Thursday, December 13, 2012

Editorial | Jeff Gerritt: Families need stronger help when loved ones need mental care

Severe mental illness affects far more than the 500,000 people in Michigan who suffer from it. Mentally ill loved ones can rock their families emotionally -- and empty their wallets -- as they bounce from crisis to crisis. Maybe one in seven families must, in some way, care for and support a mentally ill sibling, parent or child.
You'll meet two Michigan mothers today -- Jerilee McHard and Yvonne Foster -- who know the heartache and frustration of dealing with a mentally ill child in an often unresponsive public mental health system.
McHard's daughter, Maureen, died last year at age 43, after moving in and out of group homes, psychiatric hospitals and treatment centers. Foster's daughter, now 39 and in a hospital, has been homeless most of this year, refusing treatment for mental illness.
For families with mentally ill loved ones who don't want help, getting services or medications to them, or even knowing where they are, can become practically impossible. Thousands of people with a mental illness who don't recognize their condition aren't getting needed out-patient or in-patient treatment.
For court-ordered commitments, the standard most often used under the mental health code requires a person to be an imminent danger to themselves or others. But Michigan's mental health code includes other, less stringent standards as well, if the courts and mental health providers are willing to use them.
Families need a stronger and better funded community mental health system. Some also need commitments for court-ordered treatment to keep their loved ones from unnecessary suffering and even death.
When loved ones resist mental care
Jerilee McHard of Farmington Hills won't forget her daughter's 18th birthday, or the mile-wide eyes that blazed through the metal bars of a psychiatric hospital. "She was in a panic, screaming," McHard, 70, said last week. "I'll never forget her face."
On Nov. 7, 1986, McHard's daughter, Maureen Day McHard, flew to Michigan from Pennsylvania, where she had attended the Devereux School for the developmentally disabled and mentally ill. Social workers thought Maureen would bolt when she legally became an adult. So they arranged for Maureen to return home the day she turned 18.
After flying from Pennsylvania to the Oakland County airport, McHard and her daughter took an ambulance to the Clinton Valley Center in Pontiac, a fortress-like psychiatric hospital established in 1878 and demolished in 2000. There, Maureen cried and begged her mother not to leave her. McHard tried to calm her daughter as hospital nurses ordered McHard to leave. Then a heavy wooden door outside the intake area slammed shut. Through the iron bars of the door, Maureen stared at her mother in terror.
"It was horrible," McHard said.
More than 500,000 people in Michigan are severely mentally ill. Their illness affects not only them but also their families, who must help them cope, get the services they need, and guide them through crisis after crisis. Sometimes, when a mentally ill person doesn't acknowledge a problem, patient confidentiality laws can keep family members in the dark about medications, or even what hospital their loved one is in.
"It's always there, a weight on your shoulders that you feel you need to carry," said Hope Cummins of the Oakland County Alliance for the Mentally Ill. "It's a constant battle. You're continually checking to make sure they're safe and their basic needs are met. It's even more difficult when someone you want to help doesn't want to accept it."
Severe mental illness touches about one in seven Michigan families. The state should do more to support them by strengthening the community mental health system and enabling families and mental health providers to help severely mentally ill people who refuse treatment. Courts and community mental health agencies ought to communicate better, and they must use all of the legal standards for court-ordered treatment that are already included in the state's mental health code.
"The system doesn't have the resources to meet the demand," said Mark Reinstein, president of the Mental Health Association in Michigan. "Nor does it have a good answer for what happens to people who refuse treatment."
Love, anger, inconsistent care
James and Jerilee McHard knew their baby daughter was different. Maureen cried and screamed continually and never showed affection. "We didn't know what was wrong, but we knew that she was born with a problem," Jerilee McHard said.
Maureen could be cruel, too, especially to her younger brother, C.J., whom she terrorized on the backyard swing. When she was 7 and he 1, she held him upside down, bumping his head against the floor.
Despite problems, Maureen performed satisfactorily at Kenbrook Elementary School in Farmington Hills. She showed talent in music and dance. Still, her classmates shunned her.
When Maureen was 12, a psychiatrist recommended that she enter the Hawthorn Center, a children's psychiatric hospital in Northville. There, she started taking anti-psychotic medication. Later, she was diagnosed with bipolar disorder and schizophrenia.
After eight months, Maureen transferred to the Devereux School in Pennsylvania and remained there until her 18th birthday. In high school, Maureen became even more anti-social and gained nearly 90 pounds on her slim, 5-foot-2-inch frame.
"She ended up hating it there," McHard said.
Maureen never really found a home, spending most of her adult life in the public mental health system, living with other people with psychiatric disorders in supervised group homes run by private nonprofits. Two years after high school, she moved to a group home in Waterford. She did well there until placed, about a year later, in a supervised apartment. There, she mismanaged the money she earned from a part-time job cleaning bathrooms, blasted her stereo system at all hours, and grew increasingly erratic.
On a visit to her mother's condo in Farmington Hills, Maureen started to quarrel and went into a rage. She shoved her mother repeatedly, breaking the screen door and causing $3,000 worth of damage.
"I thought she was going to kill me," McHard said. "I tried to make a call and she tore the phone off the wall."
Some of the group homes Maureen lived in were filthy and mismanaged, McHard said. Others kept her heavily medicated. "She could hardly talk after a while," McHard said. "She was overdrugged."
At 26, Maureen entered another residential treatment program -- Training and Treatment Innovations Inc. -- and moved to a supervised house in Oxford with 24/7 care. She continued to do janitorial work. Maureen remained there for nine years, spending weekends at home.
Maureen continued to direct much of her anger at her mother. "It took a long time for her to realize that I was trying to help her," McHard said. "I think she felt like I abandoned her. I did feel some guilt."
In her 30s and early 40s, however, Maureen became an affectionate, loving daughter. McHard credits her progress to the right medications and Maureen's desire to get better.
McHard, who divorced Maureen's father when Maureen was 15, remarried on Aug. 8, 2008. Maureen was maid of honor. "She thanked me so many times for that," McHard said. "We grew very close. She sent me lovely cards with such nice things to say."
But McHard soon had another consuming responsibility. Six months after the wedding, McHard's husband, Robert Sallan, collapsed and nearly died from a septic infection. Sallan, who has Parkinson's disease, continues to recover at home, breathing through an endotracheal tube. A financial services representative, McHard had to reduce work hours to take care of her husband.
Maureen pressed on. In 2009, she moved to a semi-independent apartment in Auburn Hills, run by Empowered Living. She considered college and looked for a job. "She was trying so hard to be independent," McHard said.
Maureen's deteriorating health, partly due to poor nutrition and heavy smoking, eventually aggravated her mental illness. She struggled to handle basic tasks, such as managing money and cleaning. Compulsive and obsessive, she would use half a bottle of detergent on a single load of wash. She spent excessively on hair treatment and hair conditioner while continually running out of food.
McHard talked to her daughter daily but, due to her husband's illness, could make the 45-minute drive to see her only once a month. In 2010, Maureen had her gallbladder removed. Despite her health problems, McHard said, Maureen continued to sleep on an inflatable bed on the floor. McHard wanted to take her home but couldn't, with her husband's hospital bed in the middle of the living room.
"I didn't have the space," McHard said. "She also needed a lot of attention. I just couldn't handle both of them."
Maureen told her mother not to worry. She was all right.
In October 2011, Maureen contracted pneumonia. She entered Pontiac Osteopathic Hospital with bronchitis in November. She remained there for five days and was discharged, without signing a release.
Two days later, on Dec. 4, she died in Auburn Hills. Maureen was 43.
The death certificate cites natural causes. McHard paid for a private autopsy, which concluded that Maureen died from an overdose of prescribed drugs. A hospital spokesperson said she had no information on Maureen McHard and could not comment.
"Maureen's liver was failing and not processing the medication," McHard said. "No one bothered to check. She fell through the cracks."
'Courts are working against us'
Getting help for people with a mental illness who don't believe they need it is even more difficult.
Yvonne Foster's 39-year-old daughter has been homeless for most of this year, living in Oakland County shelters, abandoned buildings in Detroit and motel rooms paid for by Foster.
Despite having a nursing degree from the University of Michigan, she has been fired from 23 jobs, all but two of which she held for less than a year. Although she shows every sign of bipolar disorder, including wild mood swings, patient confidentially laws prevent even her mother from obtaining her diagnosis. She continues to deny she has a problem and declined to be interviewed.
"If I bring up the issue of mental illness, she gets outraged," said Foster, 64, of West Bloomfield. "She will sleep on the street rather than get services. I've tried to help her, but the courts are working against us. It's heartbreaking. She was a very sharp woman. Now she looks like someone who is on the street, homeless."
By petitioning the court, Foster has gotten her daughter placed four times, for five to 10 days, in a psychiatric hospital. She could not, however, secure commitments for outpatient care after her daughter's release.
"The judge ruled against me," said Foster, a retired executive. "For those who lack insight, there is no real process to get them into treatment."
Last week, Foster obtained a court order to have her daughter hospitalized again, at Havenwyck Hospital in Auburn Hills. But Foster does not know for how long, or what will happen to her afterward.
"This consumes your life," Foster said. "You worry if your loved one is dead or alive. It takes a lot of emotional energy and financial resources. If mentally ill people don't remain in services -- if they don't comply with a treatment plan -- it's a revolving door that leads back to the streets."
Limited legal options
Any competent adult in Michigan can seek, through probate court, a civil commitment order for treatment. Typically, family members or health care providers initiate the petitions or other actions.
Still, getting a court order for treatment -- either in-patient or out-patient -- can be difficult. The standard for commitments most often used under the mental health code requires a person to be an imminent danger to themselves or others. The code, however, also permits court-ordered treatment for people who don't understand their need for treatment and, based on competent clinical opinion, show a strong likelihood of injuring themselves or others. In addition, the court can order, under the so-called Kevin's Law of 2005, assisted out-patient treatment for people who have a history of resisting treatment.
Making Michigan's mental health code more compulsory is probably unnecessary and potentially dangerous. No one should want the courts to dictate the lives of the mentally ill. Nevertheless, many mentally ill people who don't recognize their condition aren't getting needed treatment. Courts and community mental health agencies -- which often see potential cases first and have financial incentives to avoid costlier hospital care -- sometimes fail to use every legal option. Oakland County appears to be one of the few counties in Michigan to make widespread use of Kevin's Law.
"We have laws on the book that we're not utilizing," Reinstein said. "If we just start using all the legal tools available under current law, we could make a real dent in the problem of people with serious mental illness not getting adequate treatment."
One step forward would be to require community mental health agencies to send information from pre-admission screenings to probate courts. Courts, moreover, should consider a finding by the local community mental health agency that a patient meets the criteria for a civil commitment order an automatic petition for such a hearing, unless someone else has already initiated it. Courts and community mental health programs should document that they have applied all legal criteria to potential cases.
Unless mentally ill people get the help they need, parents like Jerilee McHard and Yvonne Foster will continue to watch their loved ones suffer -- and even die.
JEFF GERRITT is a Free Press editorial writer. Contact him or 313-222-6585.

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