, penniless women has not worked out super well.
The gendered nature of this is another big problem. Where are the brothers and dads and uncles and adult sons?
posted by pelvicsorcery at 4:16 PM on December 9, 2022 [19 favorites]
The gendered nature of this is another big problem. Where are the brothers and dads and uncles and adult sons?
posted by pelvicsorcery at 4:16 PM on December 9, 2022 [19 favorites]
Another recent article on this: I Lost My Brother Twice
For non-NYCers, some important current context: Advocates for Mental Health Ask Court to Halt Removal Plan. Our current clown of a mayor has decided to try to lower the standard for taking people in off the streets involuntarily, without bothering to, you know, actually arrange resources to make sure they're properly cared for, when the system can't even accommodate people who want treatment. I am not wholly averse to some careful tinkering with the standard for involuntary hospitalization, but this is a catastrophe in the making.
posted by praemunire at 4:33 PM on December 9, 2022 [3 favorites]
For non-NYCers, some important current context: Advocates for Mental Health Ask Court to Halt Removal Plan. Our current clown of a mayor has decided to try to lower the standard for taking people in off the streets involuntarily, without bothering to, you know, actually arrange resources to make sure they're properly cared for, when the system can't even accommodate people who want treatment. I am not wholly averse to some careful tinkering with the standard for involuntary hospitalization, but this is a catastrophe in the making.
posted by praemunire at 4:33 PM on December 9, 2022 [3 favorites]
With respect, I don't think that's really a fair read of the article, which seems to strongly emphasize throughout how Crader has repeatedly sought resources for her son for 20 years and been railroaded the entire time, compared to one statement where she admits that after so long living with someone who she fears might hurt or kill her, she wishes she could have him committed.
Oh, to be clear, I have no problem with Crader. She's doing her best with wholly inadequate support, too. Nothing in my frustrated comment above is aimed at her, and I am pained at the weight of the burden she has carried.
Rather, I'm very angry at the implicit framing that the only thing that could be done differently now is that we remove liberties from people once they're maximally violent. The article doesn't talk about other kinds of interventions that exist, like the kinds of health psychologists brook horse mentioned. This would be a golden opportunity for a good journalist to start exploring, say, how easy it is to find that kind of treatment in that city; how easily available is it; did Justin ever have access to that kind of care; what does that therapy look like in practice and does it accommodate the traumas that develop around forcible medical care?
Or perhaps, okay, why did we move away from the asylum/institution system? How did we get here? Did we always handle schizophrenia like this?
All that information is out there. It's not hard to find. It would direct the reader explicitly to empathizing with people who need care and support as well as the people who have to try to provide that care.
For fuck's sake, have we talked about the incredibly well documented problem of burnout, low pay, and poor treatment of overloaded social workers? Because really, that man could have used a social worker to help him figure out services and a warm place to sleep, but we won't pay or train anyone much to do that.
But no: we have to emphasize the power of the carceral state looming in the background, the Worst Resort, but What Else Is There? We've run out of good options to consider! There was no other outcome we could have taken, but now we have a very aggressive, very traumatized guy who does not trust doctors or public health officials (who keep hunting him down and forcibly injecting him with things against his will) and the best we have is to lock him up before he even actually does hurt anyone?
Yeah, I do think it's fair to expect a journalist to do some legwork and ask questions about why we have the system we have, instead of emphasizing the pain of the man's mother (who, mysteriously, no one gave a shit about enough to provide any help or support to before this point) and looking sorrowfully and nobly at the looming prison down the road.
C'mon.
posted by sciatrix at 5:37 PM on December 9, 2022 [16 favorites]
Oh, to be clear, I have no problem with Crader. She's doing her best with wholly inadequate support, too. Nothing in my frustrated comment above is aimed at her, and I am pained at the weight of the burden she has carried.
Rather, I'm very angry at the implicit framing that the only thing that could be done differently now is that we remove liberties from people once they're maximally violent. The article doesn't talk about other kinds of interventions that exist, like the kinds of health psychologists brook horse mentioned. This would be a golden opportunity for a good journalist to start exploring, say, how easy it is to find that kind of treatment in that city; how easily available is it; did Justin ever have access to that kind of care; what does that therapy look like in practice and does it accommodate the traumas that develop around forcible medical care?
Or perhaps, okay, why did we move away from the asylum/institution system? How did we get here? Did we always handle schizophrenia like this?
All that information is out there. It's not hard to find. It would direct the reader explicitly to empathizing with people who need care and support as well as the people who have to try to provide that care.
For fuck's sake, have we talked about the incredibly well documented problem of burnout, low pay, and poor treatment of overloaded social workers? Because really, that man could have used a social worker to help him figure out services and a warm place to sleep, but we won't pay or train anyone much to do that.
But no: we have to emphasize the power of the carceral state looming in the background, the Worst Resort, but What Else Is There? We've run out of good options to consider! There was no other outcome we could have taken, but now we have a very aggressive, very traumatized guy who does not trust doctors or public health officials (who keep hunting him down and forcibly injecting him with things against his will) and the best we have is to lock him up before he even actually does hurt anyone?
Yeah, I do think it's fair to expect a journalist to do some legwork and ask questions about why we have the system we have, instead of emphasizing the pain of the man's mother (who, mysteriously, no one gave a shit about enough to provide any help or support to before this point) and looking sorrowfully and nobly at the looming prison down the road.
C'mon.
posted by sciatrix at 5:37 PM on December 9, 2022 [16 favorites]
I think the thing that frustrates me the most is that there's this uncritical assumption this guy is the responsibility of his mother only, because she's the person who chose to claim him. And that's exactly bass ackwards: this guy is the responsibility of the whole society he belongs to, the society that made him. We are all responsible for each other. And it makes us all so much less work and pain when we bother to set aside the resources to affirm that responsibility well ahead of time.
posted by sciatrix at 5:44 PM on December 9, 2022 [23 favorites]
posted by sciatrix at 5:44 PM on December 9, 2022 [23 favorites]
Yeah, sciatrix, I think you and I are on the same page regarding the screwed up nature of our mental healthcare and social support systems being at the root of the problem, and there being a greater need to interrogate how and why they're failing so badly that incarceration and institutionalization are the only options that people feel are left for men like Campbell who cannot care for themselves and require more resources than a family can provide. I just don't read the same implicit framing into this article that you did. In fact, somewhat the opposite: I read this article as showing in a pretty detailed way, through the lens of one individual story, how broken and Kafkaesque a system is that claims to offer services for people who need them but places arbitrary barriers and requirements in place to effectively deny those services. I think the author made a choice to emphasize that aspect of the story in a way that suggests they are sympathetic to our viewpoint, and trying to convince their readers that they should be too, using a rhetorical approach of showing rather than telling.
I don't think that an article trying to frame this as "Campbell is irreparably violent and the only good option is to remove him from society" would have taken the time to describe how he wants to make people laugh, or to include multiple portraits of him smiling with his mother despite their troubled relationship.
posted by biogeo at 6:38 PM on December 9, 2022 [16 favorites]
I don't think that an article trying to frame this as "Campbell is irreparably violent and the only good option is to remove him from society" would have taken the time to describe how he wants to make people laugh, or to include multiple portraits of him smiling with his mother despite their troubled relationship.
posted by biogeo at 6:38 PM on December 9, 2022 [16 favorites]
This story reminds me of a man with schizophrenia and psychosis who was released from jail, went to a hospital emergency department and told them he was homicidal, and was brushed off. Six weeks later he murdered a woman he had never met before because of his delusions.
He wanted to get help, but an overworked underfunded hospital system that didn't take mental illness seriously failed him. (The jail he had been in, that misdiagnosised his psychosis as drug induced psychosis, rather than schizophrenic psychosis that he had been self medicating with drugs, also failed him.)
"He said Mr Lowah was released from jail in September 2018 and the next day presented to the emergency department at the Noarlunga Hospital where he told staff he was homeless and experiencing homicidal ideation. Mr Lowah left before hospital staff could organise crisis accommodation for him, the court was told. Ms Foster was killed six weeks later."
posted by chariot pulled by cassowaries at 6:39 PM on December 9, 2022 [5 favorites]
He wanted to get help, but an overworked underfunded hospital system that didn't take mental illness seriously failed him. (The jail he had been in, that misdiagnosised his psychosis as drug induced psychosis, rather than schizophrenic psychosis that he had been self medicating with drugs, also failed him.)
"He said Mr Lowah was released from jail in September 2018 and the next day presented to the emergency department at the Noarlunga Hospital where he told staff he was homeless and experiencing homicidal ideation. Mr Lowah left before hospital staff could organise crisis accommodation for him, the court was told. Ms Foster was killed six weeks later."
posted by chariot pulled by cassowaries at 6:39 PM on December 9, 2022 [5 favorites]
Andrew Goldstein, who pushed Kendra Webdale in front of a subway, also repeatedly sought help before he killed her. New York State passed Kendra's Law, forced out-patient treatment, in response, even though forced treatment wasn't what Goldstein needed. This article is 23 years old and very little has changed.
I do believe there is a place for involuntary treatment, but anyone with more than a passing familiarity with NYC's mental health system can tell you that the problem is inadequate voluntary treatment and supports.
I appreciate sciatrix sharing their interpretation of the article, because involuntary and punitive "solutions" are typical with serious mental illness. And our current ghoul of a mayor wants to incarcerate everyone. We always have to be on guard against the ways this narrative is framed to lead to those. However, I didn't read it the same way. I read it as a desperate woman who'd been failed by all the voluntary, less restrictive options (lack of options). It's so sad.
posted by Mavri at 8:40 AM on December 10, 2022 [4 favorites]
I do believe there is a place for involuntary treatment, but anyone with more than a passing familiarity with NYC's mental health system can tell you that the problem is inadequate voluntary treatment and supports.
I appreciate sciatrix sharing their interpretation of the article, because involuntary and punitive "solutions" are typical with serious mental illness. And our current ghoul of a mayor wants to incarcerate everyone. We always have to be on guard against the ways this narrative is framed to lead to those. However, I didn't read it the same way. I read it as a desperate woman who'd been failed by all the voluntary, less restrictive options (lack of options). It's so sad.
posted by Mavri at 8:40 AM on December 10, 2022 [4 favorites]
Tried to edit to add the link to the article about Goldstein and it's not working. Here it is.
posted by Mavri at 8:42 AM on December 10, 2022
posted by Mavri at 8:42 AM on December 10, 2022
This article is 23 years old and very little has changed.
Yes, the subject has had AOT, without too much benefit, it seems. It's so depressing.
posted by praemunire at 8:48 AM on December 10, 2022
Yes, the subject has had AOT, without too much benefit, it seems. It's so depressing.
posted by praemunire at 8:48 AM on December 10, 2022
I think the thing that frustrates me the most is that there's this uncritical assumption this guy is the responsibility of his mother only, because she's the person who chose to claim him.
In many cases like this the family has to make a choice to either claim or reject a person and it can turn into a complicated game of "Not it" and many family members have to make a choice to live in this sort of situation, in fear, or have their loved one be homeless and/or terrorized by the police/carceral state. It's fine to talk about how things should be, but it's also worth understanding how they are right now which is what this article is talking about.
This is a scenario which is very familiar to me. I have a family member who has an adult child living with him who has schizophrenia, only kind of well-treated, and who isn't violent now but has been in the past. And we all know it's not the kid's fault, of course, but at the same time, he's high functioning enough to refuse care, to not require guardianship, to want to transition off his meds, to not share information about his doctors, to refuse services that would allow for respite care or other in-home supports. They live in a state (not NY) with exceptional access to health care, but you can't make someone use it unless they've really snapped.
I have another historical family member in a situation that turned out poorly, so I am somewhat touchy about this (and, apologies to all in this thread but I didn't read the article, just wanted to be part of the conversation in a hopefully constructive way).
posted by jessamyn at 8:51 AM on December 10, 2022 [11 favorites]
In many cases like this the family has to make a choice to either claim or reject a person and it can turn into a complicated game of "Not it" and many family members have to make a choice to live in this sort of situation, in fear, or have their loved one be homeless and/or terrorized by the police/carceral state. It's fine to talk about how things should be, but it's also worth understanding how they are right now which is what this article is talking about.
This is a scenario which is very familiar to me. I have a family member who has an adult child living with him who has schizophrenia, only kind of well-treated, and who isn't violent now but has been in the past. And we all know it's not the kid's fault, of course, but at the same time, he's high functioning enough to refuse care, to not require guardianship, to want to transition off his meds, to not share information about his doctors, to refuse services that would allow for respite care or other in-home supports. They live in a state (not NY) with exceptional access to health care, but you can't make someone use it unless they've really snapped.
I have another historical family member in a situation that turned out poorly, so I am somewhat touchy about this (and, apologies to all in this thread but I didn't read the article, just wanted to be part of the conversation in a hopefully constructive way).
posted by jessamyn at 8:51 AM on December 10, 2022 [11 favorites]
This article is 23 years old and very little has changed.
I listened to the latest episode of M William Phelps' podcast, Crossing the Line, today, which was about a random murder committed in 1977 by a young man who suffered from schizophrenia. It was clear that his family had tried to get help for him, but once he was medicated and stablised, he'd be released from hospital, then stop taking his meds and deteriorate, ultimately with fatal consequences. His mother was so afraid of him she even thought at one point that he might be the Son of Sam (it was during the Summer of Sam).
So, 45 years on, it seems nothing has changed.
In the UK we had a very high profile case 30 years ago when a mentally ill man, Christopher Clunis, stabbed a man, Jonathan Zito, through the eye as they were standing on the platform at a Tube station. At this point, the Tories' 'Care in the Community' policy had come into effect, which effectively closed all the mental hospitals and moved all the patients back into the community, but without the necessary support to ensure they took their meds, attended appointments, etc. Clunis hadn't been taking his anti-psychotic meds and nobody had followed up on him.
There is no safe place for these people anymore, and consequently there is the knock-on effect of a reduction in safety for the community as a whole, and more specifically for those close to the person who's ill - whether personally as a family member or maybe just living next door to them.
Ten years after the Clunis case, a report called for investment in mental health care (.pdf), but 20 years on from that, there is still no safety net for these people.
posted by essexjan at 3:50 PM on December 10, 2022 [4 favorites]
I listened to the latest episode of M William Phelps' podcast, Crossing the Line, today, which was about a random murder committed in 1977 by a young man who suffered from schizophrenia. It was clear that his family had tried to get help for him, but once he was medicated and stablised, he'd be released from hospital, then stop taking his meds and deteriorate, ultimately with fatal consequences. His mother was so afraid of him she even thought at one point that he might be the Son of Sam (it was during the Summer of Sam).
So, 45 years on, it seems nothing has changed.
In the UK we had a very high profile case 30 years ago when a mentally ill man, Christopher Clunis, stabbed a man, Jonathan Zito, through the eye as they were standing on the platform at a Tube station. At this point, the Tories' 'Care in the Community' policy had come into effect, which effectively closed all the mental hospitals and moved all the patients back into the community, but without the necessary support to ensure they took their meds, attended appointments, etc. Clunis hadn't been taking his anti-psychotic meds and nobody had followed up on him.
There is no safe place for these people anymore, and consequently there is the knock-on effect of a reduction in safety for the community as a whole, and more specifically for those close to the person who's ill - whether personally as a family member or maybe just living next door to them.
Ten years after the Clunis case, a report called for investment in mental health care (.pdf), but 20 years on from that, there is still no safety net for these people.
posted by essexjan at 3:50 PM on December 10, 2022 [4 favorites]
One of the symptoms of Schizophrenia is loss of self, you don't really know who you are.
So some patients have poor insight into how unwell they are and stop taking anti - psychotic medication.
posted by Narrative_Historian at 8:19 PM on December 10, 2022
So some patients have poor insight into how unwell they are and stop taking anti - psychotic medication.
posted by Narrative_Historian at 8:19 PM on December 10, 2022
I have watched and continue to watch a situation like this in slow motion, although without quite the same degree of psychosis and with more physical issues. But it's painful to watch and there are really no good solutions—at least that I have been able to find—for caregivers who find themselves in these sort of positions.
It's good that we have moved away from forced institutionalization and made the barrier to involuntary commitment high.
But in doing so, we have created situations where people who really can't care for themselves but are nonetheless deemed competent, get shut out of care and just free-fall until they finally either end up in jail/prison, the shelter system (if one exists), or onto whatever friend or family member extracts themselves from the caretaker obligation last.
In the situation I am familiar with, the person in question is capable of making short-term decisions ("do you want Cheerios or Kix for breakfast?") but does a bad job of managing longer-term tradeoffs, particularly around things that cause discomfort/anxiety/inconvenience in the short term but have a longer-term benefit, like physical therapy that's painful today but over time will keep you from being bedridden, or going to the pharmacy to pick up a prescription before it closes when you'd rather be watching a movie. Like, totally understandable stuff, but... if you make the short-term choice over and over, bad things happen. Eventually you end up bedridden and out of meds. And then what?
What happens is that his (state-funded, only a handful of hours/day) caretakers show up, see that he's bedridden and unmedicated, and call his relatives, who scramble to get prescriptions and go shopping and coax him out of bed and into doing his PT, etc. etc. And this is just how things go for years and years.
Until something goes wrong, because it's a terribly fragile state of affairs.
In the situation I know, the guy's parents died. One week they were there, basically managing all his care and doing his adulting for him, and then they were both gone. And now he's down to one sibling who happens to live in the area, and gets all the late-night phone calls when something goes wrong, and gets told they have to go get meds, or go shopping, or arrange for medical appointments and transportation, etc. And they are utterly trapped in this role, because there's no safety net if they just go hands-off. No vacations, no moving to pursue job opportunities, no vacations or weekends away, no turning their phone off ever, because at any time they can get a call because something has happened and there's nobody else who's going to intervene before the situation spirals out of control.
It's crushing.
The poor guy desperately doesn't want to go into a nursing home or SNF, because they're awful places to be if you're even reasonably close to compos mentis, and he's been in and out of them before, but his executive functioning is demonstrably not quite up to the task of doing the stuff that would let him actually be independent (in the sense of managing his own affairs including getting to appointments on time, taking the right pills at the right times, not berating the PTs/OTs/aides into quitting every few weeks, etc.). But doing all that stuff is basically a full-time or at least half-time job for someone else, and it's essentially destroyed his sibling's chance of having their own, independent life. It's a lose-lose situation for seemingly everyone involved.
All so a bunch of people can pay a bit less in taxes, I guess?
posted by Kadin2048 at 1:42 PM on December 11, 2022 [3 favorites]
It's good that we have moved away from forced institutionalization and made the barrier to involuntary commitment high.
But in doing so, we have created situations where people who really can't care for themselves but are nonetheless deemed competent, get shut out of care and just free-fall until they finally either end up in jail/prison, the shelter system (if one exists), or onto whatever friend or family member extracts themselves from the caretaker obligation last.
In the situation I am familiar with, the person in question is capable of making short-term decisions ("do you want Cheerios or Kix for breakfast?") but does a bad job of managing longer-term tradeoffs, particularly around things that cause discomfort/anxiety/inconvenience in the short term but have a longer-term benefit, like physical therapy that's painful today but over time will keep you from being bedridden, or going to the pharmacy to pick up a prescription before it closes when you'd rather be watching a movie. Like, totally understandable stuff, but... if you make the short-term choice over and over, bad things happen. Eventually you end up bedridden and out of meds. And then what?
What happens is that his (state-funded, only a handful of hours/day) caretakers show up, see that he's bedridden and unmedicated, and call his relatives, who scramble to get prescriptions and go shopping and coax him out of bed and into doing his PT, etc. etc. And this is just how things go for years and years.
Until something goes wrong, because it's a terribly fragile state of affairs.
In the situation I know, the guy's parents died. One week they were there, basically managing all his care and doing his adulting for him, and then they were both gone. And now he's down to one sibling who happens to live in the area, and gets all the late-night phone calls when something goes wrong, and gets told they have to go get meds, or go shopping, or arrange for medical appointments and transportation, etc. And they are utterly trapped in this role, because there's no safety net if they just go hands-off. No vacations, no moving to pursue job opportunities, no vacations or weekends away, no turning their phone off ever, because at any time they can get a call because something has happened and there's nobody else who's going to intervene before the situation spirals out of control.
It's crushing.
The poor guy desperately doesn't want to go into a nursing home or SNF, because they're awful places to be if you're even reasonably close to compos mentis, and he's been in and out of them before, but his executive functioning is demonstrably not quite up to the task of doing the stuff that would let him actually be independent (in the sense of managing his own affairs including getting to appointments on time, taking the right pills at the right times, not berating the PTs/OTs/aides into quitting every few weeks, etc.). But doing all that stuff is basically a full-time or at least half-time job for someone else, and it's essentially destroyed his sibling's chance of having their own, independent life. It's a lose-lose situation for seemingly everyone involved.
All so a bunch of people can pay a bit less in taxes, I guess?
posted by Kadin2048 at 1:42 PM on December 11, 2022 [3 favorites]
Reminder that the ending of routine institutionalization was accompanied by the Mental Health Systems Act of 1980, a law establishing federally funded community mental health centers to provide mental health treatment and social workers to help the formerly institutionalized live in their communities. It was a really good idea. Reagan demolished it in 1981 and made no attempt to provide any alternative. And things have been a big mess ever since.
The Mental Health Systems Act of 1980 (MHSA) was United States legislation signed by President Jimmy Carter which provided grants to community mental health centers. In 1981 President Ronald Reagan, who had made major efforts during his Governorship to reduce funding and enlistment for California mental institutions, pushed a political effort through the U.S. Congress to repeal most of MHSA.[1] The MHSA was considered landmark legislation in mental health care policy.posted by hydropsyche at 4:42 PM on December 11, 2022 [8 favorites]
I have a son whose mental illness appeared pretty early and spiraled in his teens. I have known a few families with a schizophrenic family member. There is so little help, so much blame, lots of opportunity for addiction. The potential for suicide is always in your mind. Mygothlaundry and others, you have my respect and sympathy. The US used to talk about a safety net, now no one bothers.
Why aren't there slow-release dosages of anti-psychotic meds, similar to birth control?
posted by Mom at 10:40 AM on December 14, 2022
Why aren't there slow-release dosages of anti-psychotic meds, similar to birth control?
posted by Mom at 10:40 AM on December 14, 2022
There are? That's explicitly what the biweekly Risperdal injections mentioned in the article are.
posted by sciatrix at 11:16 AM on December 14, 2022 [1 favorite]
posted by sciatrix at 11:16 AM on December 14, 2022 [1 favorite]
« Older The digital zeitgeber of our entrainment | SimCityist, McCentury Modern, fast-casual... Newer »
This thread has been archived and is closed to new comments
It's a terrible situation this man's mother is in and she hasn't done anything wrong. But boy fucking howdy is this story a great example of ignoring the structural reasons that lead to outcomes like this one while invoking big stereotypes about mental illness that invite the reader to identify with unaffected caregivers and bystanders, not people who need care. And the central question posed by the framework is not "how could we prevent this unquestionably shitty outcome by changing the way we do things" but instead "at what point is it reasonable to pre-emptively take human rights away from this man before he seriously hurts a person who isn't mentally ill and therefore matters?"
This is a hard case that is absolutely exacerbated by trauma, lack of resources, and shitty care. I don't know what you can do at this point to keep people safe. But this point isn't a place that is ever necessary to go--if we gave enough of a shit about people in crisis to provide sufficient resources to pay better qualified staff, teach them about non-coercive and minimal traumatizing treatment techniques, and provide enough staff to minimize burnout, we could reduce situations like this dramatically by removing the element of trauma and subsequent aggression from the equation.
posted by sciatrix at 11:08 AM on December 9, 2022 [54 favorites]