A 'gravely disabled' mental health care system
State's broken process wastes money, chances, lives
Liz Browning nudged open the unlocked door of her son's Capitol Hill apartment and recoiled at the floor blanketed with garbage -- drifts of unopened bills, mounds of cigarette butts, rotting food and feces.
"Hello ... hello?" Her voice captured on a video taken in March sounds strained, wishing her 22-year-old son into view, and at the same time terrified of what she might find. "We brought you some food. ..."
She was startled, as her son Marc loomed into the frame -- tall, baby-faced handsome but disheveled, his long dark hair hanging in his face, a cigarette hole in the crotch of his drooping pants. He muttered to himself, and glared at the camera.
Browning felt sick from the stench. She forced herself to keep talking, trying to reach some part of him that remembered who he was before: Marc -- the funny, sweet-natured scion of a prominent Seattle family and descendant of legendary firearm inventor John M. Browning; Marc -- the boy who once played Michael Darling in a Seattle Intiman Theatre production of "Peter Pan." That Marc had disappeared.
Mental illness is an insidious form of identity theft, erasing one future and replacing it with another.
But the state's mental health care system abets the crime. The Brownings, like thousands of other Washington families dealing with mental illness, are snared in a Kafkaesque system that won't help people with serious symptoms until they are in imminent danger of harming themselves or others, or gravely disabled -- standards so high they exclude many who desperately need help.
But this strategy ends up costing the public more money, and puts citizens at greater risk, a scenario tragically highlighted in this state by a string of high-profile slayings by people who had severe mental illness but could not be treated despite signs that they needed help.
How the state treats -- or fails to treat -- its mentally ill is in the headlines again after Tuesday's bloody shooting spree, which left six dead. The family of Isaac Zamora -- the man arrested in the Skagit County killings -- has said the state didn't deal with his mental illness to help him and to protect the public.
It's not for lack of spending money that the state has failed. A Seattle P-I analysis found that the state spends at least $1.8 billion a year directly and indirectly dealing with mental illness, or its aftermath. Of that money, $530 million is spent directly on mental health care. The rest -- $7 out of every $10 -- goes toward prisons, police, homeless shelters and other social services that deal with the consequences of lack of treatment and preventive care.
This approach keeps people cycling through the streets, courts and jails. Beyond that, it squanders opportunities to intervene early on when there may be a better chance for successful treatment and recovery.
Ultimately, it wastes minds and costs lives.
Liz Browning took in the bunker of her son's illness. An upright vacuum lay toppled on a table. Shaving cream blotted part of the bathroom mirror, and glass from a broken window littered the floor. Electronic devices -- a television, an iPhone and a computer -- all smashed. It appeared that a frantic intruder had trashed the place.
Marc insisted to his parents that there were people shadowing him -- people who vandalized his property and spoke to him in "voices you don't want to hear."
|Dan DeLong / P-I|
|Liz Browning wipes away a tear after visiting her son Marc at Western State Hospital.|
But Marc's connection to reality had been spotty and fading for months. He started to lose himself in pieces. Strangers called his parents to tell them they'd found Marc's phone buried in their yard. Other strangers found his wallet in the street. Occasionally he would show up on the veranda of his family's gracious Capitol Hill home, ranting through the door until, feeling trapped, his mother called 911.
Now Browning stared into the face of the intruder. The invader had taken up residence in Marc's mind. The invader's name was schizophrenia.
A few months earlier, Marc had called for help. "I love you a lot," he began in a voice message left on his parents' phone: "If I could ask for one thing -- if you could find me a good hospital ... I just can't do it ... I'm not thinking right -- everything is just going poorly for me. If I could just feel better, look to the future ... I feel so lost."
Over the next three days, Browning and her son went to three hospitals -- the University of Washington Medical Center, Harborview Medical Center and Swedish Medical Center -- none of which would or could accept Marc because he wasn't sick enough.
"You almost hope they are really, really bad," Browning said. "And that's just so wrong."
Do not pass go
Hospitalizing someone for mental illness has morphed from a medical decision into a legal issue, said Dr. Peter Roy-Byrne, chief of psychiatry at Harborview. "It's like if someone came into the ER with chest pain or cardiac arrhythmia, and we had to tell them, until they have a heart attack or need a heart transplant, we can't do anything."
Then when patients are sick enough to go to the hospital, they are often more difficult to treat. Or patients get stabilized just enough to be sent back to the community, where, without sufficient services and follow up, they fall apart again. In what becomes a malevolent sort of social Monopoly game, the players are constantly forfeiting their gains to start over -- or go to jail.
For families, it's a grim game with stakes that are too high. There's a complex web of reasons for their frustrations.
Washington is one of the few states where neither families nor their doctors can decide that someone needs to be committed involuntarily for care. The only people who can make that petition are county-designated mental health professionals -- government workers, who are not typically psychiatrists or clinical psychologists.
There are 28 such workers to handle crisis calls from a county with a population of 1.8 million, a ratio that frustrates many clinicians who say that between the laws and the decision-making process, they are frequently unable to provide care, or are forced to release people when they are still in a precarious mental state.
Strict application of only the most severe criteria for commitment, coupled with a critical shortage of psychiatric hospital beds, prevents many people from being hospitalized when they might most benefit from it. Group housing with supervised treatment, scarce to begin with, is disappearing, limiting options for people facing hospital discharge. Although community outpatient mental health programs exist, the majority of patients who end up in them eventually vanish from treatment.
Nearly two-thirds of people who used public mental health services at least once never returned, according to the state's Institute for Public Policy Research, which recently looked at compliance levels. In the lexicon of mental health workers, they are known as "leavers."
"We wouldn't let an Alzheimer's patient leave the hospital to go sit on a sidewalk grate and rot," Roy-Byrne said. "But we do that all the time for people who are mentally ill."
Jails as 'psych wards'
Between January, when he asked for help, and March, when the police finally put him into restraints and hauled him to West Seattle Psychiatric Hospital, Marc's prognosis darkened.
By then, whatever inclination he might initially have had to help himself had been subsumed by illness. On his admission, Marc told social workers he wanted to "get a restraining order against the police because they won't leave me alone."
According to hospital notes, he didn't seem aware of why he had been brought in. He was angry, his mood unstable, and he denied being sick. He refused antipsychotic medication, and the hospital by law couldn't force injections without an additional court order. Within days, Marc was out of control, attacking staff members during an altercation over his smoking privileges. Several orderlies had to forcibly restrain and sedate him.
Then they called the police.
On April 24, Browning waited behind a glass enclosure while her son, wearing an orange jailhouse jumpsuit, was led into the courtroom. He seemed oblivious to the seriousness of the occasion, or even why he was there.
Marc stared around the courtroom, and glimpsed his mother behind the glass. The judge dismissed the charges and ordered him to Western State Hospital to be re-evaluated for civil commitment. When the judge asked him if he had anything to say to the court, he said: "Why is my mother crying?"
After the hearing, Browning stood on a street corner outside the jail still shaking with frustration. She had been operating on adrenalin for months as her attempts to get treatment for Marc verged into theater of the absurd. At every turn, either the law, or the disease, blocked her attempts to intervene.
On this day, her shoulders hunched forward, and fatigue pressed its thumbs under her eyes. Behind her, the giant image of a man somersaulting down a wall in perpetual freefall decorated the side of a county parking structure, an apt, if unintended, metaphor.
It felt, she said, like they were back where they started, only worse off. Now instead of a treatment plan, her son had a jail record.
"It's like I don't even know him anymore," she said.
Marc, the youngest of three children, was an unassuming, well-adjusted, happy kid growing up, said family and friends.
"He was a sensitive and sweet with a natural charm and kindness," said his older sister, Ann.
|Photo Courtesy Of Liz Browning|
|Marc Browning, shown at age 2 in 1988. Growing up, Marc was a well-adjusted, happy kid.|
Though he was smart, school was hard for him, and he drifted with little ambition, said one of his elementary school teachers.
In eighth grade, his parents sent him to a small private school for boys with dyslexia, but his problems continued. A year later, a school psychiatrist diagnosed him with bipolar disorder.
During his junior year in high school, he was hospitalized for depression and suicide risk. Though he graduated and started college at Eastern Washington University, he dropped out in January 2005 -- the middle of his freshman year -- to go live with his older brother in Las Vegas.
One night, Marc began tearing apart the attic in the house he shared with his brother, looking for cameras he was convinced were tracking him. He accused his brother of controlling his thoughts. His parents persuaded him to go voluntarily to a hospital in Las Vegas for a week, then flew him back to Seattle.
But at home, his mental health continued to deteriorate, and in June 2005, a court committed him to a private psychiatric hospital. This time, Marc was uncooperative and tried to escape. The hospital wouldn't take him back.
So his parents did.
Marc's behavior grew increasingly erratic and frightening. He withdrew to his room for days at a time. Once, he slammed a chair through a window. His mother began locking herself into her own room at night, fearful of what he might do next.
In February 2006, the Brownings were able to get him committed on an involuntary basis, this time to Harborview Medical Center, where doctors diagnosed him with schizophrenia.
He was 20 years old.
For Liz Browning, her son's diagnosis confirmed a haunting heritage she had feared on some level since her children were young -- a genetic loading the family couldn't escape.
A genetic bullet
On a recent morning, Browning hurried to meet her mother-in-law, Gloria Browning, at a Belltown cafe. They have much in common -- both strong-willed and articulate, they also share a body of knowledge few of their friends comprehend. It's Gloria to whom Browning turns when she needs someone who understands how mental illness shape-shifts a life.
The cafe is just steps from where Gloria Browning lives in a luxury high-rise condominium, and also where many of the city's mentally ill wander the streets, untreated and unhinged. She rarely goes out in her neighborhood after nightfall.
This irony is not lost on Gloria, now the matriarch of her famous family, but she speaks unflinchingly about the Browning legacy. Browning inventions helped build the most widely used firearms of the 20th century -- weapons that saw the nation through two world wars.
No gun John M. Browning designed, however, and no amount of wealth the family enjoyed, could defend against the genealogical bullet ricocheting through their family tree.
Gloria had six sons. Her eldest, namesake of his famous grandfather, leapt from the Golden Gate Bridge at age 27 after suffering for years with symptoms of schizophrenia and struggling to tolerate his medications.
He left a note saying he wished he could have lived.
A few years after his older brother's death, a second son shot himself. That son had struggled with addictions, including to anti-anxiety medications.
Now, two of Gloria's grandsons, including Marc, also struggle with mental disorders.
Gloria keeps track of advances in brain research and hopes for the day better treatments and earlier interventions let more of those with severe mental illness reclaim their lives.
Liz Browning thought Marc had almost gotten his own life back.
After hospitalization at Harborview in the spring of 2006, he was released and lived for seven months at the Inn, a transitional group home in Seattle, which since has closed. There, he was supervised to make sure he took his medications, and soon, the witty and easygoing Marc re-emerged.
Encouraged, his family supported a move to his own apartment. He found one himself, outfitted it from Ikea and started back to school at Seattle Central Community College. He stayed on his antipsychotic medication, and paid his bills on time. His past few years began to seem a surreal detour.
But it's under this cloak of normalcy that mental illness lays its trap. People living with mind disorders start to believe that they no longer need the programs or medications that keep their thoughts in line, the voices at bay.
Within a year, Marc quit his medications. He stopped going to school. Quit paying his bills. Stopped making sense.
Because he had been out on his own, the mental health system had no mechanism for intervening, no way to break the freefall to come. Untreated, schizophrenia has its own kind of gravity, sucking its victims in like a black hole.
Even Marc could feel himself slipping. In January, he called his parents for help.
Browning saved the message, and plays it when she wants to make a point -- to doctors, to lawyers, to mental health professionals -- that the Marc they see -- the hostile youth, the disoriented inmate, the uncooperative patient -- that Marc is an imposter.
She plays it for herself.
Call back later
Liz Browning puts out a pot of tea for visitors on her back porch one recent sunny morning. She has a low threshold for small talk, and the conversation quickly turns to mental disorders. If schizophrenia has seized her son's mind, it has also taken over her own life, consuming most of her time and energy. After the April assault charges, a mental health court ordered Marc to an involuntary commitment at Western State Hospital, where he remains today. His progress there has been slow, aggravated she feels by the long periods of time he spent off medications as he pinballed through the system.
Doctors confirm that it's harder to recover from each psychotic break.
"My greatest fear is the psychosis will be so damaging, we can't get him back at all -- that he will be so ill, he's not really treatable," she said. "I might not know what I am fighting for."
She's helping to spearhead a movement to train more defense attorneys for work in mental health courts. She's advocating for the need to get commitments sooner. She's trying to organize an effort to create long-term care facilities where people with intractable mental illness can live together, work and have a decent quality of life.
But what she really wants, right at this moment, is to reach her son. She picks up the phone and dials the pay phone in the community room of his ward at Western State. A patient answers. She introduces herself and reminds the patient that she's met him, that she's Marc's mother, that Marc's the one who always wears a stocking cap. Could he tell him she's on the line?
Browning hangs on, the phone cradled against her shoulder. A few minutes pass. The patient never returns. Marc never picks up.
"I'll have to call back later," she says, to no one in particular.
This is what having your life hijacked by mental illness is like, being on perpetual hold.
Waiting to connect.