I thank the blogger and advocate Dee Dee Moon Ranahan for drawing my attention to this; it first appeared on her own excellent blog “Sooner Than Tomorrow.”
THE “RIGHT” TO BE SO ILL by Kathy Day
We just had a glaring incident of how untreated serious mental illness impacts the community.
A young homeless man that I know well and love, had an extreme outburst in front of our apartment. I don’t know what set it off. He was eating a box of cereal and drinking some milk. Then I heard him yelling at the top of his lungs. He started chasing another person down the street.
My neighbors across the street called the cops. They were terrified because they have two young boys and they didn’t want them to witness what was going on and they feared the young man could hurt someone.
The officers who came are well trained in crisis intervention. I asked them to try to take him to a hospital. They said they’d try but wanted to let him cool down first.
If he didn’t have the ‘right’ to be so ill, he’d have received the treatment he needs long ago. But the way the system is designed, he’ll have to demonstrate dangerousness, likely in the presence of law enforcement, before he gets any real treatment.
Turns out he was taken to the ER a week ago on a psych hold. The ER discharged him within 24 hours.
If he’s released early again, this family will be afraid of his next incident. It’s not fair that they should have to deal with the failures of the system of mental healthcare.
A better kind of option: Welcome Home Housing, Sacramento, CA
-Catherine Rippee-Hanson, a sister of James Mark Rippee
Mark Rippee – Mug shot taken for falling asleep on the sidewalk. One out of the more than 100 times he has been arrested in the last year alone. Photo Courtesy Catherine Rippee-Hanson.
You know about Mark Rippee if you live around Vacaville, CA. Or if you read the text of the talk I delivered at the Pathways to Hope conference in San Antonio on August 24.
Mark Rippee has survived on the streets of Vacaville for nearly twelve years despite being sightless, missing parts of his brain, enduring the pain of an interior metal rod to support his shattered right leg, fifty surgeries—many of them to heal the wounds he has suffered from repeated beatings by passing thugs. . .
. . . And, oh yes: despite his diagnosis of acute schizophrenia (a diagnosis that, weirdly, Mark’s family cannot definitively confirm because of restrictive and nearly useless laws).
Mark Rippee is one of more than one hundred thirty thousand homeless people in California as estimated by the Department of Housing and Urban Development. Most of them are unsheltered. That figure amounts to one-fourth of the national homeless population (553,742). As one legislator wrote,
“Homelessness and homeless encampments have become a part of the permanent landscape of California.”
As hundreds of millions of dollars in new-housing money languish in law-court entanglements, the death toll among California’s homeless has been rising: infections, pneumonia, cancer, cirrhosis, and other treatable diseases claim ever-more victims. In 2017, eight hundred thirty-one street people died in 2017, nearly doubling the count of 458 in 2013.
Mark Rippee – Photo Courtesy Catherine Rippee-Hanson
The homeless mentally ill (in California and elsewhere) exist under twin, paradoxical curses: they are public eyesores. Pedestrians grimace as they step over their inert forms or cross the street to avoid their wild gestures and ranting.
At the same time, they are invisible: faceless statistics, generic, interchangeable, somehow less than human because of their madness.
Mark Rippee is one of these living paradoxes. Perhaps he should be their national symbol. His nearly faceless face is the face of the faceless: the face of our gravely disabled brothers and sisters who live and suffer and howl and die, bereft of help from government, agencies, and many churches, on the streets of our cities. Force yourself to contemplate what is left of Mark Rippee’s face for as long as you can stand to hold his sightless gaze and think about the obscenity of your country’s mental healthcare system.
This is a man who is severely, gravely disabled, living on the streets for 12 years. –Catherine Rippee-Hanson
James Mark Rippee – Photo Courtesy Linda Privette
Thirty-one years ago, Mark Rippee was a handsome and hopeful young man. At age 23, he was a productive member of the Vacaville community, a robust construction worker with a girlfriend, still mapping his life-plans.
Those plans blew to bits in an instant on the Sunday night of June 21, 1987—Fathers Day. On a dark country road, astride a Harley-Davidson motorcycle that he had owned for only a few days, Mark swerved to avoid an oncoming car that had drifted into his lane and tore through an alfalfa field until the bike ploughed at high speed into a grain harvester.
This is a man who left massive amounts of grey brain matter from his Frontal lobes lying in a dark field. This is a man who paramedics transported without sirens at first, thinking he must be DOA. –Catherine Rippee-Hansen
The impact tore a deep T-shaped gash across Mark’s face, destroying his eyes and exposing his frontal lobe, grey bits of which were found around him. His right leg was ripped open from his crotch to his ankle and broken in several places The EMTs who loaded him into an ambulance assumed he was dead until they noticed movement en route to the hospital.
Mark Rippee two years after his accident. He had calmed down and more lucid although doctors warned that it would not last. Photo Courtesy Catherine Rippee-Hanson.
Mark Rippee survived his shattering injuries. His accident, however, struck hard at his close-knit family. His father James suffered a breakdown soon afterward, entering a state of denial that led him to prohibit Mark’s twin sisters, Linda and Catherine, from securing Mark’s commitment in an institution. Six years later, James Rippee suffered a stroke and died. Mark’s mother, Lou, now 78, also commenced a long, slow decline in her health.
For eighteen years Mark managed to live at the borders of a peaceful and secure life, given the givens. His mother and his twin sisters (both of whom married) threw themselves into his welfare with the aid of a part-time caregiver. At intervals, and with support, Mark could maintain his own apartments.
The three women kept hope alive. They never lost their love for the invisible man beneath the disfigurement and the ravaged brain.
This is a man who was described as sweet, caring, willing to share whatever he has, and intelligent.–Catherine Rippee-Hanson
That hope eroded with each of the twenty-odd operations on Mark’s brain to scoop out abscesses (Mark has undergone more than fifty operations in all). Each brain surgery eliminated more grey matter. Each elimination weakened Mark Rippee’s capacity to think clearly and increased his tendencies to erratic, threatening behavior.
“He lost control of his emotions, his anger management, his reasoning,” said Linda. “There was no filter. Since the accident, he has fought depression, sleep disorder, and chronic unimaginable pain.”
And worse.
Mark hallucinated. He heard voices, spoke in the personas of three different people.
“He called Travis Air Force Base several times to report that aliens were attacking,” Linda (by then Linda Privatte) said. “A voice told him to take a fork and pluck my daughter’s eyes out. He chased me with a stun gun, he began to have conversations with himself and 2-3 other people in his head.”
Mark’s psychosis deepened. He barred his mother from his apartment, yelling that he would kill her if she came in—he did not believe it was his mother. The sisters feared he would hurt her. His mother stopped caring for him; after twenty years the stress on her was taking a toll. Shortly afterward Mark was evicted for starting a fire outside his apartment door.
“He was suicidal,” Linda continued. “Mom wrestled a loaded gun from him. He has walked into traffic and tried several times to jump from a moving car. He has tried twice to jump off an overpass twice. He hates us all for saving him.”
Mark Rippee clearly was now beyond the family’s control. A few years earlier, a psychiatrist had diagnosed the young man as afflicted with paranoid schizophrenia. But Mark’s delusions had by then swept him well beyond the capacity to assent to therapeutic treatment or medications.
Mark Rippee Photo Courtesy Catherine Rippee-Hanson who writes, “How my brother looks and lives today 32 years after his accident. Social Services and County services just hold him once in a while for 72 hrs to 2 weeks and then don’t evaluate him, don’t tell the County he needs LPS Conservertorship, and just walk him out to the sidewalk and down a little ways, and leave him standing on the sidewalk…. blind, brain damaged, schizophrenic from the TBI, confused, unable to take care of his own needs and alone. Often in a new town that he is unfamiliar with…. and they don’t even have to tell the family which facility, where he is, or when they released him. He has lost another 30 pounds since this picture was taken… sometimes so weak, he can’t stand up. People beat him up all the time an rob him of everything he has with him. Over and over, over and over. 32 years. When will the State of CA, get it together and change the laws for all Gravely Disabled people?”
The sisters began to search for a therapeutic sanctuary and psychiatric care. In doing so they entered a labyrinthine world, a world that often mystifies most Americans, including relatives of the mentally ill: a world of bureaucracies piled upon bureaucracies: municipal and state government, psychiatric hospitals, police departments. A world of strange acronyms (CBT, CET, CMHC, AB, ADC, HHRMAC, SB, SHIP, SHOP—the list extends into the hundreds.) Behind the acronyms stretched a thicket of rules, restrictions, policies, protocols—all designed, it seemed, to pass the buck, evade accountability, and keep the mentally ill as far as possible from reclamatory help.
The years pass, and the trail of the sisters’ efforts grows long, convoluted, chockablock with blind alleys, false leads, rebuffs, personal humiliation. Not even Linda or CJ can fully reconstruct its nightmare skein.
Among the most infernal of the acronyms was HIPAA.
HIPAA: the Health Insurance Portability and Accountability Act. Congress created HIPAA in 1996. Essentially, it is a misbegotten tool for ensuring the informational privacy of a patient in the health-care system. In practice, HIPAA has deprived countless thousands of family members from information vital to helping them understand what is wrong with their loved one, and what to do about it. Leading advocates for mental healthcare reform have insisted that HIPAA be either radically reconceived or scrapped.
HIPAA rules prevented the Rippee family even from being able to confirm that diagnosis of Mark as a paranoid schizophrenic. (It was relayed to them by a mutual friend of the psychiatrist.) Nor could they ascertain his medication needs.
Nor could they—can they—even have him removed from the brutal mercies of the Vacaville streets and placed safely in an institution. They were—are—stymied by the monumentally absurd, fatally ambiguous system of state laws that sprang up at mid-century to counter the unintended consequences of deinstitutionalization. These laws awkwardly attempt to protect the civil rights of mentally disabled people on the street (140,000 as of 2015, as estimated by the Department of Housing and Urban Development) against involuntary commitment to therapeutic care: unless, that is, if the individual can be judged “a danger to self or others.”
The absurdity of this standard radiates from its description: how is it possible to prove that someone is a danger to self or others unless that person commits an act that is—well, one can see where one is going with this. Yet even committing such an act is no guarantee that the perpetrator will be taken under care. Consider the case of—oh, James Mark Rippee: the loaded gun. The stun gun. The threats of suicide. The threats on his mother’s life. The fire he set. The attempted jumps from moving cars and overpasses.
Yet as I write these words, James Mark Rippee remains blindly, madly, on his own; a man, in effect, without a country. Certainly without a country that gives a damn whether he lives or dies, as long as he just stays the hell out of sight.
This is a man who has no safety net at all, but has the right to die on the streets, because he can say, “No.” –Catherine Rippee-Hansen
Linda and Catherine—the latter by now suffering from cancer that has been diagnosed as terminal—turned their energies to another strategy that seemed reasonable: securing hospitalization for Mark as “gravely disabled.”
“Gravely disabled” describes one of the several lurching measures to slap a tourniquet over the worst bleeding wounds of deinstitutionalization. Encoded in two similar bills, AB 1971 and AB 2156, “gravely disabled” is the standard for which the state would intervene in an uncooperative homeless victim’s life and usher that person to shelter and treatment. A person isconsidered gravely disabled if he/she is unable to. provide for basic needs for food, clothing, or shelter because of a mental disorder of impairment such as alcoholism.
That’s the theory, at least.
Linda and Catherine—Linda, after her sister weakened from her cancer—showed up at meetings of the Solano County Board of Supervisors to encourage support passage of AB 1971. They spoke up. They wrote volumes of emails to the committee.
For their troubles, they found that “gravely disabled,” like “danger to self in others,” resides largely in the eye of the beholder: the eye being that of the agency in charge of enforcing it.
“Over the last few weeks alone, I’ve contacted more than forty-five agencies and people, trying to convince them that my brother is the definition of “gravely disabled,” Linda told me recently. “I told them he needs a conservator [a certified adult overseer], based on his family’s situation and the fact that he has been homeless for more than a decade. While I attempted to have patience, I was only told, “Thanks, we’re working on it.”
That was hardly the worst. After one early petitioning visit, Catherine reported that the Board of Supervisors let her know that they consider Mark self-sufficient “if he can eat out of dumpster. They consider him self-reliant if he knows to cover himself with newspapers, or to sleep under a bush to try to stay warm. They consider him self-sufficient if he can panhandle.” (Other relatives of street-people in the state have reported versions of the same response.)
The sisters rejoiced when AB 1971 was passed by the California Assembly, even though it was stipulated only as a five-year pilot program, and only for Los Angeles County, not the entire state.
They rejoiced prematurely. In late August, after a rash of opposition from groups that included, with splendid irony, the California Hospital Associationand the Disability Rights Education and Defense Fund, AB 1971’s sponsors pulled the bill. The Rippees, along with tens of thousands of other Californians struggling to reclaim their helpless loved ones from the California streets, are back where they started:
Nowhere.
This is a man who is suffering, body and mind, tormented, and in physical and mental pain every day . . . This is a man who hears voices he hates, like a broken record to the point of pure torment . . . This is a man who had medical doctors abandon him for having angry or unacceptable outbursts . . . This is a man who gets robbed of his income by people who he asks for help to use the ATM . . . This is a man who has family members who under current law cannot make decisions for him to help him . . . — Catherine Rippee-Hanson
With Catherine depleted by her disease and Lou Rippee awash in depression, Linda Privatte struggles on alone to reclaim what is left of her brother.
“I have not been able to as much as look at Mark,” she told me a day or two ago. “I’m feeling guilty about that.”
You are entitled to look away from your brother, Linda (though you won’t, not for long). It is the rest of us who are morally obligated to keep looking into James Mark Rippee’s nearly faceless face, until we accept that this man and all his gravely disabled mentally broken brothers and sisters are our brothers and sisters as well, and that we must not look away until we have inspired or shamed our country into facing them and giving them sanctuary.
For God’s sake, this is a man. He is not invisible. He is not expendable. With any humanity left in us, let us help him. This is a man. This is a man. This is my brother.
Note: on Monday, September 10, I invited two members of the Solano County, CA, Board of Supervisors to respond to comments by CJ Hanson and Linda Privatte that addressed their comments and policy positions. At this writing neither has responded. I will post any comments from them should they come in.
I invite and encourage repostings of this blog entry from other sites, from newspapers and magazines, and from other print and online journals. No further permission is required.
Suicide has been a persistent problem in Montana — and it’s getting worse. Now, some who have lost loved ones are mobilizing to stop the deaths.
Michael Lee, 13, died of suicide on July 27 and is buried next to his mother, who died of suicide just over two years ago. Frederick Lee and Colleen Timmins-Lee, Michael’s father and stepmother, are urging everyone they know to reach out to those who may need help.Annie Flanagan / for NBC News
WOLF POINT, Mont. — Mourners in this small town in northeast Montana, where a strip of appliance shops and bars are dwarfed by vast ranches, packed into a church this month to pray for Michael Lee.
A week earlier, Michael, a 13-year-old who dreamed of playing for the NFL, had killed himself in his family’s red clapboard home. At the funeral on Aug. 3, a row of Michael’s middle-school football teammates sat behind his relatives and friends, wearing maroon jerseys and white armbands with “R.I.P.” handwritten on them. A handful of strangers were there, too; the funeral announcement said anyone affected by suicide was welcome.
That seems to include just about everybody in the state these days.
The church was silent as Colleen Timmins-Lee, Michael’s stepmother and a state trooper, rose to speak, trembling.
Michael Lee with his father. Courtesy family
“If you or someone you know that you even think might be going through this, then please, please get them the help they need,” she said through tears. “Please, please just reach out and just tell one person and try to prevent another tragedy like this.”
For those who sat in the pews wiping their eyes, or who stood by the entrance of the church, where a table was covered in pamphlets on suicide prevention, the message was both urgent and familiar. Montana has the highest suicide rate of any state in the country, and while people here don’t often speak openly about sadness or loneliness, many have firsthand experience with loss.
That already included Michael’s family. Just over two years ago, his mother, Kimberley Evans, also died of suicide.
Afterward, Michael struggled. He saw counselors at a children’s mental health clinic in rural Wolf Point, but after it burned down last year, the closest available counselor was 50 miles away. Michael’s stepmother and his father, Frederick Lee, a patrol officer with the Montana Department of Transportation, couldn’t afford time off to take him there, and they said the counselors Michael had seen told them that he had improved.
Now, weeks after their son’s funeral, they were left wondering what else they could have done — and what Montana can do — to stop this from happening.
“When it comes to depression and suicide in our community,” Lee said, “it’s out of control.”
A GROWING CRISIS
Suicide has been a persistent problem in Montana — and it’s getting worse. The state saw 25.9 suicides for every 100,000 residents in 2016, nearly double the national average, according to Centers for Disease Control and Prevention data that is age-adjusted. Since 1999, that rate has risen 38 percent, even faster than the 30 percent national rise in suicides.
The challenges Montana faces are many. It’s sparsely populated — the fourth-largest state by area, it’s 44th in population, with just over a million people — and it has less than a quarter of the mental-health care providers required to serve its residents, according to the Health Resources and Services Administration. A strong gun culture and high rate of heavy alcohol consumption fuel the problem, as does lack of daylight in the winter and high altitude, which have both been linked to depression. And then there’s the stigma associated with reaching out for help, which many Montanans see as a sign of weakness.
“We have a perfect storm when it comes to suicide,” said Karl Rosston, suicide prevention coordinator for Montana’s Department of Public Health and Human Services. “We have a lot of factors that are all happening at the same time.”
Then, last year, came another blow: Facing a projected $227 million budget shortfall, Montana’s Republican-led legislature and Democratic governor made cuts to the state’s health department, including to mental health funding. As a result, more than 100 mental health professionals were laid off across the state and 10 rural health care programs were forced to close because they couldn’t afford to pay their employees, according to the Behavioral Health Alliance of Montana, an advocacy group for the state’s mental health providers.
Now, some who have lost loved ones to suicide — frustrated by the budget cuts and driven by the state’s urgent needs — are mobilizing to do whatever they can to stop the deaths. They are veterans and Native Americans, social workers and public health officials. They’re studying suicide prevention and opening clinics and speaking to students. But they still fear that, in many cases, their efforts will not be enough.
‘ONE IS TOO MANY’
When Ryan Ranalli was growing up in Helena, Montana’s capital, there was at least one suicide in his high school each year. Later, after he joined the military and served in Iraq as an Army infantry squad leader, he lost more friends to suicide. More than 200 Montana veterans killed themselves from 2013 to 2016, representing nearly a fifth of the state’s suicides in that time, according to the state Office of Vital Statistics.
Ryan Ranalli attends Mass at the Cathedral of St. Helena. Ranalli has been going to the same church since he was 3 years old.Annie Flanagan / for NBC News
“It’s one of those things, especially if you’re a male, not to ask for help,” Ranalli, 39, said. “People I served with, they don’t want to reach out and say ‘Hey, I’m having some problems, and I need to talk to somebody.’”
For Ranalli, the problems started in 2005 after several Army buddies in his unit were killed in Iraq, some by a bomb, others in a firefight. The same year, on his second deployment there, Ranalli was hit by a roadside bomb, ending his dream of a long Army career. He returned home with a traumatic brain injury, stuck in a cycle of nightmares, flashbacks, anger, depression and anxiety. The following year, two more friends died while fighting in Iraq. By 2012, Ranalli was overwhelmed by survivor’s guilt and frustration over his inability to rejoin the Army. One night, his wife found him in their garage, blackout drunk and attempting suicide.
Left: Roses in Ranalli’s backyard. Right: Ranalli wears a bracelet as a tribute to two close friends killed while serving in the military. Annie Flanagan / for NBC News
“I felt like a burden,” he said. “I’ve seen what [suicide] does to families, but at the time, you just don’t think about it.”
Ranalli’s wife convinced him to get help, but it eventually became clear that the treatment he needed wasn’t available in Helena. There was a traveling VA clinic that came through once a month, but nothing permanent, so he underwent months of treatment out of state, in San Diego.
After his health improved and he returned home, Ranalli decided to channel his frustration with Montana’s mental health care shortfalls into action. He worked on a letter-writing campaign for a permanent veterans mental health clinic in his hometown, and this spring, the Helena Vet Center held its grand opening. So far, it’s provided over 1,055 mental health visits to nearly 150 veterans and family members. Ranalli is one of them; he receives treatment there for post-traumatic stress disorder.
Ranalli spends an evening with his family. He plans to be open with his six children about his mental health so they feel comfortable discussing any struggles with him.Annie Flanagan / for NBC News
In the fall, Ranalli, who has six children, plans to begin speaking about suicide prevention in local schools.
“To me, one is too many,” he said, “whether it’s a vet or a high school student.”
‘YOU LOSE A LOT’
At 19, Laurencia Starblanket, a member of the Salish Tribe, has already lost more than half a dozen close friends and relatives to suicide.
Nearly a decade ago, Starblanket’s aunt killed herself. Soon after, Starblanket’s grieving mother became addicted to pills, then heroin and methamphetamine, which has landed her in prison on and off.
Laurencia Starblanket has lost more than half a dozen close friends and relatives to suicide. Annie Flanagan / for NBC News
Then Starblanket lost three friends, two cousins she called brothers and an uncle she considered a father figure — all died by suicide, all within the past two years.
“It’s hard. You lose a lot. A lot comes out of you,” said Starblanket, who lives in Arlee, a windswept town of about 600 on the Flathead Indian Reservation in the shadow of the Rocky Mountains. “After my [uncle] passed, I was just numb. I didn’t want to go to school. I didn’t want to do anything. I just laid in bed.”
Starblanket, seen at the state fair in Missoula, is dedicated to reducing the high suicide rate among Native Americans. Annie Flanagan / for NBC News
A little over a year ago, after her cousin died, Starblanket started drinking for the first time and soon began considering suicide herself. Her family sent her to Canada to spend time with relatives, and when she returned home, she decided to go to school to study tribal governance so she could address the high suicide rate among Native Americans.
Laurencia Starblanket with her boyfriend and siblings at the state fair in Missoula. Annie Flanagan / for NBC News
This year, after Starblanket came home, her younger sister attempted suicide. That only doubled Starblanket’s resolve. This summer, she worked as a camp counselor at a suicide prevention program at the Tribal Health Department in St. Ignatius, Montana.
“Ever since seeing my sister in a hospital bed because she wanted to kill herself,” Starblanket said, “I look at it as: I want to save someone else’s little sister.”
‘WE LITERALLY DON’T HAVE THE CAPACITY’
The mental health clinics serving Montana’s wide-flung communities were already struggling to meet the state’s growing needs. Then, over the course of 2017, the Department of Public Health and Human Services was hit with about $95 million in cuts, which resulted in the loss of at least as much money from federal matching funds, according to the Montana Budget & Policy Center, a nonprofit that analyzes budget issues and advocates for government investment in health care, education and the environment.
Montana — the fourth-largest state by area and 44th in population, with just over a million people — has less than a quarter of the mental-health care providers required to serve its residents. Annie Flanagan / for NBC News
State officials declined to say how much of the health department cuts directly affected mental health services. But two cuts hit mental health care providers particularly hard. The state reduced the Medicaid reimbursement rate by 2.99 percent, which meant that clinics received less money when they treated low-income patients. And the state slashed Medicaid reimbursements for case managers by more than half, so that clinics receive $8.19 across the board, rather than $17.38 for children and $18.22 for adults, for every 15 minutes that case managers spend with their clients.
In response to the funding reductions, the Sunburst Community Services Foundation, a Montana nonprofit that offers mental health care as well as arts and education programs, cut anything that could be considered extra, from office supplies to training. Yet the organization is still losing about $60,000 a month and may close two of its six locations.
“They’re my people and I really care about them, but it’s like a fool’s errand,” Megan Bailey, a licensed clinical social worker who leads Sunburst’s program development, said of their clients. “We literally don’t have the capacity to hold this up any longer.”
Gov. Steve Bullock has said mental health is a priority for his administration. His office has released figures showing that mental health funding in the state has increased by millions of dollars since 2011, two years before he took office, even with the recent cuts. Still, Montana’s mental health budget lagged behind states with a comparable population from 2009 to 2015, according to data compiled by the National Alliance on Mental Illness.
A mural in Libby, Montana, located in Lincoln County. The county, which has a population of nearly 20,000, has just one behavioral health employee. Annie Flanagan / for NBC News
Following a public backlash, including a lawsuit by the Montana Health Care Association, Bullock announced plans in July to restore funding for Medicaid reimbursements and partially restore Medicaid case manager funds. Those plans, including details on restoration amounts, will be made public by Sept. 1, the governor’s office said.
“Governor Bullock remains committed to fighting for Montanans and the essential services they deserve,” the governor’s office said in a statement. “He will again propose a budget that invests in mental health and ensures vulnerable Montanans have the health care they need. He will continue to engage in statewide partnerships to implement evidence-based programs aimed at reducing suicide in Montana.”
But struggling mental health care providers say that it may be too little, too late, and it would take years to reopen shuttered clinics and regain the community’s trust. In the meantime, Montana’s suicide toll continues to rise.
‘WE CAN’T WAIT FOR FUNDING’
Libby, Montana, is tucked between the Kaniksu and Kootenai National Forests, surrounded by mountain ranges crisscrossed with trails roamed by moose and bears. Reader’s Digest named it the state’s most charming small town this year.
Libby, Montana, lost its mental-health clinic to budget cuts. Annie Flanagan / for NBC News
But beneath the natural beauty is a growing frustration.
Libby is in Lincoln County, which has a population of nearly 20,000 but just one behavioral health employee, Amy Fantozzi, a graduate student who oversees the county’s contracts with medical providers who do mental health assessments.
The town had a clinic run by the nonprofit Western Montana Mental Health Center, the largest service provider in the region, which had 12 clinics serving 15,000 clients across 15 counties. But after the cuts were announced last year, the center laid off more than 60 case managers and shut down three clinics, including the one in Libby. That left hundreds of patients without access to therapy, medication and a case manager to check on them.
Amy Fantozzi is the only behavioral health employee for Lincoln County.Annie Flanagan / for NBC News
Now, when those patients are in crisis, their only option is the emergency room at Lincoln County’s lone hospital. Once they check in, Fantozzi gets a call, and she must decide whether to spend $100 of her $18,500 annual budget on a mental health assessment. Depending on the results, she could then spend an additional $300 to have the patient evaluated and involuntarily committed at the nearest mental institution 90 miles away.
There have yet to be any publicly reported deaths by suicide as a result of the local clinic’s closure, but county officials fear the current system of mental health triage won’t hold up.
The recently closed Western Montana Health Center in Libby.Annie Flanagan / for NBC News
“Right now it just feels like a Band-Aid on every patient,” said Jennifer McCully, 32, Lincoln County’s public health manager. “Is it going to work this time? Maybe, but we probably will see them again.”
On a recent Thursday morning, more than a dozen Lincoln County health officials, law enforcement officers, teachers, community leaders and medical providers gathered around a horseshoe of folding tables at Libby’s high school to discuss how to fill the gap left by the budget cuts. One idea was to create a list of people who may be at risk of suicide and deploy volunteers to check on them regularly.
“We can’t wait for funding,” said Liz Erickson, who provides faith-based counseling through the Libby Christian Church. “We cannot wait for the grant. We cannot wait for that help. We just have to start the dang thing ourselves.”
‘WE CAN’T GO BACK’
In Wolf Point, Michael Lee’s father and stepmother are grieving for their son, who would have started high school this fall. They are also urging everyone they know to reach out to those who may need help.
But they are well aware of Montana’s many challenges when it comes to suicide prevention, which Frederick Lee said made the recent mental health funding cuts all the more infuriating. “They’re cutting back things we need,” he said.
Frederick Lee and Colleen Timmins-Lee hold each other by 13-year-old Michael Lee’s graveside. Annie Flanagan / for NBC News
Lee hopes to help in any small way he can. He will soon begin a three-year course in a suicide prevention method known as QPR — which teaches participants to question, persuade and refer those thinking of suicide — so that he can train others in northeast Montana. And he plans to leave his job with the Department of Transportation to find work as a deputy in a school. He wants to talk to kids throughout the day and check in on them.
“If we had one more minute to talk to Michael about his depression, if we had one more minute to tell him that we loved him, maybe the depression wouldn’t have taken him,” Lee said, his voice breaking. “But we can’t go back. The problem is we have to go forward.”
Phil McCausland reported from Helena, Libby and St. Ignacius, Montana; Elizabeth Chuck reported from New York; Annie Flanagan reported from Wolf Point, Montana; and Mariana Keller reported from Missoula, Montana.
Madeline and Terrie, you tried to put me wise to the special challenges of African-Americans who suffer from mental illness. You reached out to me as I began research on NO ONE CARES ABOUT CRAZY PEOPLE.
You provided me with sources. You tried to educate me. I promised you that I would look deeply into this topic in my book. But in the end, I did not look deeply enough.
Recognition of this truth arrived, appropriately enough, on Mental Health Day, October 10. It arrived in the form of a young woman in Cleveland, an African-American service-staff employee at the Intercontinental Hotel. It arrived just minutes after I’d finished addressing an exemplary civic group on—well, on the topic of education. Education about mental illness. How important this kind of education is.
(from left) David E. Weiss, board chairman; Honoree Fleming; Ron Powers; Elizabeth Newman, president and CEO at The Centers for Families and Children Benefit Luncheon 2017.
It took a three-minute conversation with this soft-spoken young woman to make me realize that my own education has been incomplete.
This is a rich irony—or a well-deserved comeuppance, depending on your point of view. I wrote NO ONE CARES essentially as an effort at education. After schizophrenia invaded my family and attacked both my sons, triggering the suicide of one of them, my wife and I realized that we’d become citizens of a “sub-nation”: the largely opaque nation of the afflicted and their families. Years later, when I recovered my willpower, I decided to write the book as an attempt to widen public understanding (and my own) about the nature and the reach of serious mental illness. That, and to illuminate the gross deficiencies in the American systems of mental health-care, criminal justice, and political willpower in addressing the problem.
As I’d hoped, writing the book educated me—but incompletely, as I now understand.
It is not as though the book ignores the particular ordeal of mentally ill black Americans. At least the public symptoms of that ordeal. It covers the epidemic of fatal shootings, by police, of unarmed and psychotic black men on the street. It portrays the overcrowding of the nation’s jails by juveniles, mostly black, who have been charged with crimes but not yet tried; and the violence visited on them by wardens and guards.
All of this is important. Yet in merely evoking these familiar abuses, I failed to cross an elusive border: the border that defines the daily realities of a sub-nation within a sub-nation. The lives of African-Americans struggling with mental illness amounts to unknown territory—unknown, at least, to most white Americans, of which I am one.
Ron Powers – keynote speaker at The Centers for Families and Children Annual Benefit Luncheon
I was ushered across that border in Cleveland on Mental Health Day.
My guide, the young service staff member, approached me just minutes after I had finished speaking at the annual luncheon of the Centers for Families and Children at the Intercontinental. (I am withholding her name. It’s a sad possibility that in these hair-trigger times, her employment could be jeopardized by the very fact that she spoke up to me about a racially charged public issue.)
Woodlawn Avenue, East Cleveland
The Centers deserves a moment of illumination here. It is a sterling civic institution. A nonprofit with an annual budget of $55 million, it reaches out to the poor, the hungry, the under-educated, the sick, and the troubled—some twenty-five thousand clients—in a city striving to overcome chronic post-industrial poverty entrenched racial tensions. The racial stress is burned into the city’s history along lines of segregation in its housing patterns: most of its black and poor population is concentrated in the near East Side, and most of its white population farther west. Cleveland’s incidents of fatal police gunplay in recent years, highlighted by the shooting of the 12-year-old Tamir Rice in 2014, have deepened black Cleveland’s distrust, bordering on paranoia, toward the mostly white police department.
David E. Weiss
Amidst these overwhelming challenges of poverty and racial unease, the Centers for Families and Children persists as a national model of enlightened civic service and hope. Its board chairman, the lawyer and businessman David E. Weiss, ranks among the most socially engaged civic leaders in the country. Its new director, Elizabeth Newman, has re-ignited its six hundred volunteers with her own passionate sense of mission: to help people find job opportunities and early-education conduits for their children, provide food for hungry families, dispatch pharmacists to households to help manage nutrition and medications, find treatment for substance abuse, and summon emergency services in crisis situations.
And to co-ordinate intervention and help in the crises of the mentally ill. Elizabeth Newman explained this cornerstone service to me in detail:
Elizabeth Newman
“The Centers is equipped to support people with serious mental illness, this skill set actually sets us apart in the community. We routinely assist people living with schizophrenia. We have psychiatrists on staff, in addition to relationships with the local/regional hospital systems and emergency rooms. In terms of onset of psychosis, we are outpatient providers but work in partnership with inpatient providers, so it really depends on the level of severity. Another agency in town runs the mobile crisis unit, but we receive referrals and connections to clients directly from that unit.”
Which brings me (in my round-about way) to the topic of this blog.
Ron Powers
As mentioned, I had completed my remarks and was standing amidst the departing luncheon attendees when she emerged from the mix of people. She wore the brown uniform of the hotel’s service corps, and her manner was hesitant; yet it was clear that she had something she wanted to say.
What she said was, “Thank you for speaking about schizophrenia.”
I sensed the urgency behind this polite comment and asked her: “Is there a history in your family?”
She hesitated for a moment, as if trying to decide whether she could trust me with an answer, and then:
“My mother. And my brother.”
There is no way to prepare for a response like this, no matter how much you expect it, no matter how often it comes. One rule of thumb is to avoid “condolences.”
I asked her the only questions that seem fitting, and necessary:
“Are they getting treatment? Are they on medications?”
She smiled just a little before answering; and the smile should have told me everything I needed to know. But she spelled it out anyway.
“Black folks don’t like to get treatment. Black folks see it as a white man’s disease.”
While I was digesting this, she added: “Black men don’t like to talk about mental illness. They see it as a sign of weakness.”
And then, as if recognizing the need to explain the obvious to a blockhead (accurate, I suppose, in this instance): “So, no. They aren’t getting any treatment.”
And there it was: a key to the inner realities of a sub-sub-nation. The culturally learned set of attitudes that makes it all the harder for doctors and psychiatrists to intervene in the mental-illness crises of African-Americans. African-American men in particular, who routinely suffer violations of their self-respect, their safety, their very humanity, at the hands (and guns) of those who view them as inherently alien, dangerous, unworthy of inclusion in society.
Which, when you think about it, is exactly the same way that many people view the mentally ill in general.
I left the Intercontinental Hotel in Cleveland as the educated educator. I thought of my friends Madeline McCray and Terrie Williams, and about the exasperation they must have felt at my failure to cross that border. Felt silently, without rebuke, in the way many African-Americans experience the myopia of their white friends.
Back home, I sought to verify the viewpoint of the young service-worker at the Intercontinental in Cleveland. Below are some samples of what I came up with. There are more, many more, as a Google search of “African Americans mental illness” will show.
–That African Americans are 20 percent more likely to experience serious mental health problems than the general population, owing in part to the exceptional stress they experience just living their lives. The problems include major depression, attention deficit hyperactivity disorder, recourse to suicide, and post-traumatic stress disorder (this last because African Americans are especially likely to be victims of violent crime).
–That many black Americans misunderstand what a mental health condition is and don’t talk about it. Many thus believe that a mental health condition is a personal weakness punishment from God.
–That stigma—which knows no color lines—triggers especial reluctance among African Americans to discuss mental health issues and seek treatment.
–That a pervasive deficit of information—education—causes many African Americans to have trouble recognizing the symptoms of mental illness and to underestimating its dangers. Some may think of depression as “the blues” “or something to snap out of.”
–That black Americans’ distrust of doctors has some factual justification: Blacks are “over-diagnosed with schizophrenia, frequently misunderstood by their psychiatrists, and largely disenfranchised,” in the opinion of William B. Lawson, the distinguished African-American professor and chair of psychiatry at the Howard University College of Medicine. (https://www.medscape.com/viewarticle/768391#vp_2)
A Closing Thought
This has been far from an easy blog entry for me to write. No one likes to own up to failures of understanding, especially in the fraught arena of of racial relations. As with NO ONE CARES ABOUT CRAZY PEOPLE itself, I at first resisted writing it at all. Then I decided I had to write it because it was the truth. I hope that it is read with an understanding that writers are often fallible—just like ordinary people.
