(3-20-18) A mother’s testimony to be delivered today (Wednesday) before a judge who will decide if her 22 year-old seriously mentally ill son will be hospitalized. This plea tells much about our broken system and, quite frankly, makes me angry. This letter is representative of what happens every week in our country. We’ve got to do better. Lives are being destroyed.)
Your honor,
In one of my hundreds of calls to crisis during the past three years, a clinician asked me, “What is it that you want?” My answer was clear:
I want my son to receive treatment in a safe environment, under the care of a qualified physician, with sophisticated medication management and therapy and enough time to determine whether the treatment is working.
The clinician laughed and said flatly, “You will never get that.”
Sadly, she has been correct.
My son has been in hospitals at least a dozen times with acute symptoms from his brain illness, sometimes voluntarily.
He’s been committed under the Involuntary Treatment Act four times in the past year and a half. Every single doctor upon release has stated that my son is too ill to truly function in his life but that a law or an insurance protocol is forcing his premature release against medical judgment. Every single doctor has been correct, and my son hasn’t been well enough to make and maintain workable plans.
Doctors Overruled by State’s Civil Rights Law or Insurance Despite Son’s Mental Illness
In 2016, my son was incarcerated for two months because he was too ill to be safe in the community and the State of Washington had no other place to contain him. We’ve heard again and again that limited resources make it impossible to expect a reasonable hospitalization, yet the state found the resources to house our son in jail for two months without any evidence of a crime.
The arrest was predicated on a bench warrant issued during a short stay at an Involuntary Treatment facility. He couldn’t be there and in a court arraignment at the same time. The court arraignment was for a DUI charge because he had been so sick that he was presumed on drugs. The short hospitalization didn’t make him stable and when he got super sick again the police took him to jail on the bench warrant.
Three months after his arrest, my son’s charges were dismissed because toxicology results indicated no drugs at the time of the arrest. Although my son does struggle with the symptoms of a dual diagnosis, the system has tried to blame him for his illness by claiming that substance use makes him sick and therefore he should own all fault and responsibility for his condition.
Somehow he’s supposed to take charge and fix his brain illness by sheer force of will. This is incoherent medical treatment.
My son’s inappropriate jail term included a competency restoration at Western State Hospital. That 15-day stay provided no therapy, unknown medication and absolutely no follow-up care. He left without a prescription or any description of the treatment he may have received. If my husband and I had not posted bail, the state would have kept him in jail indefinitely to await a trial that would never happen because there was no evidence of a crime. And he probably would have joined the thousands of other inmates in our state who cycle between decompensation in jail and court competency processes because of our state’s unwillingness to provide appropriate mental healthcare.
I’m begging you today to provide hospitalization so that my son doesn’t become another statistic in the tragic criminalization of mental illness.
My son entered your hospital last week after several months of troubling symptoms. As he has lost insight, my son has exhibited strange and often angry behaviors. He has lost an apartment lease and been fired from various jobs. He’s had a number of street encounters with police, and he has abandoned community-based medical services. As his decompensation escalated, he stopped communicating coherently with family and he has threatened my husband and me that he will commit suicide if we stop paying his bills. A year ago, when we attempted to hold him accountable for his illness by ending financial support, he jumped off the I-5 bridge into the Columbia River in a suicide attempt. That suicide attempt happened a day after my son’s release from a 5-day involuntary hospitalization; I had begged a social worker to convince a doctor to recommend commitment.
“I believe your son is in danger,” he told me, “but there’s nothing we can do.”
Just over a week ago, my son texted me a bizarre message demanding that I stop sending angry telepathic messages. He also called to demand that we buy the house he’s living in and kick out the other renters and the landlord. He threatened that somebody would soon get hurt. My son’s cell phone was found buried in a community garden last Friday, after he stopped answering calls or communicating in any way with people who know him. I reported all of these alarming signs of decompensation to our county crisis and commitment team and also to my son’s providers at a community psychiatric clinic. It cannot converse with me because my son withdrew his Release of Information, although maintaining an ROI with providers is a condition he agreed to for ongoing family financial support.
A mobile team from the county visited my son at his rental home last Wednesday and agreed with me that he had reached a dangerous level of decompensation that warranted a court order to detain and hold. While they filed the court paperwork, my son disappeared for 48 hours. Getting him into this hospital was a huge effort and filled with risk. Please don’t let all of that effort be wasted by prematurely releasing my son back into a situation he is medically unfit to manage.
My husband and I recognize that by supporting our son financially we have enabled him to maintain a thread of safety, but this is not a sustainable arrangement. We will not pay his rent any more unless he engages with treatment. We are begging you today to keep him in the hospital long enough to restore his insight so that we as a family can design a plan for his recovery and reinstatement in the community. If you release him today, he will become homeless when his rent expires at the end of the month.
The risk that he will fixate on suicide as a solution to his predicament is a credible threat, given his recent threats and his past actions. The risks for incarceration are equally alarming, given his history.
According to RCW 71.05.245 in the Washington Administrative Code, “the court must consider the symptoms and behavior of the respondent in light of all available evidence concerning the respondent’s historical behavior. Symptoms or behavior which standing alone would not justify civil commitment may support a finding of grave disability or likelihood of serious harm….”
If you ignore my testimony today and do not consider historical evidence in making your judgment I believe you will be in violation of this statute.
Our son is not choosing to be sick. Saying that he is denying medical treatment by choice ignores the well-known medical reality that he is unable to see his own illness because of the impairment itself. The medical term anosognasia describes my son’s illness: he cannot see he is sick because the organ of perception—the brain—is damaged. He also has state-dependent learning and memory. When he recovers a little bit of insight, he cannot access any memory of having ever been in a different state of perception. No healthcare worker has ever helped him develop a system for recognizing the cycles of his illness, and so he continues to believe that he has always been fine but mistreated by others who “don’t understand.”
My son thinks the system and his parents are trying to control him and doesn’t understand that we are trying to help him develop self control. I’m begging the medical workers present today to hear this message. He needs to be healed enough to perceive his inability to perceive and only then can he be taught to recognize his illness and responsibly manage it. Until he’s ready for this, he should not be held accountable for managing his own recovery. He has shown that he is too disabled to access the complex environment of a community-based system of care. He has the right to be treated in a safe environment until there is some level of assurance that a transition into an outpatient protocol can succeed.
The neural and neurochemical damage in my son’s brain is medical, not psychological.
If a doctor told a paraplegic that he could walk if he just tried harder, society would lash out: Telling a patient with a biological brain illness that he could recover his insight if he just tried hard enough is just as ridiculous and should not be an acceptable standard of care.
Until my son’s insight is restored to a significant extent, my son will be unable to support his basic needs. He doesn’t have any resources, and my husband and I are not going to support him unless he agrees to treatment. His compliance will be impossible to ensure without more time for him to recover insight.
He is too sick to maintain housing, as evidenced by his past year of wandering with periods of homelessness in California and Washington. He has lived at his current home less than two weeks, and his new landlord’s frightened calls to police last week indicate that this living option is at risk, even if we agree to pay. He has been asked to leave every place he has lived since he left home and I maintain an Order of Protection to keep him away from our home because I believe his extreme and uncontrolled illness is a threat to my safety.
My son’s mental impairment renders him unable to work. He has lost 6 jobs in the past year.
My son’s mental impairment renders him unable to engage with services in order to get state assistance. He cannot keep track of deadlines, phone numbers, protocols… His SSI application sits awaiting his initiative, but he is too ill to take that initiative and refuses help because he cannot recognize his impairment and therefore doesn’t believe he is sick and needing help.
My son’s mental impairment renders him unfit for participation in a community based system of mental healthcare. This system requires a high level of organization and navigation that my son is unable to access because of the very nature of the illness that requires treatment.
My son suffers from a rapid-cycling form of Bipolar 1, with psychotic features. When his biological brain illness is at its worst, he enters mixed states of mania and depression, with rage and paranoia as his primary depressive symptoms. He responds to hallucinations that are visual and auditory and these hallucinations have been aspects of incidents with police. In Vancouver, Wash., and in San Francisco, Calif., he has been picked up for wandering in traffic.
The Vancouver police included in their report that he said deities were instructing him to light himself on fire in order to end his life.
Underneath his illness, my son is incredibly intelligent, loving, kind and capable. Before this biological illness impacted his insight, he earned academic honors and was a state champion debater. He was beloved by friends, who have abandoned him in fear and confusion because his illness turned him into someone they couldn’t recognize or understand. Because he has never received any enduring medical help, he has become increasingly isolated in his life and this isolation is well-known as a risk factor for all manner of tragedy.
My husband and I are begging you to give our son a fighting chance to get his life back on track. We have resources to share if he is held long enough to regain enough insight so that a program of care can be designed with my son as a functioning participant.
My son deserves access to treatment for his biological illness in a safe environment, under the care of a qualified physician, with sophisticated medication management and therapy and enough time to determine whether the treatment is working.
Your honor, you have the power today to participate in restoring my son so that he can build a life. He has dreams and goals and so much potential. Please grant him the opportunity to at least begin to get well.
Thank you.
Mother of a Son who needs help.
(Again, I have to ask: is anyone listening? -PE)
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