Waffle House shooting, other incidents show burden of dealing with family member with mental illness
Chicago Tribune - 5/3/2018
May 03--With years under her belt, emergency room nurse Anastasia Robey has treated more patients having mental breakdowns than she can count. She can quickly recognize the symptoms of someone who has skipped urgently needed medication, is experiencing a psychotic break or has become temporarily violent.
But even Robey had difficulty seeing the changes in her older sister Michele's personality over the course of a decade. While some unusual traits emerged, Michele Robey -- a supervisor at Cook County's CORE Center whose work helped lower HIV transmissions between HIV-positive mothers and their newborns -- had managed to keep her life in order until she lost her job.
"The changes are so subtle that it's not really apparent," Anastasia Robey recalled recently. "You just kind of look at the person and ... it just doesn't fit. It's just so hard to put your finger on."
Family members eventually underwent training to learn how to handle Michele Robey's bipolar schizoaffective disorder diagnosis, but it didn't prevent tragedy. In February 2017, the 55-year-old was fatally shot by Chicago police outside a North Center CVS Pharmacy. Authorities said she lunged at officers with a knife. Her family said she was having a psychotic episode after a period of decline.
For police and health care workers, dealing with people with mental illnesses who commit crimes can be daunting. But for family members, the weight of responsibility can be overwhelming. Some families, like Robey's, miss red flags while others turn a blind eye, too ashamed to acknowledge it. Others, who are aware of a relative's illness, may be unable to get the person into treatment or lack the resources or knowledge about where to start.
"I think (Michele's deterioration) was happening long before we even recognized it, and we're a pretty perceptive bunch," Anastasia Robey said. "So if it took us that long to recognize it, people who don't have the tools that we have, they're at even more of a deficit."
Much scrutiny has fallen on the father of Travis Reinking, 29, originally from Morton, Ill., who was arrested April 23 and accused in the AR-15 rifle attack that left four dead and four injured in the Waffle House shooting in Nashville, Tenn.
Tazewell County sheriff's reports show that Reinking's father had taken possession of his son's guns and then returned them at least three times. The reports document odd behavior, a suicide threat and recommendations for mental evaluations.
While only a small percentage of those with mental illness ever display violent behavior -- 3 to 5 percent of all violence is attributable to serious mental illness, according to the American Mental Health Counselors Association -- relatives and mental health professionals say the long-standing stigma associated with it persists even as public awareness has increased.
"We see very often family members feel embarrassed or ashamed," said Alexa James, executive director of the Chicago chapter of the National Alliance on Mental Illness. "It's a very painful burden for anybody to bear witness or to experience threatening behavior that is associated with a mental health condition."
In recent years, Chicago -- which closed half of its 12 community mental health centers in 2012 -- has been home to a number of high-profile cases involving people possibly suffering from mental duress, from Laquan McDonald to Quintonio LeGrier.
More recent incidents include a Central Michigan University sophomore from southwest suburban Plainfield accused of fatally shooting his parents inside his dorm room in early March; a couple weeks later, a 34-year-old Elgin woman fatally shot by police on Interstate 90; and, in early April, a 21-year-old University of Chicago student shot and wounded by campus police after authorities said he charged at officers with a metal pipe.
In a previous Tribune report, Kathleen Thomas, who lives with bipolar disorder, spoke about how she kept a close eye on her 21-year-old son, the U. of C. student, for symptoms of her condition.
"I have never seen him act that way. ... I have never seen anger like that," Kathleen Thomas said after viewing video footage of the incident.
Some experts caution against playing the blame game too quickly, saying the risk factors for mentally ill people to become violent are common.
Tazewell County sheriff's reports show Reinking was ordered to go to a mental health clinic for evaluation after deputies were called to a CVS parking lot in May 2016 after he threatened to commit suicide. In June 2017, a report documents Reinking jumping into a pool in a woman's housecoat and threatening lifeguards. An officer told Reinking's father "he might want to lock the guns back up until Travis gets mental help," and Reinking's father said he would. Two months later, Reinking was arrested after an incident at the White House.
"The real problem is that we cannot predict violence," said Linda Teplin, a professor of psychiatry and behavioral sciences at Northwestern University who has spent years researching youth, mental illness and violence. "It is tempting to examine the background of a shooter and say, 'We should have known,'" she said. "In reality, predicting violence is neither simple nor straightforward. Why? Thousands of people exhibit risk factors but never become mass shooters. In short, mass shootings, though dramatic and memorable, are too rare to predict. It is like trying to pinpoint where lightning might strike. We need to develop creative ways to address this public health crisis."
James, a licensed clinical social worker, said teens and young adults can present a particular challenge when diagnosing mental illness. "Identifying signs and symptoms in adolescents and teens is challenging because, developmentally, there's a lot of change going on anyway. So parents may not feel like they want to pry, or they may think it's normal adolescence, and I'm sure many times, it is," she said.
Nationally, the country's mental health systems are not designed to prevent people like Reinking from falling through the cracks, James and Teplin say.
In the Chicago area, struggles to treat mental health patients coincide with drastic cuts in recent years to mental health services statewide, according to Mark J. Heyrman, a clinical teacher at U. of C.'s Law School. Preventive screening and more community-based care carry considerable price tags.
To fill some of the gaps, Heyrman and U. of C. law students represent certain people facing criminal charges through the law school's mental health project.
"The frustrating thing is many of the people we represent end up in the criminal justice system or committed to a hospital before they have ever been offered mental health services," Heyrman said. "People will say they never took advantage of mental health services. Well, we never offered them services. And we shouldn't be blaming the victim."
The U. of C. mental health project says there are more people with mental illness in Cook County Jail than in the 185 public mental health facilities in Illinois, and there are more people with mental illnesses in state prisons than in all of the public and private mental hospitals statewide.
Relatives have several options if they suspect mental instability in a loved one. Ideally, a family member or friend would persuade someone to seek treatment voluntarily. Otherwise, relatives could seek to have someone committed against his or her will through the court system. Law enforcement officers also can determine whether a person with mental illness is a danger to themselves or others and take her or him to a hospital for psychological evaluation.
"If you never come into contact with the mental health system, there's no trigger for this happening," Heyrman said.
In Reinking's case, he visited a mental health hospital at the request of law enforcement, records show. But even though his father took away his guns on several occasions and eventually his firearm owner's identification card was revoked, he still did not get the help he needed.
"You can think of a lot of reasons why he should've come to someone's attention, where it required action by the school, police or family," Heyrman said. "All those things never happened."
As for Anastasia Robey, she supports mental health emergency training for law enforcement and sending trained de-escalation teams to the scene of emergencies. Her sister's death has inspired her to try to show more compassion for patients who are having even the most disturbing kinds of mental episodes.
"(Often) somebody's out of control and you can't quite get them down off the ledge ... psychotic issues and overdose and just tired and the patient won't come down, no matter how much you medicate them. And then I hear my sister's voice and it's like, 'You can deal with them, Stacey.' And I hear it. So she does serve me. She's with me all the time."
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