24 January, 2011

It's Not That Easy

So David Dayen wrote this article right after the Giffords shooting, taking the WaPo out to the woodshed and administering some tough love for being such complete fuckwits.  You see, WaPo decided that since there's a law on the books in good ol' AZ saying crazy folk can be committed, all those people who didn't take advantage of the law to get Loughner off the streets before he put a bullet in a Congresswoman's head and killed a whole bunch of others have something to answer for:

According to the Washington Post, Arizona has a law on the books that enables anyone to identify a potential victim of mental illness, and remand them for treatment:
Under Arizona law, any one of Jared Lee Loughner’s classmates or teachers at Pima Community College so concerned about his increasingly bizarre behavior could have contacted local officials and asked that he be evaluated for mental illness and potentially committed for psychiatric treatment.

That, according to local mental health and law enforcement officials, never happened.
Ah, yes.  Good ol' Title 36.   Title 36, wot could've saved 'em all.

Let me tell you a little something about Title 36.  And it's gonna get personal.

 My mother, you see, is off her nut.  She won't mind me telling you.  She'd tell you herself, if you asked her.  I'm sure she'd be happy to tell you about being Title 36ed, too, and what the Arizona mental health care system was like.  And keep in mind something: that was before they slashed the funding.

When my mother went nuts, my dad and I didn't know about Title 36.  We didn't know about psychiatric disorders.  Sure, my uncle was crazy as a loon, but he'd been in the service, so the feds had taken care of that.  And this was my mom.  Sanest woman in the universe.  At least until the accident.  An old biddy rear-ended her.  She hit her head on the side window.  Nothing major.  But after that, she started getting odd.  She'd go to the chiropractor to have her neck adjusted and come back convinced that she had to change her diet.  She started eating nothing but squash.  She lost her skills as a homemaker.  She started flying off the handle at the least little thing.  We never knew what would set her off. She became withdrawn.  And we put it all down to stress from the accident.

Then she started sitting in my room at night.  I'd wake up with her breathing heavily over me, terrified, and she wouldn't tell me why.  I started locking her out.

She'd wander off down the street, and howl at my dad when he dragged her back.  He had to lock her in the house to keep her from running off.  Otherwise, she'd just walk away, and we were afraid something would happen to her, because by then it was crystal clear she wasn't rational.  But we had no idea what to do.  We didn't know about Title 36, and she refused to admit anything was wrong.  So, for that matter, were we.  Hard to admit that your loved one's crazy as a loon.

One of our physician friends finally got us in touch with a psychiatrist, a wonderful woman who persuaded my mother to sit with her long enough to figure out what the problem was: Bipolar Disorder.  The kind with the psychotic features.  Chemical imbalance, not a personality flaw, not something you could just snap out of if you really put your mind to it.  She'd need medication.

Oh, that did not go over well.  You see, my mother was convinced people were trying to poison her, although we didn't know that at the time.  She refused medication.  And we couldn't just bundle her off to a nice treatment facility.  Even with a supremely capable psychiatrist on your side, it's hard to get someone committed against their will.  And when they wander the streets, it's hard to get the police to take them in.  At first, it's because there's no diagnosis.  After that, it's because getting them picked up could make their paranoia worse, so you're reluctant to ask for police help.  And what can they do?  If that person's not an imminent threat, they just drop them off at home, where a working father and a teenage daughter are at their wit's end while they wait for the courts to decide the problem's severe enough to do something about it.

We finally did get her committed.  And then came the issue of getting her to the facility.  A long drive up the canyon to Flagstaff, winding roads with cliffs, and a crazy woman trying to jump out of the car at 30mph.  She howled when we gave her to the orderlies.  She had to be heavily medicated and put in solitary at first.  If that doesn't break your heart, nothing will.  It almost seems kinder to leave them alone with their paranoia, at home, where they find occasional moments of comfort.  Not everyone has the stomach for it.  Not everyone can apply that kind of tough love.

But we got her there, and the facility (a private one), returned her to normal.  So normal, in fact, that after a few months of having my mother back, she went off the meds, thinking she didn't need them anymore.

Thus began the cycle: commitment, normalcy, go off meds, commitment.  My dad handled the court stuff.  I never saw how difficult that was.  But I know it was very nearly a full-time job for him.  You can't just say, "Hey, this person's gone bonkers again, can I just drop them off at the mental hospital?"  It doesn't work that way.

Private insurance wouldn't cover the expensive private facility after so many go-rounds, so it was off to the state's.  And she was never right after that.  Never.  They'd return her to something approaching sane and eject her before her medications were fully adjusted.  The state facility wasn't an institutional horror, but it was a dim, depressing little place filled with desperate people who also would never be right.  She hated it there.  She'd beg to come home.  And when she came home, she wasn't my mother and never would be again.  She'd gone off her meds too often, for one, and for another, the doctors there weren't as good.  They were underfunded and overworked and they did their best, but they could only do so much.

They kept her alive, and that's something.  But the state of Arizona just patches you up.  They don't do all it takes to fix you.  And this was back in the halcyon days, before they cut the funding by 37%, and told all of the people who couldn't afford mental health care but were too rich for Medicaid to fuck off.  Here's what Arizona's doing now:
To fill a $1 billion hole in its 2011 budget, Arizona slashed this year’s budget for mental health services by $36 million — a 37 percent cut. As a result, advocates say 3,800 people who do not qualify for Medicaid are at risk of losing services such as counseling and employment preparation. In addition, more than 12,000 adults and 2,000 children will no longer receive the name-brand medications they take to keep their illnesses in check. Other services such as supportive housing and transportation to doctor’s appointments also will be eliminated.
Let me tell you about something about people who can't get their meds and can't get to their appointments: they're condemned to hell.  A worse hell than my mother ever faced.  At least the state always made sure she had a place to go when she was too crazy to survive on her own.  At least they gave her a refuge when she was suicidal, and provided her medications that, while they didn't set her completely right, at least gave her some sanity back.  She didn't have to hear voices telling her awful things would happen to her family if she didn't kill herself.  She didn't have to believe her only option was suicide.  They saved her, over and over again, and now, if she were there, they wouldn't.  Not if we had it to do over again.  Instead of her divorcing my dad because she'd concluded he was the root of all her problems, he'd probably have had to divorce her in order to leave her poor enough to qualify for care, once the insurance ran out.  And it would have killed him, because he is an honorable man who didn't abandon her, not when she went nuts and not when she left him for another man, but would occasionally come back to him for help because he was the only one who knew what to do when the voices returned.

Now imagine trying to do this.  Imagine trying to navigate this morass of mental health law.  Imagine trying to get authorities to understand that a very odd man is a deathly danger, when he hasn't done a damned thing other than freak people out.  Imagine trying to get that man help, when you're afraid of him, when you don't know how to navigate this morass, can't get anyone to take it seriously, and can't convince the person in question to get help, and even if you could, who's gonna provide it, with budgets slashed so severely?

If you walk out on an Arizona street and say, "Title 36, who knows what that is?" how many hands do you think will go up?  If you ask for volunteers to get a man picked up for possible insanity, who do you think will take that step, knowing they could be wrong, knowing that man may blame them, hate them, for what they've done?  How many of us really feel comfortable enough judging another person's sanity to make that call?

It is not so simple, WaPo, even with a law on the books.  First, you have to know there's a problem, and that this problem is severe enough to report to the authorities.  Then, there has to be a court system willing to get treatment for those refusing it, and a mental health care system well-funded enough to provide said treatment.  None of those things is assured in the great state of Arizona.  Few places in America will do all in their power to heal broken minds.  

And you, WaPo, have no idea how desperately hard it is.  You've never been there.  You've never walked in the shoes.  So don't tell us a phone call would have done it.  There was too much: the deterioration of Arizona's health care system, the easy access to guns, the relentless drumbeat of eliminationism, the stigma of being branded mentally ill in a wild west state, and the simple fact that things this complex care rarely be prevented by picking up the phone.

Especially when the people on the other end of it don't have the funding to take you seriously.


Suzanne said...

very well said dana. in the past, i've had to try to navigate the california mental health system for family and friends in addition to my experiences on the pd.

even before the draconian cuts that have happened in ca, the cops had to determine that the person was (1) a danger to themselves (suicidal); or (2) a danger to others (homicidal); or (3) gravely disabled (ie dementia/alzheimer) in order to place an involuntary 72 hour psychiatric hold. the patient would then be transported by ambulance to the county contracted mental health facility where the docs would either agree or disagree.

more times than i can recount, if ya didn't have good insurance, that 72 hour hold was ignored the patient would be discharged early -- many times later that same day.

it is heartbreaking what is happening to our safety net in the country.

its not that easy -- and it is being made harder and harder each and every day.

Silver Fox said...

I hope you tweet a link to this at them, there is some possibility that someone there will read it. And send it in as a letter to editor.

And all the rest - so sorry for your and your dad's experiences, and your mom's. People w/ bipoloar too often go off meds because they feel fine, and also sometimes because the meds make them feel dull and not as alive as they remember feeling.

Woozle said...

Oh man. This is definitely comparable to our experiences with Josh. harder in some ways, maybe easier in others, but definitely on the same scale. "A full-time job."

Bits of it were gut-wrenchingly familiar...

...wrestling Josh into the car (twice -- the first time, I forgot to activate the childproof lock on one side) to get him up to the facility, an ~80-minute drive across the border to Virginia -- with me wondering if his repeated hovering at my shoulder meant that he was going to try to escape over me as I was driving.

...having to lock all outside doors and hide the keys (and add a keyed deadbolt to the front door, and put up a shelf blocking the windows in the living room, and screw down the window crank in the breakfast nook), so that he wouldn't randomly leave the house (possibly in the middle of the night or wearing only a swimsuit).

...not knowing that Medicaid could help, not knowing that he qualified for Medicaid, not knowing the stupid tricks you have to do in order to get Medicaid, being given the wrong form to fill out, applying for SSI three times and being turned down for having too many resources... (how can you have too many resources when your net worth is in the negative 5 digits?)

And yeah, most of that happened before the budgets were cut. And now they're constantly trying to end Josh's stay at the institution when he has just started making real progress and of course long before we've any hope of finding a permanent group home for him (been looking for that since at least 2007).

So yeah, it's a crazy, stupid, system -- and I hope that "smaller government" advocates understand why I think they are full of it when they suggest that the solution to our national woes is to both cut social services and cut taxes for the rich.

If the free-marketeers can deliver universal healthcare, then they can talk about making the government smaller. Until then, they should STFU.