After the crisis: What happens when mental care ends?

By Elizabeth Simpson, The Virginian-Pilot
McClatchy-Tribune Information Services

Feb. 09--There's still a mark on John and Carolyn Crosby's bedroom door where their teenage daughter came at them with a pair of scissors.

When the Chesapeake couple think of state Sen. Creigh Deeds, they realize this: What happened to Deeds in November -- his son stabbed him in the face before committing suicide -- could have happened to them had they not locked themselves behind the door to call 911.

Their story ended differently that day in 2009 -- with five police officers, a psych bed and residential treatment for a daughter who has been diagnosed with an array of mental conditions during the past 13 years.

They are glad to see mental health on the front burner of the General Assembly, but they hope legislators look beyond emergency orders and psych beds to another piece of the puzzle: long-term housing and support.

The Crosbys managed to find crisis services, but they always returned to the same question: What happens when the treatment ends?

Today, the couple have a protective order against their 19-year-old daughter, who is living in a group home she must leave when she turns 22. They asked that her name and location not be used, for their safety and hers.

Carolyn questions why mental health treatment isn't viewed as a medical condition that requires lifelong treatment rather than a community services problem that can easily fall through the cracks.

"I don't know what is out there for her past 21," she said. "It's kind of scary. Realistically, I think she'll be in the prison system."

The question of long-term services is one that advocates for people with mental illness have raised as the country moves from institutional care for the disabled to community-based living, driven by the civil rights call for least restrictive environments.

Colleen Miller, executive director of the disAbility Law Center of Virginia, a statewide protection and advocacy group, said she thinks state legislators are too focused on hospital beds for people with mental illness instead of creating services in the community for them.

She cites a Virginia report that says 133 people in state hospitals are ready to be released but can't be because they don't have housing and services in the community. And while $38 million in the proposed budget is for additional mental health services, the majority goes toward expanded inpatient care rather than community services.

Miller's organization is advocating to increase supportive services and to change the state's auxiliary grants, which pay for housing for low-income people with disabilities. The grants can be used only in assisted-living facilities and adult foster care, but a bill would expand that to housing and services monitored by the state's Behavioral Health Department.

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"Language fixes here and there is not making the problem go away," Miller said. "I think that's what we've been doing, tinkering with words and not doing anything significant to increase services available to people in the community. What we've been doing has been so incremental it's not commensurate with the need."

The Crosbys began dealing with the mental health system when their daughter was diagnosed at 6 with bipolar disorder, a mental condition that leads to extreme high and low moods and behavior problems.

She was given to violent outbursts and over the years kicked holes in walls, broke windows, knocked panels out of doors.

The older she became, the harder she was to control. By the time she was in seventh grade, the Crosbys were calling 911. They said help was hit or miss, but she had stints in psych units at Bon Secours Maryview Medical Center, Virginia Beach Psychiatric Center, The Pines Residential Treatment Center, The Barry Robinson Center and Riverside Behavioral Health Center in Hampton.

At some point, though, insurance coverage would come to an end, and she'd be discharged. It was during one of those periods, in 2009, that she came at her parents with a pair of scissors.

"Something will build, build, build in her, and then there's a trigger, and then she's gone," Carolyn said.

After the police and a mental health case worker arrived, the teen was assessed and taken to an emergency room. Once there, she calmed down. She asked whether she was still going to the mall the next day.

"She exists in the moment," Carolyn said.

Instead, she went to a psych unit.

The Crosbys no longer felt safe having her in their home, so they gave up custody to the state. That enabled her to qualify for Medicaid, the state and federal insurance for people with low incomes and some disabled people.

She has since been diagnosed with schizoaffective disorder and spent time in residential treatment centers across the state. After a year in a Danville facility, Medicaid coverage ran out, and officials called the Crosbys to come get her. They said they didn't feel safe doing so and needed to protect themselves and their younger daughter.

She was brought back to Chesapeake anyway, and she ended up in a series of group homes and boarding rooms throughout the area.

Sooner or later, outbursts and property destruction would require the police again. One report from a residential center described her as a large and strong woman: "When her aggression becomes a matter of safety, the behaviors necessitate a response team of three to five large males to implement a personal restraint." The report said even those close to her can't "de-escalate" her at times and end up being targets.

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The Crosbys took out a protective order against their older daughter this past summer. They provided documentation of her past attack and property destruction but asked that she not be contacted because she might retaliate against them.

"She's a wonderful, caring, compassionate person until something happens in her brain, and that gets switched off," Carolyn said. "And then there's no rational thought, just animal instinct."

People with mental health problems and their advocates say there are programs that can help, but not nearly enough. Crisis services such as the ones being discussed by legislators are critical, but more support is needed in the community for when the emergency is over, or to prevent crises in the first place.

While there are funding sources known as "Medicaid waivers" that support people with intellectual and developmental disabilities in housing and work environments, they don't apply to people with mental illness.

That population often depends on disability payments and Medicaid, which don't go far in paying for housing and help.

There's also concern that people with mental illness end up in assisted-living facilities with the frail elderly. That can pose risks and can lead to dumping the disabled in "mini-institutions" that are too restrictive.

Jamien Basso, 32, believes so passionately in the services he's found that he traveled to Richmond a few weeks ago to ask legislators to expand them. Basso was 2 when he was diagnosed with a neurological seizure disorder, and 12 when bipolar disorder was added to his medical history. He's since been diagnosed with a disorder in which he feels more than one personality controls his behavior.

His mother, Nancy Herrera, said he received services through the schools -- first in New Jersey, then in Norfolk. After he graduated from high school, he went to Woodrow Wilson Rehabilitation Center.

Basso said he'd have periods when everything went fine, and then he'd fly into a blind rage: "I'd go off on people for no reason."

Sometimes he didn't even remember the incident.

Once, he hit his mother in the head with a tackle box and ended up in jail for two days.

He joined a carnival at one point, returned to Virginia Beach to live off and on with his mother and sister, and was homeless for a while.

"He was so mad at the world, I couldn't live with him," Herrera said.

She said he told her that one of his personalities, "War," wanted to hurt her. In 2012, he got into an altercation with his sister, and Herrera called the police.

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It was one of dozens of times she asked for help over the years. Some calls resulted in a psych bed, some in waiting lists. But this one brought both a bed and long-term help.

He was taken to Bon Secours Maryview Medical Center. From there, he was hooked up in January 2013 with the Beach House, a day program for people with serious mental illness operated by the city of Virginia Beach.

Case workers lined him up with an apartment with supportive services that teach living and coping skills. A vocational counselor helped him get a part-time job at a fast-food restaurant.

Debbie Amme, vocational coordinator at Beach House, said a staff member first trains for the fast-food jobs and then trains people like Basso.

One of the barriers that prevents people from keeping jobs is absenteeism because of their mental illness. If an employee can't come in, Amme finds someone else to go, even if it's a staff member.

Basso said he feels less isolated, more able to deal with life, since he became a Beach House member: "I was tired of being stuck inside myself, like I was in a cage."

Herrera said she's proud of how well her son has done: "They made him feel like he is a person, a human being, not just a person born to sit around and do nothing."

Such programs take ongoing outlays of money, and there's not enough to go around.

Virginia Beach has supportive transitional housing for 48 people with mental illness and permanent housing for 113, paid for by a combination of federal, state and local money.

But nearly as many are on a waiting list: 128.

Natasha Sams, supervisor for supportive residential services for Virginia Beach, said such programs save public dollars in hospital and crisis services.

"They end up paying for themselves," she said.

Virginia Supportive Housing is another example. It's a program that uses a combination of city, state, federal and private money to move the homeless into housing with supportive services.

The organization began operating a 240-unit apartment complex in Norfolk in 2006. Half its residents have a mental illness, according to Esther Robert, director of the organization's Hampton Roads Mission Advancement.

The organization does not keep a waiting list but estimates that 1,300 others need the help. In addition, the Office of the State Inspector General reports that 6,000 people with mental illness are in local and regional jails in Virginia.

The fact that the supply can't meet the demand makes stories like the Crosbys' common, according to Kay Ashby, president of the Virginia Beach chapter of the National Alliance on Mental Illness.

People with a history of violence have a harder time finding housing. She's heard stories of people being released from treatment centers with nowhere to go and left to fend for themselves.

The public usually hears about gaps in the system after tragedies but loses focus when news dies down. After the Virginia Tech massacre, for instance, $40 million in additional state money was funneled into mental health services. But when the economy soured, budget cuts eliminated the boost.

Deeds has put the issue in the spotlight again.

For every Deeds, there are countless families like the Crosbys, waiting and wondering whether enough services will unfold in time for their relatives.

The stigma of mental illness causes many to live in silence, another barrier to progress. John Crosby decided he would not be one of them. He wrote letters to the editor and to every City Council and School Board member in Chesapeake last summer.

"Why do tragedies like Newtown, Connecticut happen?" he wrote, referring to the 2012 mass shooting at an elementary school. "They happen, in large part, because government has denied its responsibility for mental health and public safety."

John said it was his way of breaking the stigma.

"It was basically the end of the road for us at that point," he said, "and I thought, 'It can't do any harm.' "

It didn't do any good either. He didn't hear anything back.

He hopes Deeds has better luck.

Elizabeth Simpson, 757-222-5003, [email protected]


(c)2014 The Virginian-Pilot (Norfolk, Va.)

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