The last time Donna Smith’s son disappeared, a police officer in Oklahoma found him incoherent in his truck in May, unable to give his name but adamant that he was an agent sent by Israel to investigate fracking irregularities.
On the seat beside him was a collection of kitchen knives; behind him, a samurai sword; beneath him, a pellet gun.
“Don’t hurt my son. Don’t hurt my son,” Smith remembers pleading with the officer, who had gone through her son’s phone and called numbers until reaching her. “He’s mentally ill.”
This is the fear that haunts Smith unceasingly, that a law enforcement officer or a store clerk or a neighbor will encounter her 31-year-old defiant and delusional son, be confused or enraged by his bizarre behavior and harm or even kill him.
“And I’m not just thinking about my son,” she said. “What an unconscionable position to put a police officer in, having to make a split decision on whether this person is in need of medical treatment, or is dangerous, or both.”
If there’s one person in North Carolina who should be able to navigate the mental health system to get a severely ill son the help he needs to be safe, it’s Smith.
The Raleigh woman has a master’s degree in rehabilitative counseling and a master’s of divinity. She spent 12 years working on involuntary commitments with the Chapel Hill Police Department. Her husband is a lawyer.
Yet for the past seven months, Smith has careered from crisis to crisis with her son, and the unrelenting ride isn’t over. For the third time since being found in Oklahoma, he has been involuntarily committed.
I’ve agreed to call her son Michael because Smith worries about his privacy and, sadly, the still-strong stigma. Her concern is not that he’s violent, but that he’s vulnerable. He was first diagnosed at age 18 as having bipolar disorder with psychotic features after he complained of having stigmata and knowing everyone else could hear his thoughts.
A too literal standard
After Michael spent 10 days in a facility in Oklahoma in May, he was reluctant to return to the farm where he had been living in North Carolina. He believed that its well had been contaminated by fracking, that passing helicopters were spying on him and that the man he secretly knew was the head of the KKK was going to kill him.
Some of Smith’s friends in the mental health field visited Michael on the farm and left believing, as she did, that he needed to be hospitalized again. He was living in squalor, clearly not taking his medications and not taking care of himself. Smith asked Michael’s doctor to initiate an involuntary commitment, but he declined, she said, because Michael was not overtly homicidal or suicidal – a standard she believes is taken far too literally in North Carolina.
1,461 The number of publicly funded psychiatric beds in North Carolina in 2005
761 The number in 2010, or eight beds per 100,000 state residents
44 Where North Carolina ranked in public beds per capita
82,000 The estimated number of North Carolinians with schizophrenia in 2014, according to the Treatment Advocacy Center
164,000 The estimated number with severe bipolar disorder
“The bottom line for the psychiatrist was that if he committed him, he would no longer trust him,” Smith said. “My response was, ‘Well, if he’s dead, you aren’t going to be able to work with him anymore, either.’ ”
Angry with his mother for speaking with his doctor, Michael chose to become homeless and spent the summer bouncing around state parks. He survived only because he allowed family members to take him food and to move him every two weeks, Smith said.
On a 100-degree day in August, Smith was packing up Michael to move him to another park when he donned a long-sleeved shirt, a down vest, a scarf and a wool hat, grabbed a backpack and announced he was walking to Utah.
Worried that her son would die of heatstroke, Smith left and took out commitment papers. Deputies picked him up the next morning.
Michael spent three weeks in a Wake County facility and, over his mother’s protestations, was released on a 90-day outpatient commitment with no place to go. He can’t live with his mother for long because his dependency on her exacerbates his condition, she said.
The hospital had put a community treatment team in place to meet with Michael and monitor his well-being. But once Smith managed to finally secure him an apartment he could afford on his disability payments, Michael refused to tell his team where he lived and insisted on meeting in public places to receive his medications, she said.
“Since the day he was discharged, I sent email after email to his team discussing my concerns for his safety, the deterioration I witnessed in his condition and the need for a long-term hospitalization,” she said. “I asked them repeatedly if they knew whether he was taking the medications.”
Police on the way
Around Christmas Day, Smith got a phone call from Michael’s apartment manager saying the police had been contacted about a disturbance he was creating. Smith immediately called the team’s crisis number and was told that Michael’s 90-day commitment had ended without an extension and that he could not be recommitted because no one on the team had witnessed his behavior, she said.
Again, Smith saw a magistrate and took out commitment papers herself. At Michael’s home, she found unopened packs of medication.
“Obviously the community services we have are not sufficient to keep him from being hospitalized,” she said, “because that’s where he is again.”
Because there were no beds in Wake County, Michael was sent to a short-term acute facility in Jacksonville. He was scheduled to be released Friday.
The problem with mentally ill people is they don’t know they’re mentally ill.
Donna Smith, whose son suffers from mental illness
With that deadline looming, Smith frantically wrote to every state lawmaker on a mental health committee (only one responded), called and emailed officials at the state Department of Health and Human Services, called and emailed the medical director at the Jacksonville facility, desperate for someone, anyone, to see that Michael needed a long-term placement.
“The problem with mentally ill people is they don’t know they’re mentally ill,” Smith said. “Ten-day stays don’t allow for medicine to kick in and for things to calm down.”
For a decade after his diagnosis, Michael lived near relatives in Nebraska. One night early on, he disappeared. Three terrifying weeks later, he was found in Utah, incoherent and robbed of all of his possessions, including his shoes.
The seven weeks Michael then spent in a Nebraska facility provided enough time for him to respond to medications, to understand he was seriously ill and to feel equipped to continue treatment when he was discharged, Smith said.
For the next four years, Michael worked to support himself and enrolled in college, doing so well he decided he could stop taking his medications. After a psychotic break and another seven-week hospital stay, Michael lived six more years without incident before deciding two years ago he wanted to move back to North Carolina.
“I had not wanted him here because I knew we couldn’t get him the services he needed if something happened,” Smith said. “But it had been years since he had been in the hospital, and I felt like he was stable enough.”
But at some point early this year, Michael again decided he no longer needed his medications.
What she’s seeking
All Smith wants is for Michael to stay in a hospital until he is well enough to understand he is sick.
She wants magistrates and doctors to realize that “danger to himself” includes an inability to maneuver through everyday tasks and an obliviousness to potential harm.
She wants her son, who as a boy loved reading “Encyclopedia Brown” books, who was always so pleasant and even-tempered, who played clarinet in the high school marching band, to have a chance to be as well as he was for 10 years in Nebraska.
She wants him to cultivate his roses and do his wood-working and help on horse farms. Maybe work on social justice issues the way he wanted to when he graduated from high school.
“If he does not get the help he needs, he is a tragedy waiting to happen,” Smith said. “Everyone will turn around and ask, ‘How could this happen? Why was no one getting him help? Where was his family?’”
On Wednesday, his family was making another round of frantic calls about his impending release. Finally, an assurance came from the sympathetic director of a Wake County facility that Michael could have a bed there, a fourth commitment in seven months. Smith will drive to Jacksonville to get him.
Whatever we want to say about mental health reform in North Carolina, closing long-term beds in favor of more community treatment simply has led to a revolving hospital door for some very sick people – and to a prolonged whirlwind of pain and panic for their loved ones. What of all the Michaels in our state who don’t have mothers like Smith?
Even now, Michael was guaranteed a bed for only two or three more weeks.
Wheeler: 919-829-4825, firstname.lastname@example.org, @burgetta_nando
Find NAMI-Wake County’s Mental Health Services Guide for Wake County Residents at nando.com/mentalguide.