NOTE from John Rabe 12/18/2012: I'm reposting this story in the wake of the Newtown massacre. It's a really good, personal look into how hard it is to commit a truly troubled and dangerous mentally ill person, and how the problems with the system affect the patients and the families.
(David Haldane's Off-Ramp story is based on a longer article that appears in Orange Coast Magazine.)
The call I feared finally came on a Friday. A woman's voice said, "I'm a nurse at Hollywood Presbyterian Hospital. Don't panic but we have your son."
Schizophrenic and homeless at 24, my son Drew was in the ICU with a blow to the head. I had imagined this conversation, or variations if it, many times. Now I rubbed my eyes and grabbed the car keys.
My boy hadn't always inspired alarming calls. Once he had a winning smile and unlimited future. Then he got arrested for setting fire to trash cans, stole candy from a liquor store, and ran away from home. We thought these were teenage shenanigans. But they were signs of something far more sinister. Drew always had an active imagination. In elementary school he had a mysterious friend named Carlos whom only he could see. He also had trouble focusing in class. The ADD meds they prescribed didn't work; Drew fell behind, eventually landing at a continuation school. For a time, under the tutelage of a caring teacher, he seemed to be reborn.
I knew something was seriously wrong when his mom called while I was out of town. We were divorced by then and Drew had recently moved to my house. "Are you home yet?" Dawn asked, confused. "Because Drew says he hears your voice." A few weeks later he drove to a construction site and nearly killed himself injesting sealant. My son spent his high school graduation day in a psychiatric hospital--the first of many stays.
I thought of all this as I drove to Hollywood Presbyterian. And I remembered his 19th birthday, when I had gone to his apartment. Before I could even knock he opened the door and began pummeling me in the hall. Then, when the anger subsided, he retreated silently into his room as I called 911. The police arrived with just one question: Did I want to press charges? I convinced them that he needed help, not jail, and they took him back to the hospital on a 72-hour hold.
Thus began the process of having Drew conserved. That's a legal procedure by which the court assigns someone to act on another person's behalf. In our case a public guardian became Drew's conservator, with broad powers and obligations including forcing him to get psychiatric care. Drew was put in several board-and-care homes, but got evicted for attacking other residents and made more suicide attempts. Finally he was sent to a locked psychiatric facility where at least we knew that he and those around him were safe.
But four years later, disaster struck anew. As usual, the news reached me by phone. My ex-wife Dawn asked, "Are you sitting down? Drew's conservatorship has been dropped." It happened after a psychiatrist missed three court hearings. The hospital said he claimed "not to have gotten the fax." So my son was set free and our nightmare went on.
Drew's situation is not unusual. In any given year, according to the National Alliance on Mental Illness, roughly one in 17 Americans suffers from serious mental disease. And yet only a third of them ever get treatment. There's a serious lack of funding, few empty beds in psychiatric hospitals, and strong patients' rights laws that block getting many people the help they need. Conservatorships, like the one Drew fell out of, are difficult to get and annually reviewed.
Pulling into the ICU's parking lot, I recalled another drive to Hollywood just days before. It had been weeks since anyone had seen Drew at the Lynwood board-and-care home to which he'd voluntarily been assigned. Then he called.
"Hey, Dad, what night is it?"
"Saturday," I told him. "We're wondering where you are."
"Working in LA," he said. "I'm at Hollywood and Orange; why don't you and Mom visit me wearing black ties?"
The next day Dawn and I drove to that intersection and, sure enough, Drew appeared and jumped into the car. I had never seen him like this; disheveled and sunburned with long hair and wild eyes. "Let's go!" he ordered, glancing nervously behind. "You guys are in so much trouble."
At a McDonald's, Drew said he was working undercover for the CIA, protecting the president from assassins. Did he actually know the president, we asked? Our son said he'd written speeches for him and they spoke by phone. "People keep messing with me," he said. "The cops follow me everywhere, security guards follow me around; it's all over the news."
Was he still on his meds, Dawn wondered? "Sure," he said. "Actually I make my own from stuff on the street." Suddenly, Drew growled, "Got to get back to work." And we watched him disappear into the crowd.
When I finally entered Hollywood-Presbyterian, I hardly recognized my son. And, semiconscious with a thick bandage around his head, he barely recognized me. Huddling in the hallway, I got the full story.
Apparently Drew had returned to his board-and-care just long enough to pick a fight. The much-larger man had knocked him out cold, literally bruising his brain. "Is there damage?" I asked, almost afraid to know. "If there is," the doctor said, "it will be evident from his behavior." But Drew's behavior was already erratic. In the previous months he'd been calling us at odd hours, sometimes angry, sometimes in tears. "You have five days to live," he told his mom in one conversation. Then later: "Dad, I don't know what's going on." Around Christmastime, he wrote his stepfather asking for a gun.
Here's how it's supposed to work with the gravely mentally ill: The presiding psychiatrist at a hospital to which the dangerously-acting patient has been admitted initiates conservatorship proceedings. Then, if the judge agrees, the patient is put on a waiting list for longer-term care.
How it actually works is far different: If you're lucky enough to learn that your loved one is hospitalized, you have 72 hours to respond. So you get on the horn with the hospital's social worker and fax a detailed history. The next day you learn that the social worker is off and his replacement has no idea what you're talking about. So you fax the document again, or personally deliver it to the front office, praying that it will land in the right hands. Then you get a call from your loved one saying he has been released and is back on the street.
In a year and a half, Drew was hospitalized 10 times. Each time we swung into action, making as much noise as possible. And each time we were rebuffed or ignored. The same patients' rights laws that were designed to protect him were also blocking much-needed care. Until one day, seven months after being released from the ICU, he showed up at his mother's house pounding on the front door. "I need money right now!" With the door opened only a crack, she asked, "Would you like us to take you to the hospital?"
He readily agreed, probably assuming he'd get a warm bed and hot meal. The next day we again got on the phone and manned the fax. This time the authorities listened; Drew was transferred to the same hospital where, years before, his horrific journey began. Six weeks later a judge ordered a one-year conservatorship by a public guardian. So our son is safe at least until the next renewal hearing, which we will attend ourselves.
To be honest, I can't tell you how much Drew understands. Visiting him is like being on a carnival ride; sometimes it's smooth, then the craziness pops up to holler boo. At various times Drew has told us he's a powerful drug dealer and a famous songwriter on TV. Recently he had to be restrained after violently attacking an aide.
As bad as it gets, though, we see glimmers of the boy we love. On Father's Day, he was the first to call. "Have a wonderful day," he said. "Life is a gift; unwrap it and be glad."
Yet we still live by our phones. Mine rang again recently with one of those calls I dread. "Dad," Drew said weakly, "am I going to die?" "Not any time soon," I told him. "Just cooperate with the doctors and you'll improve."
Our fondest wish is for that to be true.