Friday, May 18, 2012

No one really sat down and said "he's a sick guy, let's see what we can do to make him better"


BROOKLIN — Oddly enough, it was often a relief to Gail Angell when she heard her son was in jail.
At least, she said, she knew where he was and that he was safe.
Her son, Chris Angell, died from burns last month when he tried to asphyxiate himself in his car and the motor overheated and ignited.
And although jail could be somewhat of a haven, Gail and her husband, Chip, say it was no place for someone who is mentally ill.
Angell, like many schizophrenics, was diagnosed as a young man soon after he graduated from Clemson University.
“A sick person is square,” said Chip. “All their holes [jail] are round. He’s sick. He’s not a criminal. Someone who’s mentally ill cannot go through the court system. He needs to be diverted right away.”
His mother, a registered nurse, said Chris’s illness was complicated by anosognosia, a condition that rendered him incapable of realizing he was sick. For that reason, she said, he often refused medication and hospitalization.
Despite his illness, Chris was a gifted tennis player and pro. And a caring father. But the mental illness constantly derailed his life, his parents said.
The Angells say Chris would have fared better with adequate treatment.
They have filed a grievance against Riverview Psychiatric Center, which is run by the Maine Department of Health and Human Services.
The other treatment provider whose care of their son they are questioning is a Bangor psychiatrist who also sees patients at Community Health and Counseling in Ellsworth.
“Very few of his providers followed the law or their own procedures in treating someone who was very sick,” said Chip. “They didn’t have the guts to put him in the hospital.”
Riverview Superintendent Mary Louise McEwen said she could not say anything about Chris’s care because of privacy laws.
The psychiatrist did not return a call left at his Bangor office. A Community Health and Counseling employee told the American, “He will not be speaking with you.”
The one institution that provided proper treatment, the Angells said, was the Dorothea Dix Psychiatric Hospital, where Chris spent some time in 2006.
But there was no room there for Chris. Two wings have closed at the mental hospital in recent years.
It was the Bangor hospital’s namesake, Dorothea Dix, who fought in the 19th century to get mentally ill people out of jail cells and into hospitals.
But hospitalization of the mentally ill shifted direction during the 1960s.
A recent report by the National Sheriff’s Association and the Treatment Advocacy Center states that “deinstitutionalization, the emptying of state mental hospitals, has been one of the most well-meaning but poorly planned social changes ever carried out in the United States.”
The report said the change did not take into account the fact that many of the sickest patients are not able to make sound decisions about their need for medication.
The Treatment Advocacy Center says that only one state —
Mississippi — meets what the center considers a minimal standard of 50 psychiatric beds per 100,000 residents.
The center lists Maine and 20 other states as having a severe shortage at 12 psychiatric beds per 100,000 residents.
Hancock County Sheriff Bill Clark said it is difficult to estimate how many inmates are mentally ill because they don’t always know themselves or haven’t had medical care.
Clark did say as many as 60 to 70 percent of Hancock County drug court clients show symptoms of mental illness.
“That could be serious depression all the way up to schizophrenia,” he said. “They come in with an addiction problem, then we find out they become more difficult to rehabilitate because of a co-occurring mental health illness.”
Chip Angell said his son’s schizophrenia would lead Chris to self-medicate with alcohol.
When he was “raging” the family would call the police for help.
Eventually, they took out a protection order to keep Chris away from the family business, the Brooklin Inn.
The idea, they say, was to protect not only employees and customers but Chris himself.
Chip said that during one psychotic episode, Chris told two women at the inn’s pub that he was going to cut them with a knife. He could have been hurt if a few patrons had overheard that comment, they said.
During a police intervention at the inn in early February, the police told Chip they could take Chris to the hospital, “but he’ll be home before we are.”
Instead, the deputies arrested Chris on a charge of violating the protection order with the hope he would be sent from jail to the psychiatric hospital.
The jail did send Chris to Riverview, which, despite his long established history of schizophrenia, classified him as a forensic patient, which meant he would be evaluated to see if he was fit to stand trial.
During Chris’s five weeks at Riverview, the state’s forensic psychiatrist found Chris competent to stand trial.
“She sent him back to the jail,” said Chip. “The court had no charges of any significance to keep him.”
A judge then had Chris plead guilty to violating the protection order, sentenced him to a year’s probation and let him go, Chip said.
“It’s very clear they didn’t follow any logic with regard to a patient but they used all kinds of paperwork excuses,” Chip said. “Nobody really sat down and said, ‘He’s a sick guy, let’s see what we can do to make him better.’”
The discharge plan for Chris after his release from jail was to spend a night at Jasper’s Motel in Ellsworth, at his expense, and then go to Augusta to pick up his medication.
The Angells were told a case worker would be available for Chris in a few weeks. It was the case worker who arrived in Brooklin the morning of April 24, saw Chris’s car on fire and called 911.
“To turn a guy, medicated, out in the public, that’s not a discharge plan,” Chip said. “It’s just incompetent or careless.”
Gail said that while her son could be a raging psychotic one moment, he could be calm enough the next to talk his way out of a hospital.
A year ago, after an episode in which Chris was “raging,” police escorted Gail and Chris to the emergency room at Eastern Maine Medical Center (EMMC).
Gail went home. In the process of being admitted Chris just walked out, she said.
In November 2011, Chris was taken again to EMMC, which kept him overnight.
Chip went to talk to the hospital the next morning.
“A guy from Acadia [mental hospital] lectured him about being nicer to his dad and off he goes home again,” said Chip.
Angell said that medical professionals and social workers are not following Maine rules and laws with regard to persons with mental illness.
In the past, patients needed to be in danger of harming themselves or others in order to be forcibly hospitalized.
Today medical professionals also must consider a patient’s past history and testimony from other people as well.
“A social worker must get testimony from others to help in her evaluation,” Chip said. “But, it’s not happening.”
Of 29,000 suicides in the United States each year, about 5,000 are believed to be persons with schizophrenia or bipolar disorder and most were not receiving adequate psychiatric treatment, according to the Treatment Advocacy Center.



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