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Carrie Seidman: Our mental health system's revolving door

The Herald-Tribune - 8/23/2018

Aug. 23--About once a week I hear from an anguished relative trying to help a family member with mental illness who's been in and out of crisis hospitalizations. That they've turned to me -- someone with interest and empathy, but no special training, connections or magic wand -- is telling. They're desperate.

That's how I met Ron and Tracy Tuerk. Their son's story -- I'm going to call him Sam -- is all too familiar.

Diagnosed with schizoaffective disorder at 20 after years of anxiety, substance abuse and personal altercations, Sam has been through inpatient and outpatient treatments, a Christian rehab program and countless interventions. To still the voices in his head, he has turned to alcohol, drugs and over-the-counter meds; to deflect the violence they urge toward others, he's cut himself with a beer bottle, run in front of a car, and poured Drano in his eye, poking it with a guitar string to rid himself of the camera he believed was implanted there.

As of this week, Sam has been Baker Acted five times in the past 90 days. (The Baker Act is a Florida law that allows someone to be involuntarily committed for a 72-hour observation if deemed an imminent harm to oneself or others.) This has included two holds at Coastal Behavioral Healthcare's Crisis Stabilization Unit and three at Bayside Center for Behavioral Health at Sarasota Memorial Hospital.

Each time, the Tuerks have provided Sam's extensive mental health history and letters pleading for him to be held involuntarily for a longer period. Each time, Sam -- who is 25 and still covered by his parents' private insurance -- has denied the delusions he shares with his parents and mouthed the rote words he knows will get him released.

The cruelty for parents in this situation is that hope continues beyond all reason. On July 22, during Sam's third Baker Act to Bayside, a doctor agreed to recommend him to the state hospital and provided the Tuerks with health care proxy forms. At last, they thought.

Two days later, a different doctor discharged him after he refused medication.

Three weeks later, Sam was Baker Acted again, after wrapping a copper wire attached to an electrical conductor around his head, hoping to "fry the snakes and demons" residing there. While waiting in Coastal's lobby to see her son, Tracy Tuerk overhead a nurse saying he was "high risk, high need." She dared to dream this time might be different, especially when her son remained in the CSU after his hold expired last Wednesday night.

The next morning, he was discharged.

Coastal's CEO, Jack Minge, told me he couldn't discuss individual cases and bridled when I asked why anyone might be released when they were still exhibiting instability.

"I would disagree with that statement that we're discharging people before they're ready," he said. "The people we discharge from the CSU are stabilized and they are given a follow-up appointment." Pressed for more, he said he had "no further comment on the situation."

Four days after his discharge, Sam was admitted to the hospital emergency room after guzzling an entire bottle of DXM, a cough syrup and sedative. After being stabilized medically, he was sent to Bayside on another Baker Act, where, as of this writing, he is still being held.

Terry Cassidy, who moved from Massachusetts in April to become Bayside's executive director, said a situation like the Tuerks" is heartbreaking and "shines a spotlight on one of the deficits of this system." But given Florida's lack of funding and legal options, "We don't have a lot of recourse."

"Unfortunately, it comes up against the patients' rights," she said. "In order to detain someone against their will in a locked facility, we have to really prove they are actively at risk to hurt themselves of someone else. Certainly we take into consideration the parents' input. But we are really bound by what the patient is showing in the here and now."

Cassidy said it's "unfortunate" that Florida doesn't have a law like Massachusetts' Section 35, which allows a court to mandate involuntary treatment for up to 90 days. But even if we did, she noted, there are almost no residential facilities available and a three to four-month wait for state hospital beds.

"We just don't have anything down here to keep them," she said.

It's ironic, Cassidy added, that someone with mental illness who is homeless and has committed a crime is more likely to get the help they need through a court diversion program offering housing and treatment than someone like Sam, who has a clean record, strong family support and private insurance.

Tracy Tuerk, a special education teacher accustomed to doing "whatever it takes" for her students, says the impasse of her son's situation has left her utterly frustrated.

"I just wish we could stop it," she said. "If you're rowing a boat and you're going toward a destination, at least you're going somewhere. If you're rowing and you're just spinning in circles ... that's the definition of insanity. The biggest frustration is there is nothing available for people like this and there seems to be no one in this profession who cares enough to put together something to fill in this gap."

The Tuerks' questions are the same ones I asked eight years ago when my son was released after a Baker Act from Coastal, unstable and delusional, and disappeared to I-still-don't-know-where for 10 days. Once I found him, I ended up paying out-of-pocket to put him in a depressing, lock-down assisted living facility because there was no better option.

Sometimes Tracy Tuerk allows herself to think of her son in his younger years. Sam was a worrier, a gentle kid who always wanted to help anyone hurt, homeless or lonely. The last time she visited him in the hospital, he sobbed over what the voices were telling him to do because he so desperately wants not to hurt someone else.

"Here's my kid, who has the gift of mercy, who loves people so much, and he's afraid of his own self," she said. "It just seems like there should be something so I can get him back. Isn't there someone who can make such a place? I'll quit my job, I'll go work there tomorrow. But pretty soon it's going to be too late. And my son is going to be collateral damage."

That's what the Tuerks fear most, of course -- the day the door stops revolving.

"At some point, people will die," Ron Tuerk said. "It may be (Sam); it may be members of the public, or of our family. There is no way that I will be able to say that we did not see this coming. In fact, we did and do."


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