Wednesday, June 27, 2007
Looking to break a cycle of illness
Elizabeth Strother
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Phil says his son, Jeff, started having behavioral problems in high school. "The doctor thought it was depression." Jeff spent a week in the hospital, but he gave his family greater cause for pride than worry.
He was a good student, took advanced placement courses and made it into the College of William and Mary.
"Six weeks into the session," Phil recalls, "he had a break. That was the first time the doctor called it schizophrenia."
And that was the beginning of one family's battle against a life-changing disease that led, eventually, to a father's battle with his son and Virginia's mental health laws.
Phil and Jeff are pseudonyms. Phil's latest efforts to get treatment for a grown son who repeatedly has resisted it have paid off. For now, Jeff is in a psychiatric hospital. Phil fears saying anything that might affect his son's treatment, so he asked me not to use their real names.
After that first "break," Jeff got outpatient treatment for 10 or 12 days. He got a job. But he wanted to go back to William and Mary. Within three weeks of his return the next semester, he "had another break." This time, the formal diagnosis was paranoid schizophrenia.
Jeff came home to his parents in the Roanoke Valley and, after seven years, earned a degree at Virginia Tech. His illness advanced.
"He was hearing voices all the time," Phil said. "He couldn't sleep. People at work were 'doing things to him.' He couldn't work, outside of school."
Several times over the years, Jeff would stop taking his medication. Eventually, his grasp on reality would deteriorate so far that his father could seek and get a temporary detention order from a magistrate, confident that his son would meet the state's high threshold for involuntary hospitalization.
The diagnoses varied slightly for different admissions: schizophrenia, bipolar, schizoaffective disorder. But the procedure was the same: Jeff would be committed, put back on his medications, stabilized and discharged into the care of his family and doctors. And the cycle would start again.
The fifth time, a psychiatrist recommended he apply for Social Security Disability. He received it, moved into subsidized housing and started getting services from this area's community services board, Blue Ridge Behavioral Healthcare.
A couple of years later, Jeff found out he had diabetes. His psychotropic drugs caused weight gain as a side effect, but it was hardly the only factor, his father said. Family history, diet and lack of exercise all played a part.
"In his mind," Phil said, "he figured doctors were giving him these diseases. So last June, he decided to take control of his life. He canceled his appointments with his doctors and threw all of his medications away."
His parents called Blue Ridge, which tried to keep him engaged in its services. But Jeff said he didn't want them anymore. The agency couldn't force him to participate.
By Virginia's standard for involuntary commitment, a person must be adjudged an imminent danger to himself or others or be unable to care for himself. Sliding, predictably, in that direction for the sixth time isn't enough to get a special judge to order involuntary care.
"Then," Phil said, "the question was how long will it take till he's so seriously ill that I can get him help."
Phil wants Virginia law to change that dynamic. He says Jeff suffers from anosognosia, a neurological condition that impairs a person's ability to recognize that he has a brain disorder. Thus, Phil says, Jeff is incapable of making an informed choice about whether to comply with treatment, even at his healthiest. Treatment should be mandated.
That is a controversial stand among mental health advocates. But Phil is supported in it by the Treatment Advocacy Center, a national nonprofit organization based in Arlington that dedicates itself, according to its Web site, "to eliminating barriers to the timely and effective treatment of severe mental illnesses."
John Snook, the center's legislative and policy counsel, says the legal barriers in Virginia make it such that "till you're really, really sick, even violent, there's no way to get care except voluntarily." If part of your illness is an inability to recognize that you have a brain disorder, all that is left is to deteriorate till you qualify for involuntary commitment.
And the consequences of nontreatment are severe, Snook noted: "higher degrees of arrests, hospitalizations and victimization."
Both men also would like to see Virginia change its mandatory outpatient treatment model so that courts can order very ill people living in the community to accept intensive community-based services known as PACT, Programs of Assertive Community Treatment.
"Virginia has PACT teams for the most difficult cases," Snook said. "They are hospitals without walls. But they are entirely voluntary."
Six months after Jeff decided "to take control of his life," he was committed again to a psychiatric hospital. He has been there for several weeks, Phil reports. "He's getting better, but he's not where he needs to be. I'm trying to get him on the PACT team before he gets out."
If, after his intensive hospital care, Jeff will agree, he might break a cycle of self-destruction.
Strother is on the editorial board of The Roanoke Times.
