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- [00:01]
Ann Roderick Jones
Get Adults with financial literacy skills have 82% more wealth than those who don't. From swimming lessons to piano classes, Us parents invest in so many things to enrich our kids lives but are we investing in their future financial success? With Greenlight you can teach your kids financial literacy skills like earning, saving and investing and this investment costs less than that. After school treat start prioritizing their financial education and future today with a risk free trial@greenlight.com wondery click greenlight.com wondery this episode discusses sexual abuse, adverse drug reactions, self injury and suicide. If you or someone you know needs Support, call or text 988 and connect with a trained counselor. Please take care while listening. The St. Joseph State Hospital is located on a large swath of land the highway among a sprawling set of brick buildings. The four story complex that once served as a psychiatric hospital, surgery and outpatient building is now home to the Glore Psychiatric Museum. A few days after Sandy's hearing, our team drove out to St. Joe to visit this museum. The former state hospital was one of the many places Sandy was housed during her years in psychiatric care and it's where police interrogated her. We wanted to see it for ourselves. You have arrived. Look at this old building right here. Yeah. Barred windows. Is that inside of the.
- [01:39]
John Laskowski
That's the old facility, I think.
- [01:41]
Ann Roderick Jones
I think that's the museum. Upon arrival, we immediately notice the razor wire fences surrounding a large part of the property and that's because a prison is located here as well. In addition, there's an old white building with barred and broken out windows. Though it's not in use, it was once home to Progress hall built in 1893, which housed a chapel, barbershop and the patient library. You could tell that it was once a beautiful architectural structure but now looks almost eerie. The $10 entry fee gives you access to four floors that feature exhibits meant to chronicle the history of the state hospital as well as the history of treatment for those who have lived with mental illness. Alrighty. So the Bloor Psychiatric Museum is on all four floors of the building going from basement to third floor. Right now we are right over. The woman who's working at the front desk explains that they have a lot of nurses and psychology students who visited and those who were just plain curious. The museum itself is modern in aesthetic, but is filled with relics of the past that frankly could have used one gigantic trigger warning. Oh my goodness. So this is a trigger warning room, I'd say.
- [02:58]
John Laskowski
Yeah. Careful when you come in here.
- [03:01]
Ann Roderick Jones
A lot of exhibits were Hard for me and my team to look at. Some feature makeshift treatment rooms with mannequins receiving electroconvulsive therapy. Others have real images of those who were administered ice pick lobotomies. A patient had an ice pick lobotomy, inserted it above the eyeball, banged it through her eye socket into her brain, and made cuts in her frontal lobes. When he was done, he sent her home in a taxi cab. There are wood and metal cages on display that were used to detain patients. They call it a lunatic box. You put in here and like, put in the dark until you behave. And there's an exhibit of 1,446 items that were removed from a patient's stomach in 1929. Among a room of medical devices. You can also browse beautiful woven rugs and artwork, all created by patients that wouldn't feel out of place in an art museum. We've heard a lot about Sandy living in and out of psychiatric care since her youth. And we wanted to try to understand what it may have been like for her and others who have lived with severe mental illness before her. In this episode, we're investigating how those who live with mental illness are often misunderstood. It's a topic that's personal to me. We're diving into the past to get a better understanding of the current state of care for those living with mental illness in Missouri and to look at the intersection of health care and prison systems in the state, systems that Sandy has been navigating for too long. Sean o' Brien is a professor at UMKC School of Law in Kansas City. He works primarily with clients who live with mental illness and are in prison rather than a hospital. Shawn is on Sandy's local council for the Innocence Project, but he's not allowed to speak with us directly about her case, at least not yet. But he is able to explain broad stroke law in the state of Missouri. He kicked off our conversation with a pretty depressing fact.
- [05:17]
Sean O'Brien
If you look at the prison population In America, about 2/3 of them are mentally ill. 2/3 of our prisoners in America, and we're talking about 2.1 million people in American prisons. So the. That's an incredible statistic. The other interesting figure is that the largest mental health facility in the world, if you just measure it by patient beds, is the Los Angeles County Jail. Because of all these dynamics, the lack of access to public mental health and the inability to respond with resources until somebody does something dangerous, our primary system. And people think I'm a radical for saying this, but it's demonstrably true. Our primary means of delivering mental health services to poor people in America are jails and prisons. That's where you go in America for mental health treatment if you are poor.
- [06:24]
Ann Roderick Jones
There was no question as to whether Sandy suffered from mental illness. She was hearing voices at the age of 12, shortly after a sudden death in the family and subsequent related sexual abuse. From that point forward, her life was defined by delusional thinking and depression. Between the ages of 12 and 19, Sandy was in and out of psychiatric institutions. She regularly suffered from suicidal ideations and engaged in self injury. During the evidentiary hearing, we heard clinicians, law enforcement, and attorneys confirm these behaviors and describe Sandy's disorganized thoughts, her tendency to be out of touch with reality, and her experiences of auditory hallucinations. But my question here is a question that extends beyond Sandy. Why are people with known mental illness being sent to prison instead of getting the medical attention they need? We were talking about how people who are living with mental illness are often in the prison system. Can we talk about how this issue is specific to Missouri?
- [07:29]
Sean O'Brien
Sure, sure. In the time that I have been practicing law, Missouri closed treatment facilities and mental health hospitals in Farmington, in Nevada, Missouri in St. Joe, Missouri, in Booneville, Missouri, in Maryville, Missouri, and reopened them as prisons. So Missouri is reducing patient beds in mental hospitals at the same time that they are building new prisons. And when you build a new prison that once upon a time was a hospital, sometimes you have the same people in it. We've gone from treatment to punitive measures. And then when you get in prison, you know, our prisons are like glorified dog kennels. You know, they're concrete and steel. As you know, they're not places that people can go to get better. If you go to prison and you get better in Missouri, it's totally by accident.
- [08:31]
Ann Roderick Jones
I had no idea what it meant to live with severe mental illness until my brother was diagnosed with schizophrenia in 2011. In his early 20s, my baby brother, the artist, game designer, music composer, and basically all around genius, lives with a disease that robs him of so many parts of his life. So while I don't know what it's like to live with severe mental illness, I know what it's like to love someone who does. That's one of the reasons why Sandy's case hits so close to home. By the age of 12, Sandy had already been in psychiatric care. But care doesn't look the same for everyone, and medications aren't one size fits all. The side effects can be Incredibly difficult to navigate. My brother's effects started off with a significant amount of weight gain and constant sleeping. When not sleeping, it was extreme drowsiness. He'd tell me about the brain fog he'd experienced and feeling a total disconnect with his environment. He had so much trial and error in finding a balance between being medicated and being able to participate in his life. It's hard to think about him going through that rollercoaster, let alone going through it. In addition to managing his illness, I couldn't imagine what it would be like to throw in the police and the judicial system into that mix. Currently, my brother is on a course of prescriptions that he feels has helped, but it still isn't perfect. His journey navigating different medications has changed over the years with improvements in modern medicine and a better understanding of schizophrenia. But it's still been going on for over a decade. I can't imagine what Sandy was dealing with in the 1980s.
- [10:11]
Sean O'Brien
In 1980, you get a president who is determined to shrink government, and that goes to all levels of government. And so they're literally closing mental health hospitals. And it's done a couple of things. You know, increasing the threshold to force somebody into treatment, reducing mental health services that are available to the public.
- [10:34]
Ann Roderick Jones
A lot has changed since Sandy was 20. Notably our society's attitude towards mental well being, but also our conversations around mental health still fail to include psychotic disorders in the role of our public health system. There's a lot to unpack here and a lot that needs to be explained. So I've reached out to someone who could help me understand the complexities that I've been reading about in these court documents. I'll just kind of start out. I'd like to know your full name and your preferred title, please.
- [11:02]
John Laskowski
My name is John Laskowski. I am an MD, so my title is Dr. John Laskowski. Most of my career was in private practice in Jefferson City, Missouri.
- [11:13]
Ann Roderick Jones
We reached out to Dr. Laskowski, or John, as he's asked me to call him. He's an expert with work experience similar to that of Dr. Edersheims, who was a witness in Sandy's hearing. Because of her testimony in court, she's not able to speak with us at this time. John has worked with patients who are hospitalized because they're being evaluated to see if they're competent to stand trial. So what competent means, according to John, is the ability to answer questions like do they understand what court is, what the proceedings are, who the judge is, what lawyers are, the different roles and what charges are being brought against them, stuff like that.
- [11:51]
John Laskowski
Other patients are ones who have been found not guilty by reason of insanity. That's the classification Missouri. So they had gone to trial and the question was raised what was their mental condition at the time of the alleged crime, the charge, Sandy was living.
- [12:10]
Ann Roderick Jones
At the St. Joseph State Hospital psychiatric ward, receiving treatments for hallucinations and derealization. I wanted John to explain this to me.
- [12:20]
John Laskowski
So hallucinations are when you have an abnormal perception. So that would be. You see things that aren't there. You hear things, you smell things, taste things, feel things on your skin. Derealization is when people have a feeling that things are unreal. So they may feel like suddenly just the way their eyes are working, looking at the world, it's too sharp, or I feel awkward. The way I move through the world, it doesn't feel right, it doesn't look right. It's a perception thing. So in our diagnostic manual, what they call the DSM 5, when you talk about somebody being psychotic, and that's somebody who's very dysfunctional. So they're having things like hallucinations, like delusional thinking that these are thoughts that are way beyond the possible. It may be very great disorganization in their thinking that they maybe can't think, can't talk. They could be catatonic or they might be so disorganized you can't follow their train of thought. That would be a psychotic symptom or psychosis.
- [13:29]
Ann Roderick Jones
One thing that's been circling in my head throughout this hearing was the description of Sandy during police interrogations. I wanted to get John's opinion on this as an expert who's worked with other patients on trial. And I'm just kind of wondering if you can give me your thoughts as to how that would look today or how that should look. If a patient is being interrogated by police with their doctor present in the state hospital and exhibiting those particular. Whether they're symptoms or whatever they may be. Is that something that you can see happening now? Does that seem like that checks out to you?
- [14:05]
John Laskowski
No, it seems inappropriate. I think if the patient is overly medicated and you're maybe in a point of trying to adjust things and control symptoms but minimize side effects, it sounds like that person was overly sedated. And also maybe if it was a time of what we might call medication titration, she might have been also very ill at the time, very disorganized in thinking, maybe hallucinating at times. So it sounds like she was definitely having medication. Side effects and, you know, we don't know what else was going on, but it sounds like it would be inappropriate to try to be getting information out of her.
- [14:47]
Ann Roderick Jones
We heard similar descriptions from Dr. Edersheim during Sandy's evidentiary hearing, during which she gave us some insight into different prescriptions and diagnoses that Sandy had. Court documents show that Sandy had a volatile hospital stay between November 25 and December 5 of 1980, which was precisely during the time of Patricia's murder investigation. On November 26, Sandy was given an injection of haloperidol, which you might also hear referred to as Haldol, and continued to receive injections in the days following. On November 28th at 1:45am Sandy was placed in seclusion and forcefully received yet another injection of haloperidol. It was under these circumstances that police began to interrogate her.
- [15:35]
John Laskowski
Those drugs are antipsychotics and really they're main use or almost only use. You might use those drugs in an emergency situation for non specific agitation. And when you mentioned her eyes were turning back in her head. But the stomach reaction is an acute muscle kind of spasm, often in the eyes looking upward or in the spine where the spine arches. And it's very uncomfortable. It's very scary to the patient. It's even upsetting to the staff. It's something we know can happen. And there's meds we give an injection for to counteract it. And in fact, it happens so much with Haldol, especially when you're using shots of Haldol, that you often give that side effect pill at the same time, because in a younger patient about half of them are going to get that. So you want to try to prevent it.
- [16:29]
Ann Roderick Jones
You may remember that Dr. Edersheim explains that now if a patient has an adverse reaction to haloperidol injections, they would be immediately administered an antidote and its use would be discontinued. This wasn't the case for Sandy. She endured the extreme pain before being given a sedative. And then she endured it over and over again. When John was explaining the situation, I thought about Sandy sitting there experiencing so much pain and taking counter medications to try and mitigate her symptoms. I thought about how the medical staff often feel upset witnessing those symptoms Sandy was having. It seemed so unfair, so wrong to be interrogating her at this time, but maybe that's why it happened. Do you think that that seems fair that that person is being interrogated at that time?
- [17:20]
John Laskowski
Not at all. I mean, that's a person. It sounds like they're in the zone of medication adjustment, that they're unstable, that things are being introduced and they're trying to gain control of the patient and the symptoms, and they're also trying to gain control of side effects. So, you know, I guess an analogy is if you had a car accident victim and the police want to clarify whose fault this was or something, you know, you're not going to go to the ICU when the patient's very unstable and severe pain and is getting a blood transfusion. You might just decide, let's put this on the back burner until you get a kind of an all clear signal from the medical team. You know.
- [18:04]
Ann Roderick Jones
We'Ll be back after this short break. During our time in the evidentiary hearing, we heard multiple law enforcement agents express that they had clearance from Dr. Jacks to interrogate Sandy and that they would have banked on him to step in if things went awry. We also heard that sometimes police are trained to assume blame. Shawn told us about something called the Reed method of interrogation and how this could have contributed to Sandy's implicating herself in this crime.
- [18:37]
Sean O'Brien
Beginning with detectives who have been trained to spot people who are lying, they go in very confident that they know when they're being lied to. And if they get a sense that they're being lied to now, they get a sense that that individual is guilty or hiding something. Right. And so then they go into the intense interrogation mode, and the results are that they spotted the liar 50% of the time. That's a coin toss, right? There is zero empirical science behind it. Zero empirical science.
- [19:18]
Ann Roderick Jones
Who would be the advocate for the patient in that case? If they weren't, you know, particularly not lucid at the time or vulnerable, who would be the one to be their advocate? Here's John again.
- [19:34]
John Laskowski
Well, sometimes the attorneys, and in our community in Fulton, where I was dealing more with attorneys than in private practice in the other city, the attorneys for the patients were assigned by the courts. We didn't have a public defender's office. So a lot of them were. These were private practice attorneys, and they were very considerate and were, in a sense, advocating for the patient and fighting for the patient's rights and trying to do what the patient was requesting and not just imposing something. I think other times it would be hopefully the physician that was on with the patient or the nursing social worker, and hopefully the physician cared and would be helping. But I think, you know, a lot of people are stretched thin and overworked and they're just trying to check boxes. So certainly a patient could get lost in the. In the shuffle.
- [20:31]
Ann Roderick Jones
We certainly see this in the state of Missouri as psychiatric hospitals continue to close due to funding, and those patients then become prisoners. As far as how trauma and someone's psychiatric condition, how might they be more vulnerable to interrogation tactics?
- [20:53]
John Laskowski
Well, I think the population, like in the state hospital and what we would call the forensic clients. So these are people who have had mental illness plus a criminal charge. They're overrepresented with people that have had other traumas from very disadvantaged backgrounds, and they're also overrepresented by intellectual impairment. And so those two things, I think, make people prone to be very intimidated. New situations, new people, people that are being aggressive, accusatory, demanding. I think that could overwhelm these types of patients. And for one thing, it could lead them to, you know, agreeing to anything. And certainly we have had cases that are documented of when something terrible has happened in the community. We've had mental patients come forward to confess to the crime that had nothing to do with the crime. It was impossible that they had committed the crime. But nonetheless, for some reason or another, they come forward and were admitting guilt and they really weren't the criminal at all.
- [22:00]
Ann Roderick Jones
What would be a reason that they might confess to something they didn't do?
- [22:04]
John Laskowski
Well, it could be a delusion. Severe mental illness is irrational. So like, this could be somebody who's delusional and not thinking right, or it could be just some sort of strange idea of attention and note telling.
- [22:21]
Ann Roderick Jones
As I listen to John, I'm making so many connections between what he is saying and what Dr. Edersheim explained. During the evidentiary hearing, Sandy was experiencing delusional thinking. She had PTSD and likely had a depleted sense of self. She was living with borderline personality disorder, an illness that has symptoms like acting with bravado and often needing attention. Dr. Edersheim actually said that bad attention would be better than no attention. I asked John what the correct protocol would be for someone in Sandy's position.
- [22:55]
John Laskowski
So it's like, did she have established mental illness? Did they do a forensic evaluation? Did they put her into one of the state facilities to evaluate forensically and then present that? And it was rejected by court. You know, did they first look, was she competent to stand trial?
- [23:14]
Ann Roderick Jones
As a reminder, Sandy's lawyer did not request a psychiatric evaluation.
- [23:19]
John Laskowski
What are the context? What was the date of the hospitalization? When was there a clinic appointment with a counselor or psychiatrist? Did she feel a medication? Did she have symptoms around during that week or that month?
- [23:33]
Ann Roderick Jones
And the answer to that is A resounding yes, we know that Sandy not only lived in and out of psychiatric care since the age of 12, but that she had also received multiple treatments for what would be considered a severe case of mental illness, all at the same time of Patricia's murder investigation. Add to that something even more disturbing. Sandy had several interactions with law enforcement at the state hospital without a lawyer present, and not a single one was recorded. When I started researching this case, I was hoping to discover that mental health care has changed dramatically since the 1980s, and that our current understanding and compassion for people living with mental illness has helped to make progress in the judicial system. But I'm not so sure that's the case in Missouri, especially as psychiatric hospitals close and access to mental health resources continue to decline. But what can we do to make sure this doesn't happen to people like Sandy? I posed this question to Sean o' Brien. In your opinion, what can we do to make sure that those who are living with mental illness aren't subject to these unfair interrogations and that they end up in prison?
- [24:50]
Sean O'Brien
Part of it is police training. You know, when you look at if you really wanted to make a difference, I think you start in the juvenile courts, and I think that there should always be a protective person. There's supposed to be a parent or guardian present during juvenile interrogations, and that can be satisfied if there's a juvenile officer present. But the juvenile officer are typically people with a prosecutor mindset. I think if there's a therapist present whenever a juvenile is questioned by the police, and then second, that any child, if they're interviewed at all by the police, they should not be interviewed as a suspect. There should just simply be guardrails.
- [25:37]
Ann Roderick Jones
After listening to Shawn, it seems that there's an opportunity for change, but it's still such a long road that requires a lot of funding. Mental Health of America states that 1.2 million individuals living with mental illness sit in jail and prison each year and that the states with less access to mental health care have more adults who are in the criminal justice system.
- [26:00]
John Laskowski
I guess I feel like either, you know, she was innocent and this was some very suspicious activity and railroading by law enforcement, or the other suspicion is that if in fact, this happened, in fact, she was guilty of this crime, it's very possible that she would be considered to be very mentally impaired at the time of the crime and, you know, would have been treated in a different system in a different way. She probably shouldn't be incarcerated.
- [26:36]
Ann Roderick Jones
And I get what John is saying. Even if Sandy did commit this crime, she would be better served at a hospital rather than a prison. In the next episode of Ozark's True Crime, we look at what comes next for Sandy and what happens if she is exonerated. Yeah, when I came home, I can just tell you, you know, everything.
- [26:56]
John Laskowski
It's different for each individual.
- [26:58]
Ann Roderick Jones
But most of us come home, we're homeless, and as I said, I came.
- [27:02]
John Laskowski
Out seeking some help from the reentry program. But they don't help people like me. And most of the guys who get.
- [27:10]
Ann Roderick Jones
Out, if they don't have family, if.
- [27:12]
John Laskowski
They don't have a support system, it's hard to try to figure things out.
- [27:17]
Ann Roderick Jones
If you or someone you know is struggling, support is available. US listeners can call 988 and connect with a trained counselor. For a list of international resources, please check our show notes or find your country's lifeline. The Sandra Hemmes story is part of the Edit Audio original series Ozark's True Crime. It is written and hosted by me, Ann Roderick Jones. This episode was produced by Ali Sierwah and Kathleen Speckart and was edited, mixed and mastered by Ali Sirwah. Our executive producer is Steph Colburn. Thank you immensely to the entire Edit Audio team and to Patrick Rendell for the theme music. If you want to get in touch with us, you can email us at helloditaud IO that's H e l l o d I T A u d IO.
- [28:18]
Sean O'Brien
Sam SA.