Lost Patients: Episode 2 - "Against Their Will"

Podcast Information:

• Title: Lost Patients
• Host/Author: KUOW News and Information
• Description: Lost Patients is a deeply-reported six-part docuseries exploring the complexities of mental healthcare in America. Through real-life testimonials from patients, families, and professionals, it examines the systemic challenges in treating serious mental illness and seeks solutions to break free from the cyclical struggles that often leave patients lost in a maze of streets, jails, clinics, and courts.

Introduction

In the second episode of Lost Patients, titled "Against Their Will," reporter Will James delves into the intricate and often obstructive processes surrounding involuntary commitment for individuals with severe mental illness. The episode centers around Kathleen and Michael, parents struggling to secure psychiatric care for their son, Vinnie, who is battling schizoaffective disorder. The narrative uncovers the bureaucratic hurdles and systemic shortcomings that make it exceedingly difficult for families to obtain the necessary help for their loved ones in crisis.

Kathleen and Vinnie's Struggle

The episode opens with Kathleen leaving a distressing voicemail, highlighting her dire need to have her son Vinnie committed to a psychiatric hospital:

• Kathleen [00:31]: "I have been crying for so long. He's in a psychotic break and they let him go. Please call me. Thank you. Bye."

Will James emphasizes the frequency of such stories, where parents attempt to secure involuntary treatment for their loved ones amid resistance:

• Will James [00:57]: "When you're reporting on problems with psychiatric care, this is one of the most common stories."

Kathleen and her husband Michael describe the emotional and logistical challenges they face in navigating the mental healthcare system:

• Kathleen [03:28]: "We're getting really confused over here. I don't know how to navigate this system. I'm just hoping that Vinny's. I'm just trying to keep him alive right now. Just trying to keep him alive."

Vinnie, diagnosed in his late teens, has experienced episodes of disorganized thinking and paranoid delusions. Despite periods of stability achieved through medication, recent behaviors have escalated concerns:

• Michael [08:21]: "Vinnie was paranoid, and when he gets paranoid, no place is safe."

The Complicated System of Involuntary Commitment

Kathleen and Michael's quest to have Vinnie committed highlights the stringent legal standards required to override an individual's rights for involuntary treatment. The criteria include:

1. Danger to Self: Real risk of suicide.
2. Danger to Others: Serious threats to harm someone.
3. Danger to Property: Actions like flooding an apartment.
4. Gravely Disabled: So incapacitated by mental illness that life is at risk.

• Will James [02:08]: "They have to prove their child is so ill they're a danger to themselves, a danger to others, a danger to someone's property, or so unable to care for themselves that their life is in danger."

Kathleen likens the system to a "rickety doorway," emphasizing the unpredictability and difficulty of gaining access:

• Will James [01:22]: "To the parent, this can feel like being stuck at a rickety doorway to psychiatric care with a knob that sometimes works if you play with it, or. Or that someone accidentally locked."

The Role of Designated Crisis Responders (DCRs)

Designated Crisis Responders (DCRs) are mental health professionals tasked with evaluating calls for involuntary commitment. However, the system is plagued by resource shortages and long response times:

• Lauren Richards [16:06]: "We all wish we were getting out there more quickly. There's nothing worse than someone calling in, and you listen to them and you think, wow, these people really need help. And you look at the log and realize we're not going to be there for three or four days. It does not feel good. It's not what any of us are aiming for."

The COVID-19 pandemic exacerbated these issues, leading to increased call volumes and a significant decrease in available DCRs:

• Lauren Richards [17:00]: "I believe it probably goes back to funding and we need to pay people more. This job is very difficult."

Kathleen and Michael's repeated attempts to engage DCRs often end in frustration, as illustrated by their experiences:

• Will James [10:04]: "Seeing him suffer. Seeing him suffer, Knowing he's suffering, Knowing he's suffering. Terrified, wondering where he is."

ITA Courts and Legal Processes

Involuntary Treatment Act (ITA) courts play a pivotal role in the commitment process. These courts evaluate whether individuals meet the criteria for involuntary commitment based on evidence presented by DCRs and other witnesses. Public defenders like Nathan Bays advocate for the rights of the mentally ill during these proceedings:

• Nathan Bays [30:07]: "We are the sole person in that courtroom who is giving a voice to the respondent, the person who's being detained."

Despite the intention to protect individual rights, ITA courts often result in the detention of individuals:

• Will James [31:28]: "In ITA court, prosecutors have a lower burden... they only have to prove it. 51%, and the patient gets detained."

Nathan Bays discusses the emotional toll of representing individuals in ITA courts, emphasizing the delicate balance between advocacy and compassion:

• Nathan Bays [33:13]: "Recognizing that this is a horrific process for everyone involved to go through and trying to preserve as much of that love and care for each other that they had as they're going through it."

Personal Accounts and Impacts

Kathleen's journey reflects the emotional and psychological strain faced by families:

• Kathleen [21:28]: "I saw Vinnie's imminent death. It dropped me. I couldn't. I couldn't be upright."

The culmination of Kathleen and Michael's struggle occurs when Vinnie is finally committed, albeit through a convoluted process involving law enforcement:

• Kathleen [19:28]: "He needs help. And this guy was treating it as a domestic violence issue."

Post-commitment, both hope and uncertainty linger:

• Kathleen [37:10]: "Yes. Yes. He'll be able to express himself easily and freely. He'll feel safer. I'll hear him say things like, life is good, mom. I'm content with my condition."

However, Kathleen remains aware of the potential long-term impacts of recurring psychotic episodes:

• Will James [37:44]: "But Kathleen is aware of the scientific reality that every episode of psychosis can cause brain damage."

Systemic Issues and Potential Solutions

The episode highlights systemic failures, such as inadequate funding and the insufficient number of DCRs, which impede timely interventions. Efforts to widen the involuntary commitment doorway have been met with mixed feelings:

• Lauren Richards [38:10]: "And it's great to see the relief, right. To help them and to get their loved one into the hospital. It's a lot of times the first step, Right. But there are a lot of folks who. You can see them and their palpable relief and their sort of sense of, oh, this is over finally. When in reality, it's probably just the beginning."

Experts argue for a more integrated approach to mental healthcare, emphasizing early intervention and robust support systems to prevent crises:

• Nathan Bays [40:23]: "There is a shortage of care available between the kind of like private voluntary care that you can get with insurance and, and appointments and things like that and then compulsory court ordered involuntary detention. And there should be a much broader bridge between those two things."

Lauren Richards advocates for increased investment in pre-commitment support and comprehensive discharge planning:

• Lauren Richards [40:38]: "I would like to see that part of the system get invested in more heavily. Sometimes it's also about the care before and then also making sure there's a really good discharge plan and people to support the person after the crisis so that they don't end up back where they were."

Conclusion

"Against Their Will" paints a poignant picture of the struggles faced by families seeking mental healthcare for their loved ones within a restrictive and under-resourced system. Through Kathleen and Michael's story, the episode underscores the urgent need for systemic reforms that prioritize early intervention, adequate resources, and integrated support systems to ensure that individuals like Vinnie receive timely and compassionate care without being lost in the maze of bureaucratic obstacles.

Notable Quotes:

• Kathleen [03:28]: "We're getting really confused over here. I don't know how to navigate this system. I'm just hoping that Vinny's. I'm just trying to keep him alive right now."

• Will James [00:57]: "This is one of the most common stories."

• Michael [08:21]: "Vinnie was paranoid, and when he gets paranoid, no place is safe."

• Nathan Bays [30:07]: "We are the sole person in that courtroom who is giving a voice to the respondent, the person who's being detained."

• Lauren Richards [38:10]: "But there are a lot of folks who... oh, this is over finally. When in reality, it's probably just the beginning."

This episode of Lost Patients was reported, written, and produced by Esme Jimenez, Sydney Brownstone, and Will James, with contributions from a dedicated production team. For more insights into the complexities of mental healthcare, consider subscribing to KUOW and the Seattle Times.