Failing Jenny

May 26-- May 26--Jenny Rose Madsen is not her cowlick-haired, scabbed-skinned and wild-eyed booking mugshot.

She is a whip-smart, college-educated, born engineer with a curious mind and the ability to put together and pull apart complex ideas and machines.

She is not the feces-covered, combative inmate who flung her excrement at jailers trying to medicate her.

She is not the woman sitting on the street corner pounding her fist against her head.

She is not the woman shouting that demons are exiting her TV and punching holes into the drywall of her apartment.

She is the beloved daughter of frustrated mother Bonnie Henrickson, who has tried to get her daughter the help she needs.

Madsen, 31, was diagnosed with schizoaffective disorder, bipolar type, which includes schizophrenia symptoms like auditory hallucinations and depression and manic episodes, according to court records. She doesn't seem to understand what is happening or why she has hurt herself and others. But she has made clear to her mother she doesn't want to go back on lithium -- which makes her overwhelmingly lethargic -- to abate the voices she hears in her head. Instead, Madsen has used marijuana to try to even herself out, Henrickson said.

The facts about Madsen come from police reports and witnesses and counselors. She was too dangerous and too delusional to be visited at the jail, where she was held for allegedly punching an officer. Madsen was held there for a month until being transferred to State Hospital North in Orofino on Wednesday. Henrickson tried multiple times to see her daughter since her incarceration April 6, but each time Madsen was aggressive or refused to clothe herself, so jailers wouldn't permit a visit.

Many warnings preceded Madsen's incarceration. But, according to Idaho Code -- and policies followed by mental health care providers -- she didn't meet the standards to be committed involuntarily. She may have pounded her fist against her head and frightened her mother with the things she said and did. But she wasn't deemed an "imminent danger" to herself or others, nor was she "gravely disabled" to the point she couldn't care for herself -- the standards needed to enforce care.

"The cops would tell me their hands are tied; (Idaho department of) Adult Mental Health tells me it's criminal, they can't do anything or she's an adult," Henrickson said. "You can see this escalation of behavior; it is not an event. Why is it not accumulative?"

It is rare for mental health care to be forced on an individual who refuses it. The old ways of separating those with mental illness from the rest of society, locking them away under sometimes gruesome conditions, were long ago revamped. But as patients are supposed to be diverted from institutions to counselors and other resources, many have fallen through the cracks.

It's a pervasive problem that stretches across the United States. Individual states approach the problem differently, and services and funding vary.

Idaho recently chose to fund some mental health crisis centers, where people in crisis can stay for a day or two at no cost until their situation stabilizes. No one is compelled to stay in one of these centers, and entering one is voluntary.

Different from elsewhere in the state, Idaho Public Health District 2 in Lewiston is working with other agencies to design a more diverse offering of resources for those in crisis in Lewiston, Moscow and Grangeville. It's still in the planning stages, but district Director Carol Moerhle said a plan will be announced by June. A crisis center is slated to open in July in Moscow.

Even if a crisis center were available, it might not have helped Madsen, since she often refused help.

When officers responded, Madsen was usually left at her home, where police were called about a dozen times in a matter of months. Each time, she shouted and created a disturbance, but finally she lashed out and allegedly punched an officer in the face after the officer grabbed her arm, ready to arrest her, according to court records.

Henrickson said it never had to get to that point. Madsen should have been committed to a mental hospital months ago. She should have been in treatment, seeing a counselor and being medicated. Henrickson sought help, but officials' hands were tied. Madsen, after all, is an adult. Her civil liberties are constitutionally protected, even if she is hearing demons and her paranoia prevents her from looking into mirrors out of fear.

Winding up in a crisis center is preferable to an involuntary mental hold or incarceration, which is where many patients ultimately end up. The U.S. Department of Justice estimated about a third of jail inmates had some type of mental disorder in a 2017 study.

Madsen's behavior escalated behind bars, where she damaged jail property and injured herself. She was kept alone in a "safe cell" with fewer amenities than even a normal, sparsely designed cell, according to jail reports.

Jailers wore protective suits when Madsen acted out, to shield themselves from injury or contamination.

'It's like you're setting them up'

Police had grown accustomed to Madsen's outbursts.

In about a two-month period, Henrickson or Madsen's neighbors, or people watching Madsen punch herself, called 911 about her behavior. But little changed after each police contact.

Henrickson often refers to her daughter's symptoms and episodes with the pronoun "we." Every time Madsen escalates, Henrickson tries to help, and it becomes her issue as well.

She recalled a time when Madsen smashed the windows of her home and shoved a box spring against the hole. She tried to calm her daughter, but in such instances Madsen would give her a frightening look or grab her and scare her. Police arrived, but they couldn't do anything. Madsen was destroying her own property. There was no crime, and Henrickson didn't want to press charges against her own daughter.

Henrickson pleaded with officers to do something. But, according to their training and the lack of actionable criminal activity, they could only stand by while Madsen calmed down.

"They always give the same response: 'It doesn't rise to the level, Bonnie. We can't take her to the hospital. If she attacks me we can arrest her,' " Henrickson said. "It's like you're setting them up so they can get arrested. How is that a process?"

Law enforcement and mental health experts understand seeing a person experiencing a hallucinatory episode is disturbing. So much so, that witnesses often call 911. Watching a person mutter to himself or gesture wildly or shout frantically feels wrong. The jerky movements, unpredictable behavior and disturbing utterings are difficult to watch -- even more difficult to comprehend and try to treat with empathy. But someone in crisis isn't going to benefit from being arrested for acting erratically, police officers said.

Lewiston Police Lt. Jeff Klone said all officers at the department are trained to deal with mentally ill people and prevent escalating behavior. Police are not mental health counselors, but increasingly they are the first to have run-ins with someone having an episode that can be a precursor to a larger problem.

Patrol officers respond daily to subjects who have mental health issues, Klone said. It's not uncommon for officers to initiate an involuntary mental hold on a subject, but more often they try to calm the person and direct her to resources.

"We try to approach it as person to person, not officer to citizen," he said. "It is key to avoid having to physically control them, or have them get upset."

It can be difficult to determine if someone is a danger or disabled to the point they can't care for themselves. It's almost always subjective and rarely clear, like someone has a weapon and is being threatening, Klone said. Typically officers respond to situations such as a person yelling in the street and causing a disturbance.

"We try not to arrest people just for minor crimes because they are having a mental health crisis," Klone said. "That's a short-term solution to a bigger issue. Now if they are a danger to the public, sometimes we will have to arrest them on that."

These types of calls can pull officers off the road for extended periods of time. Caring for a person in crisis requires patience, and an officer may escort a subject to a hospital and stay with the person for several hours to make sure they are safe and don't harm themselves or hospital staff, Klone said.

Idaho Code allows for an involuntary hold to be enacted quickly in a dangerous situation. But a person in crisis can escalate suddenly and act out before anyone has a chance to initiate a hold.

"It can be difficult and frustrating for us too," Klone said. "We can have officers responding three, four, five times in a day on the same subject walking down the street screaming. But they're still fine and not rising to the level."

Resources and warning signs

Madsen spent time at State Hospital North in Orofino but was released after about two months when her condition improved. She went to an assisted-living facility at Winchester in 2018 after being released from the hospital and again showed improvements.

But when she was released and monitoring of her condition by local mental health resources wasn't enough, Madsen stopped taking her medication. She refused the medication because she felt zombie-like on them, Henrickson said.

There are some resources in the area for people struggling with mental illness, such as Adult Mental Health, which coordinates teams to assist people with counseling and case management.

Adult Mental Health Program Manager Teresa I. Shackelford said the program is an option for patients without health insurance. Madsen is on disability but also received some assistance from AMH.

Shackelford said the program also offers medication management and peer support for adults. It usually works for people who want treatment. But if a patient refuses treatment, as with Madsen and countless others, the job becomes increasingly more difficult.

"It's always a balancing act: safety versus liberty," Shackelford said. "We don't have a crystal ball. ... The behavior some end up engaging in is completely unpredictable. (A patient with schizophrenia) may fall in and out of treatment, but they never hurt anyone and nothing ever really happens. This will happen for years or decades or their entire life, and they never hurt a soul or themselves."

According to the National Institute of Mental Health, schizoaffective disorder is relatively rare, with a prevalence of around .3 percent in the U.S. But the illness can become progressively worse and is one of the top 15 causes of disability worldwide. Statistically, people with the illness suffer from a premature mortality rate and have a suicide rate of almost 5 percent, significantly higher than other groups.

The National Alliance on Mental Illness estimates nearly a quarter of Idahoans have some form of mental illness and nearly 6 percent have a serious or co-occurring illness.

Prevention versus protection

In Idaho an involuntary hold process can be started by any member of the community. Then a judge must review the circumstances of the person being committed and decide within 24 hours if the behavior reaches the level of "gravely disabled" or "imminent danger." In the meantime, the person is committed to a hospital for evaluation and not free to leave.

Shackelford said it appears judges more often err on the side of protecting a person's civil liberties. But there are circumstances in which a hold is warranted.

If a person is deemed by a mental health examiner to meet the criteria, then the prosecutor's office will order a detention, and a hearing process is initiated.

It's an imperfect system. If the paperwork isn't filed in the proper timeline, the hospital where a person was detained is required to release that person within 24 hours. Shackelford said the process is much improved from the past, when mentally ill people were considered inmates instead of patients. Though some of the same problems persist.

"A hundred-plus years ago we would just throw them into an institution forever," Shackelford said. "We don't want to do that. But since then, they've been thrown out on their ears, and we're still playing catch-up from that as a system."

Why did it get to this point?

The state now has custody of Madsen.

A conservatorship hearing was held at the end of April to determine if she should be sent back to State Hospital North. After being evaluated by a doctor, she was found incompetent to stand trial in Nez Perce County 2nd Judicial Court due to her mental illness. The conservatorship hearing was also necessary so jailers could inject Madsen with the medications she's been prescribed, Henrickson said.

She will be evaluated by doctors at State Hospital North and will spend up to 90 days there to "regain competency" so she can stand trial. If she needs more treatment after three months, a doctor will request she stay longer until her competency is restored. Regardless of the treatment, she will still face the criminal justice system. Idaho doesn't have a "not guilty by reason of insanity" defense, meaning she could face up to five years in prison.

Henrickson said she feels immense guilt over her daughter reaching this point. But she called and met with various parties for months prior to Madsen being jailed.

The extent of Madsen's troubles escaped some. But the signs were clear. In September 2018 she allegedly shoved a nurse against a wall at St. Joseph Regional Medical Center, where she had voluntarily gone to be checked over by behavioral health workers, according to police reports.

Officers arrived and forcibly shoved her to the ground to handcuff her, according to reports. That case was later dismissed, so she never got the chance to engage in something like Mental Health Court, a specialty long-term court designed to rehabilitate mentally ill people who interact with the justice system.

Madsen's future is uncertain. Her condition has deteriorated since being jailed, Henrickson said.

The circumstances are so far removed from the "vibrant, smart" girl her mother raised.

"She was the perfect kid. Just low maintenance. A mechanic from the day she was born," Henrickson said.

Danielle Pecoff, who has known Madsen since she was 2 years old, said her friend was athletically gifted and picked up any physical activity almost immediately. Madsen taught herself how to ride a unicycle and how to juggle and took up ice hockey, Pecoff said.

It used to be Pecoff could call and speak with her for hours, and for maybe 10 minutes of the conversation Madsen would seem "off."

"More and more in a phone call over the course of an hour maybe 10 minutes would seem like her, and the rest it was someone else," Pecoff said. "Even in the middle of that she would have lucid points where we would reminisce and she'd remember things in elementary school; Jenny is still in there."

Pecoff said her friend felt embarrassed having to be treated at a hospital. She said maybe if Madsen was living in a big city she could have had more resources, though it may have ended the same way given the restrictions built into the process of committing someone who is mentally ill.

'It's like she fell off a cliff'

Madsen was studying engineering at the University of Idaho when her schizoaffective disorder symptoms began. She had her first episode, was hospitalized but then went back to school and made the dean's list, her mother said. She couldn't finish as her symptoms worsened.

"It's like she fell off a cliff. She's been in and out of hospitals ever since," Henrickson said. "I don't want anybody's freedoms taken away. I don't want my daughter's freedoms taken away."

But not enough was done, Henrickson said.

In a disturbing display of forethought, she said she has seen her daughter look at her with murderous intent but said it wouldn't be her fault if Madsen killed her.

"I imagine as soon as something happens she'd be like, 'What have I done,'" Henrickson said. "But it wouldn't be a conscious thought beforehand. If anything ever happens, be her advocate."

Henrickson said she understands the challenge of trying to predict someone's erratic behavior. But she pointed to a "body of evidence" supporting Madsen getting more treatment at a state hospital and that the system failed her and will continue to fail others like her with its limitations.

"There were so many opportunities to get in front of the train wreck," Henrickson said. "I don't think these people are horrible or unwilling, but their hands are tied."

Holm may be contacted at (208) 848-2275 or [email protected]. Follow him on Twitter @TomHolm4.

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