New Boston Globe Spotlight series: Closing psychiatric hospitals seemed humane, but . . .
I just watched the movie Spotlight, which is excellent and shows how the Spotlight team at the Boston Globe works. Just yesterday Spotlight began a new series on how the government has failed to provide care and support for the mentally ill, a vulnerable population that has been abandoned.
The article begins with some effective graphics, so I urge you to click the link and compare what the Spotlight team is finding in Massachusetts and how that might compare to what they would find in your own state. The article notes, “This story was reported by Michael Rezendes, Jenna Russell, Scott Helman, Maria Cramer, and Todd Wallack. It was written by Rezendes.” (Rezendes was played by Mark Ruffalo in the movie.) The text begins:
Nancy Chiero was making a cup of mint tea in the kitchen of her Uxbridge home that January morning.
It was a small, characteristically kind gesture toward her 35-year-old son, Lee, who had always worried her, and sometimes scared her, too. Also, unfathomably, it was a fatal one.
Lee’s life had been ruled by severe mental illness, the pattern of his repeated unravelings devastatingly familiar to his mother and family. A psychotic episode would send him to an emergency room. Once released, he would refuse to take his medications, the delusions would return, and the cycle would repeat. And repeat again.
Through it all, Nancy had remained devoted and unimaginably patient with him. There was no one else who would. He had been living in a basement bedroom of her home; he had nowhere else to go.
The cycle was repeating again now, in 2007, she could see, and in even more alarming form. Lee had been videotaping his conversations with her, suspecting her in a plot against him.
He suspected everyone. Lately, Lee had disconnected computers and even the electric power in the house to prevent his imagined enemies from spying. He made his mother drive him hours from home for grocery shopping to elude his pursuers. He’d come to believe he’d been abducted by aliens and abused by animals, and feared he would be again.
Finally, just before Christmas, Nancy had Lee rushed by ambulance to Boston’s Tufts New England Medical Center at the urging of his primary care doctor, who agreed that he had become dangerous. But at the hospital, Lee insisted he was fine and a Tufts psychiatrist released him after four days, concluding that he “did not seem to present a danger to himself and others.”
Now, alone in her kitchen, Nancy faced her son’s fevered imaginings armed only with a cup of tea. Mint is soothing, she said, adding that even animals took pleasure in the fragrant herb.
With little warning, Lee lunged at her, knocking her down the basement stairs, convinced that her casual comment referred to the animals that would sexually assault him after his abduction.
He pulled out the knife he carried for protection and began stabbing his mother in the eyes, demanding she confess.
“That’s what you get for following me around,” he said, ranting on, with his camcorder running.
Then, it was over.
In the sudden quiet Lee began to doubt that Nancy was really part of the conspiracy that had taken control of his life. She hadn’t confessed. And if the house was bugged, if his every move was being watched, why hadn’t anyone intervened? Why hadn’t anyone stopped him? Why was he suddenly so alone in the overwhelming silence of his mother’s home?
In the instant of her death at the hands of her son — a deeply troubled man discharged without restrictions from hospital care — Nancy Chiero wasn’t merely failed by the state mental health care system. She was her son’s mental health care system — or at least the only one he could rely on.
In a state that prides itself on leadership in human services and compassionate government, it has come to this, a Spotlight Team investigation has found: threadbare policies, broken promises, short-sighted decisions, and persistent underfunding over decades. As a result, the seriously mentally ill, including those at greatest risk of harming others or themselves, are far too often left in the care of parents, police, prison guards, judges, shelter workers, and emergency room personnel — almost anyone, in fact, but professionals trained to deal with their needs.
Families of these sufferers find themselves up against obstacles that earlier generations didn’t have to face. Fifty years ago, Lee Chiero might have been treated — and locked away — in one of the public psychiatric hospitals that once dotted Massachusetts.
Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it.
Even those beset by the most ferocious inner demons, such as Lee Chiero, are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. Chiero was hospitalized at least 10 times in a half-dozen hospitals over two decades before he killed his mother.
“I can’t tell you how many emergency rooms we visited to try and get him in,” said his sister, Gina.
This is the choice Massachusetts has made, a choice with deadly consequences. . .
And yet the public (at least, the public not directly affected) and the legislators have deliberately ignored this situation and shirked the state responsibility to support the most vulnerable.