IT WASN’T RAINING ON THAT DAY LAST JULY, BUT IT MIGHT AS WELL HAVE BEEN. JUDY, 68, WAS BORN AND RAISED UNDER COLORADO’S BLUEBIRD SKIES, AND LATELY SHE FELT TOSSED AROUND IN A TORRENTIAL, UNRELENTING STORM THAT ONLY SHE SAW. IT WAS OFTEN LONELY AND BLEAK. AND NOW IT WAS FRIGHTENING: SHE COULDN’T FIND HER SON.
HER MICHAEL.* HER TROUBLED, TALENTED THIRD CHILD, WHO WASN’T A KID ANYMORE. HE WAS 42, YET SHE COULDN’T STOP THINKING OF HIM AS HER BOY. NOT WHEN HE NEEDED HER SO MUCH. NOT WHEN SHE FELT—KNEW—THAT NO ONE IN THE WORLD CARED ABOUT WHETHER HE SURVIVED MORE THAN HER. NOT THE COPS. NOT THE THERAPISTS. NOT THE HOSPITALS.
She’d check in with him by phone several times a week. Usually they discussed mundane stuff, simple conversations that let her touch base and get a sense of what he was feeling. Lately, he’d been feeling a lot, probably too much. In truth, he’d been doing terribly. He’d moved into his own apartment and over the past few months had lost so much weight she thought he might have an eating disorder. He was even more antisocial than normal. He said he’d been talking with his neighbors, but she knew those conversations were just the voices invading his mind. That was Michael’s reality; how could she convince him something so vivid was imaginary? How much would she fight if another person told her to distrust her own thoughts and instincts? That something about her was off? That the voice that says “go talk to that person” is actually a schizophrenic delusion?
She had to try to help Michael see when his brain shifted between reality and an alternate world. She’d done it before. With a slew of help—psychiatrists, ER doctors, counselors, social workers—she’d gotten him on medication. He hated the side effects, especially the inevitable weight gain. Even worse, Michael was an artist, a painter, and a poet. He was convinced the prescriptions dulled the edge that allowed him to feel and create. Plus, the voices reassured him, he was fine. He didn’t need help.
So he’d quit the meds, just like before. And when he spun out of control, Judy picked him back up, just like before. Because that’s what she does. For the past 15 years, she’s worked as an elder-care provider, helping seniors manage their twilight years. As Michael’s caretaker for many more years, though, she’s had the opposite mission: to ease her youngest son back into life, and, most important, to not let him die before she does.
Judy knows the statistics. Michael is 11 times more likely than the rest of the population to be a victim of violence. He is expected to die 25 years earlier than his three siblings, not just because of higher rates of suicide or an accident, but because American options for mental health patients are so dismal he might as well live in a third-world country.
Some days, it seems like neither Michael nor his mom live here, in Colorado. They inhabit a separate world dealing with what professionals call a “no-casserole” disease. If your son is mentally ill, neighbors don’t bring over cheesy concoctions for you while he’s in the hospital. Co-workers don’t organize fund-raising drives to find money for treatment. Friends don’t stop by to walk the dogs or fold the laundry. Mental illness is the biggest cause of disability in the United States. Yet the National Institutes of Health (NIH) reports that of every dollar spent on research, less than one cent goes toward severe mental illness. By contrast, 25 cents is allocated for AIDS and cancer research.
That’s why Judy so often feels alone in this battle. And when Michael didn’t call that day in the middle of the summer, when he didn’t answer her calls, she knew something was wrong. She phoned a few places, including the Mental Health Center of Denver (MHCD), where Michael was a client. Eventually, she climbed into her gold minivan and drove to his apartment to make the landlord let her in. When she saw Michael’s car parked outside the building, she knew what she’d find on the other side of his door.
THE NEXT TIME YOU’RE at a grocery store, or a bank, or a restaurant, look around. In Colorado, statistically speaking, one out of every 12 people suffers from a severe mental illness such as bipolar disorder, schizophrenia, post-traumatic stress disorder, or dissociative personality disorder. Now, take another look: At some point, one in four of them—maybe even you—will experience anxiety, bouts of depression, obsessive-compulsive tendencies, or other behavioral health issues.
Although these all are treatable diseases, when most people think of mental illness, a very different stereotype emerges: mug shot images of mass murderers, such as the gunman who killed 12 people at the Washington Navy Yard last September 16. Or the man in Tucson who killed six people and shot U.S. Representative Gabrielle Giffords in the head in 2011. Or James Holmes, who allegedly killed 12 people and injured 58 more in Aurora in 2012. As deplorable and incomprehensible as these shootings are, they provide an image of mental health that’s sensationalized and incomplete. These violent incidents are extreme examples of mental health care system failures, the results of treatment having not been sought or maintained. They shift focus away from early diagnosis and therapy—the kind of interventions that might prevent such atrocities—to what do we do now?
That was the dilemma Colorado faced last legislative session. Within hours of the Aurora shootings, Governor John Hickenlooper convened politicians and behavioral health experts to discuss gun control, mental health, corrections, and homelessness, and he demanded a legislative response. The legislated result was a convoluted, sometimes misguided, package of bills that included gun-control legislation to limit magazine capacities and changed background checks for private gun purchases. Another bill proposed the creation of a state or national list of people who had been held in a hospital longer than 72 hours for mental health reasons, but an odd-bedfellow mix of mental health advocates and pro-gun lobbyists halted it. Other legislation explored the possibility of holding mentally ill people in hospital limbo for up to a week before they could enter the legal system, where they would be entitled to due process and access to an attorney. The American Civil Liberties Union quickly stepped in, and that one didn’t pass, either.
The efforts reflected the governor’s emphasis on gun control and public safety. The trouble is, the numbers don’t support the widely perceived need to protect “us” from the mentally ill. Only three to five percent of violent crimes are committed by people with serious mental health diagnoses. This is where the discussion in Colorado and beyond (by last summer, most states had addressed some kind of new mental health legislation) becomes uncomfortable: Severely mentally ill people not in treatment are six times more likely to commit violence than those who are. Forcing people into treatment might be the most reliable way to prevent Aurora-type incidents. But punishing a group of people for a crime that might be committed quickly starts to sound like herding Japanese into internment camps during World War II or the forced sterilization of prison inmates, acts that are both unconscionable and unconstitutional.
Instead, Colorado legislators focused on what they could do: prevent and provide. They passed a broad $25 million initiative to completely restructure the state’s crisis system to focus on the majority of mentally ill patients, rather than on the sensationalized minority. This included a statewide hotline—much like Denver’s Metro Crisis Line, a 24/7 phone number that connects people to mental health assistance—to ensure that struggling people in eastern Colorado’s Last Chance have access to the same expert care as those in LoDo.
In addition, the state will build several community-focused crisis care centers to help move psychiatric patients out of emergency rooms and into facilities designed to address the difference between a broken mind and a broken hand. And in one of the bolder plans, Colorado would create mobile crisis teams that could respond, like 911 paramedics, to someone in the throes of a mental health crisis, such as contemplating suicide. Similar programs elsewhere have reduced hospitalization rates by eight percent.
Critics called the infusion of funds too little, too late. Others disagree, including Lisa Clements, director of Colorado’s Office of Behavioral Health for the Department of Human Services. She runs the state’s public mental health efforts, a system that includes two hospitals—in Fort Logan and Pueblo—nine specialty clinics, 17 community mental health centers, and more. “It is a huge investment. It is the largest behavioral health investment that we have made as a state for—ever,” she says. “I would not minimize that in any way. But we have not invested for years, and so we have a lot of catching up to do.”
THE TEENAGE MICHAEL was on his way to a prototypical all-American life. He got mostly A’s and B’s at a local private high school. He loved to read and write. He was quiet and sensitive, but Judy thought those traits would serve her son well, and she was proud to have raised a modern man.
Michael struggled a bit during his senior year, in 1990, after a breakup with his girlfriend. Although he drank and smoked pot, Judy never thought her son was out of control. It all seemed like normal teenage behavior.
He was going off to college soon: Michael was six feet tall and athletic; his success on the lacrosse and soccer fields earned him a spot at an elite Midwestern college. He left his mom’s house for frat parties, sports, and a liberal arts education—but he wasn’t gone for long.
After Michael’s second year, Judy got a letter from the school. Today, she doesn’t remember exactly what the letter said: something about his academics slipping and a suggestion that he needed a break. Maybe six months to a year, the school said, and then Michael might be able to return.
Judy knew something was wrong, and she realized how serious Michael’s problems were almost immediately
It seemed like he
had found focus
amid the chaos.
after he returned home from college. Her high-achieving son had changed. Her own life was transforming, too—she was divorcing Michael’s dad—so it was a turbulent time for everyone. When Michael enrolled in a wilderness education school and headed to Africa, it seemed like he had found focus amid the chaos.
Three months later, he was back—with the dubious news that he’d been made a shaman in Africa. So Judy, like she so often does, started searching for information. While her son was on a spiritual quest, Judy was on a parenting one. She found a book called Spiritual Emergency: When Personal Transformation Becomes a Crisis. The book examined the point at which a spiritual awakening ends and a mental health crisis begins. Each page she read made her more certain: Michael’s brain had been rewired. He wasn’t a shaman; he was sick.
It forced Judy to rework her own way of thinking , to figure out a new normal. Maybe her son wouldn’t go back to college. Maybe he wouldn’t get married. Instead of musing about future graduations and grandkids, she researched 72-hour hospital holds and long-term housing. Caring for an adult child upsets a family’s natural order, but her son was in pain. Every neuron in her body told her to be a mother, to just be there for him.
One day, Michael came to her with Spiritual Emergency, the same book she’d read, holding it up as proof he was indeed a shaman. He lost weight. He stopped talking to friends. Soon, he wasn’t talking to anyone. In 1994, shortly after Judy had finalized her divorce, they decided Michael needed a hospital stay to get him on medications—for what, they didn’t know yet. She tried to reassure herself: This is just a blip; he’ll get better after a little break. She just had to convince him to hospitalize himself, because even though everyone around Michael knew he was sick, it is difficult to institutionalize an adult against his will. Judy called in reinforcements: A nurse came to the house to coax Michael into a hospital psych ward. It worked.
IT’S BEEN 50 YEARS since a bullet ripped through John F. Kennedy’s skull as his motorcade passed through Dealey Plaza in Dallas. The shot did more than silence Kennedy’s brain; it slowed or halted some of his New Frontier policies that tackled a variety of social issues, from unemployment to civil rights. Kennedy pioneered a national conversation about mental health. For him, like so many others who get involved, it was a personal issue: His sister Rosemary underwent a lobotomy, in which surgeons—to minimize mood swings, among other things—drill through the skull and separate the brain’s sections. The dangerous procedure left the 23-year-old incoherent, and she spent the rest of her life in institutions.
On October 31, 1963, just three weeks before his death, Kennedy signed into law the Community Mental Health Center Act. It was—and remains—the largest attempt to destigmatize mental illness in our nation’s history. Since the 1950s, the country had slowly begun shutting down asylums. Kennedy’s actions meant those institutions would be replaced with centers dedicated to modern treatments that wouldn’t remove people from their communities. In a special appeal to Congress, he called for a “bold new approach” and wrote:
“[T]he Federal Government has recognized its responsibilities to assist, stimulate, and channel public energies in attacking health problems. Infectious epidemics are now largely under control. Most of the major diseases of the body are beginning to give ground in man’s increasing struggle to find their cause and cure. But the public understanding, treatment, and prevention of mental disabilities have not made comparable progress since the earliest days of modern history.”
Although one of the first mental health hospitals dates back to eighth-century Baghdad, by the 1900s we still didn’t know much about mental illness, its causes, or its treatments. Historically, psychiatric patients have been bled, dunked in ice water, or spun in a twisting chair until they passed out or calmed down. Beginning in the 1930s, the lobotomy was used extensively for more than two decades as a treatment for “emotional” housewives. And in perhaps the darkest moment in behavioral health history, during World War II the Nazis sterilized as many as 400,000 people with mental health problems and murdered more than 200,000 mentally or physically disabled people. As recently as the 1960s, institutions still used centuries-old techniques for restraint and isolation.
The Colorado State Insane Asylum opened in Pueblo in 1879, just three years after the Centennial State joined the Union. As the state grew, so did the hospital’s population. A quick read through the newspapers of the time shows reporters raising concerns about food quality; a female “inmate” who, after six years in the institution, had a baby; and the ratio of caretakers to patients. In fairness, the hospital seemed on par with what was happening nationally, which is why Kennedy’s call for more humane, community-oriented programs—even today, 50 years later—remains so revolutionary.
The president’s death meant the plan was never fully funded. Institutions continued to close, but the wraparound services Kennedy had pitched didn’t evolve at the same rate. By the 1970s, President Richard Nixon suggested lowering costs by shutting down Kennedy’s community centers, and President Ronald Reagan’s social services cuts in the 1980s closed many of the remaining mental hospitals for good—which left thousands of people unsheltered and helped create the national homelessness crisis that continues today.
Fast-forward to 2013: (Isaac Newton, Abraham Lincoln, Winston Churchill, Jane Pauley, Florence Nightingale, and Nina Simone, to name a few). Even so, many people with treatable mental illness concerns don’t seek help. From moms suffering from postpartum depression to people like Michael who are intermittently in treatment, on any given day you will interact with people in need of medical care. But because their symptoms usually aren’t obvious, only rarely do you realize it.
Why do we treat mental illness as something separate from all other types of disease? As President Barack Obama said in June, “We wouldn’t accept it if only 40 percent of Americans with cancer got treatment. So why should we accept it when it comes to mental health?”
TODAY, A PSYCHIATRY WARD doesn’t look like a scene from One Flew Over the Cuckoo’s Nest or even Girl, Interrupted. At a glance, it resembles any other hospital wing. But a closer examination reveals subtle but distinct differences: Patients walk around in street clothes, including hoodies and tennis shoes, only with the strings removed so they can’t use them to hang themselves. Whiteboards outline treatment plans that focus on group therapy and meds. Dark “seclusion” rooms contain only a mattress—no restraints, no sheets. A system of locked doors prevents “elopements” (people hoping to escape).
Psych wards usually offer a shared phone on which patients get 10-minute calls with friends and family. With as many as 30 patients in a ward, the phone is almost always occupied. On certain days each week, visitors pour in for 60-minute chats. Everyone seems shell-shocked: Patients are zoned out because their pharmacists have been working frantically to discover which medications work. The feverish pace is necessary because the medical professionals never know when a patient’s insurance company might suddenly decide, based on its own criteria, that the patient is miraculously ready for the world again and discontinue its in-patient payments.
Family members sort through diagnoses and reel from grief at the realization that their son or daughter or sister or brother will never be the same. “Most parents like to think they come well equipped to deal with a child no matter what’s going on,” says Dr. Carl Clark, chief executive officer of the Mental Health Center of Denver. “As it turns out, that’s not always the case.”
After a baby is born, hospitals shove pamphlets about poison control centers and how to identify rashes at new parents. They rarely offer information about how to prepare for a child who suffers from anxiety—which may start showing up before age 10—or how to recognize early signs of depression. No one tells you that one in 12 babies that reach adulthood will have a severe mental illness, or that your children are much less likely to have their tonsils out than to suffer from trauma. No one tells you that if your child is diagnosed with a mental illness, people will judge and stigmatize them. “There are two stereotypes of mental illness that we have in our country,” Clark says. “One of them is that if you are mentally ill, you are dangerous. The other is that if you’re mentally ill, you’re an idiot. Nobody wants to identify with that.”
Michael was no exception. After the nurse his mother called convinced him to enter the hospital in 1994, it took a few days for the medications to start unwinding the chaos in his mind. The hospital kept Michael for about a week, enough time for some of the meds to start working but not long enough to stabilize him.
Soon, not wanting to believe or accept his schizophrenic diagnosis, he decided he didn’t need meds or treatment. He wasn’t ready to return to school. He didn’t have a job. He was broke. Judy refused to let him end up on the streets. With no other option, she brought her 22-year-old son home.
THE BRAIN IS THE MOST COMPLEX part of the body. It weighs about three pounds, consumes as much as 25 percent of your body’s oxygen, has 400 miles of capillaries, and makes more than 10 quadrillion calculations every second. Mental health treatments seek to stop, alter, or divert neural impulses that travel at 220 miles per hour. At best, it’s an imperfect science.
“The problem is with the medications,” says Robin Wackernah, a clinical psychiatric pharmacist and assistant professor at Regis University. “When I do medication education groups with patients, I start off by telling them: ‘We know these medications work. We know that. The problem is that they work differently for different people.’ ”
Mental illness is not strep throat, for which an antibiotic will
The brain is
the most complex
part of the body.
straighten you out in a few days. It’s not like blood pressure medication or insulin shots that make a patient feel noticeably better within minutes or hours. Instead, mental health patients start treatment with a series of medications from drug families with hard-to-pronounce names such as “tricyclic antidepressant” or “escitalopram.” The goal is to settle on a drug or a cocktail of medications that fits the individual’s unique body chemistry, so what often unfolds is a trial-and-error roller coaster. One drug may help your anxiety but give you nausea.
To combat the pain, you might take something else, which gives you nightmares. To help you sleep better, you take something else that leaves you lethargic and unable to get out of bed.
If you want a better option, you’ll have to wait: New drug treatments can take 20 years to be approved. Pharmaceutical companies are exploring ways to predict how patients will react to medications based on DNA, but the research is new and unproven. Some of the most effective drugs for mental illness aren’t available through insurance until you’ve proven that you failed other drug therapies. Patients can pay $200 out of pocket each month for the medicine they need to be well.
Is it any wonder patients start to question the prescriptions? Maybe the voices in your head were nonviolent. Maybe they once even whispered a winning lottery ticket number to you. Was that so bad? Or maybe it’s better to have occasional mood swings at work than to be curled up in a ball on your bed, unable to move, for days or weeks at a time. You can’t pay your bills without a job, but you can’t keep a job until your medications get figured out. There are so many drug options, but seemingly few choices: Do you want to be well, homeless, or just go back to the way it was?
ABOUT HALF OF ALL PEOPLE FAIL to take prescribed medication correctly. Missing a birth control pill or accidentally taking two pills post-surgery because you forgot to write down when you took the last one are common occurrences for even the most diligent patients. Imagine having to keep track of 10 medications every day—in the middle of a mental health crisis.
Despite all that, Michael managed to get himself on a treatment schedule while Judy busied herself learning about his needs. She’d work on a plan for him, but after years of distressing trial-and-error cycles, she realized how something that seemed effective one day could be useless the next. She learned to say, “My son has schizophrenia,” not, “My son is schizophrenic” (because no one says they “are” cancer). She learned the 10-year prognosis for her son was encouraging: 25 percent recover and 50 percent experience improvement; the other 25 percent are unimproved or dead.
Judy wondered if she should have figured things out sooner or gotten him help earlier. But he never presented any serious symptoms until he’d gone to college. (Schizophrenia tends to show up in the late teens and early 20s. Other disorders, such as anxiety, often have earlier symptoms.) Because Michael didn’t have a job or any money, his private psychiatrist suggested he look into public services like the ones offered at the MHCD. Unfortunately, Judy and Michael lived in Aurora and the MHCD’s services are only available to Denver residents. Geographic limitations plague Colorado’s mental health patients because more than 80 percent of the state’s psychiatrists work in Denver and Colorado Springs. It can take weeks to get an appointment with a psychiatrist, regardless of whether a person in crisis can wait that long. (If the patient is under 18, the situation is even more dire: There are 75,000 taxidermists in the United States but only 8,000 child psychologists, meaning it’s easier to stuff that elk you shot on your last hunting trip than it is to schedule an appointment for a mentally ill kid.)
So Judy and Michael moved to Denver. As easy as it would be to dwell on the hard times, Judy always tried to remember the good things about Michael’s life; the times before he got sick, of course, but also moments since then, when he was securely in treatment and they shared what she calls “bright spots.” Like when he became a patient at the MHCD. The center monitored his physical health as well as his vocational aspirations. The MHCD also helped him enroll at a local university, where he earned a bachelor’s degree in psychology while working at the campus bookstore.
Judy didn’t have the legal authority to compel her son to keep up with treatment, but she often went to his appointments with his OK. She’d talk about side effects or behaviors, not to contradict Michael, but to give a more complete picture when he couldn’t. She became such a regular at the MHCD that eventually she was asked to join the board. She felt empowered because Michael was recovering, and she was with him through it all.
At times, it seemed like he wasn’t the same person as before, but a new, better man who’d make it through. One of those “bright spots” came when Judy and a friend took him trekking across Thailand, Cambodia, and Nepal. The Nepali children loved Michael. He was so good with them. Maybe he could work with kids? Or get a job that made him feel rewarded?
The MHCD convinced Michael to volunteer at a Denver animal shelter. Maybe working with pets would give him a personal connection to other living things. He loved it and volunteered there for nearly a year. He even adopted a cat he called Shish. Like so many plans, though, this solution didn’t last. “They bring in all these cats, and I take care of them,” he told Judy. “I know they euthanize them. I can’t do it.” She couldn’t argue with that, so after he quit, she kept working with him to figure out what his next step would be.
Years earlier, Michael had qualified for Supplemental Security Income (SSI), more commonly referred to as “disability.” Although it gave him money for food and rent, it also incentivized him not to work. Earning an income decreases SSI payments, and it can be difficult to re-establish the original disability level if you later lose a job. Michael started working as a peer counselor at a MHCD home. (MHCD has work programs that don’t pay enough to compromise a patient’s disability allowance.) He seemed to thrive for about two years—until the Great Recession hit, Colorado slashed the MHCD’s budget, and Michael was let go.
MICHAEL WASN’T THE ONLY person impacted by the budget cuts. Colorado has underfunded mental health care for decades. Exactly how much is uncertain because there are at least 34 separate mental health line items in the state budget. “At the state Legislature, we cut provider rates for Medicaid and for drug and alcohol [programs] in 2002, when we had the downturn,” says Moe Keller, who spent 16 years in the state Legislature and is now the vice president of public policy and strategic initiatives at Mental Health America of Colorado , the local outpost of a national group that advocates for mental wellness reform. “We cut beds, and we closed a couple of units around the state. We never really re-funded that when the economy came back.” Then in 2008, the state again cut Medicaid providers and closed more units along with consolidating and reducing services. “Today, the prison system is by default the largest behavioral health center,” Keller says. “Police are the first responders.”
In 2010, Colorado spent $887 million on behavioral health, but in national watchdog reports—even after
In 2010, Colorado
spent $887 million
on behavioral health.
our own state’s task force requests—Colorado often lacks comprehensive financial and medical data. These reports read like redacted intelligence documents. The lack of transparency is not malicious, per se. It’s a symptom of how fragmented the mental health care system is. The private sector (i.e., insurance-based recovery centers) doesn’t have to share information with the Office of Behavioral Health. Mental health patients cycle through a variety of state agencies, including programs that deal with homelessness and veteran’s affairs. There’s no single line on a budget spreadsheet that accounts for a homeless veteran with post-traumatic stress disorder.
What we do know: Between 2009 and 2012, Colorado cut $9.7 million from its behavioral health budget, which included shutting down the entire juvenile ward at Fort Logan. (As a result, there are few juvenile beds for mental health treatment left in the state.) While the Affordable Care Act will aid access to mental health care, the rollout has been excruciatingly slow. In 2013, there were across-the-board federal cuts. As of press time, funding for 2014 was on hold as a result of the government shutdown in October.
AFTER MICHAEL LOST HIS MHCD position, he stalled. He had a few jobs or volunteer gigs, but nothing stuck. (Mental health issues account for 65 percent of job terminations.) Judy watched him deteriorate, trying not to direct her anger at his employers, the state government, or the economy. He’d been doing so well. Against the odds, he was recovering, and now his unemployment threatened it all.
The years since Michael’s diagnosis had been especially painful for Judy because he’d
He wouldn’t need to
find shelter under
a bridge or in a
doorway during a
December snowstorm.
come so close to living on the streets. Homelessness for the mentally ill is even more common in recent years, as Denver’s hot rental housing market has vacancy rates hovering around four percent. A recent search for a Section 8 (affordable housing) unit in the metro area found fewer than 10 options for less than $400 a month. (A typical monthly SSI check is $528.25.) Moving out of Denver may mean more rental options but also a loss of access to services. A person might have to choose between paying more or forfeiting the chance to see a weekly therapist who may be his most effective lifeline.
Back in 2003, Judy made this decision for Michael: She bought a one-bedroom apartment in Denver, applied for Section 8 status, and “rented” it to her son. The hope—the dream, really—was that he’d always have a place to live. If one day she was no longer around, at least he’d have a roof. He wouldn’t need to find shelter under a bridge or in a doorway during a December snowstorm. He’d be safe.
While she could protect him from storms, Judy couldn’t keep Michael safe from his own choices. He started using illicit drugs and soon was wasting away from cocaine abuse. He became a cliché: He was always looking for a quick fix. For the first time in years, he had “friends” stopping by his apartment, only they were drug dealers. Eventually, Judy reached her limit.
In 2005, she made a surprising decision: She called the cops on her son, and they raided the apartment. Michael wasn’t there at the time, and his brother helped him go to Denver Health and get clean. It took two weeks, but it was better to recover in a hospital room than a jail cell.
Michael would get better, then relapse. Judy reassured herself that many physical diseases involve similar cycles, but she also held on to the idea that her son still had personal responsibility. Where did Michael end and the illness begin? Did it even matter? She—and he—knew she’d always be there for him. She’d seen others make different choices: limiting or severing ties because it simply became too much. She never looked down on that decision; she only knew it wasn’t one she could make.
Judy also knew of the correlation between mental illness and drug abuse. The presence of both is called “co-occurring disorders,” and some mental health advocates say substance abuse can begin as a self-soothing mechanism that turns into a debilitating addiction. The result makes diagnosis and treatment complicated. Just ask Roberta Payne, a retired University of Denver adjunct professor who has been sober for 33 years and lives with a schizophrenia diagnosis. “I got up in the morning,” Payne says of the time before her diagnosis, “and for many years, the first thing I would do before brushing my teeth was get high on marijuana.”
When she decided to get sober, her psychosis became worse. Her delusions and paranoia led her to wander alleys on South Broadway at 2 a.m. in her nightgown. During the day, she’d go to class and study for her Ph.D. exams, and no one ever seemed to notice her pain. She qualified for disability insurance, so she taught at DU for nearly two decades as an adjunct professor without pay so as not to lose her medical benefits or government financial support. Says Payne: “Disability insurance saved my life.”
IMAGINE HAVING 10 YEARS of your life disappear. That’s usually how long it takes for someone to get successful treatment for a mental illness. We’ve known since the 1990s that the primary reason people avoid treatment is stigma: the paralyzing fear of what society will think of them.
Perhaps you can’t fully understand that fear until you’ve lived it, like Jennifer Hill, the manager of programs and volunteers at Colorado Mental Wellness Network. She knows because she’s lost friends and even been fired from a job after a hospitalization (she’s been diagnosed with dissociative identity disorder). “I got a lot of ‘bronchitis’ after that,” Hill says.
Recovery, though, took some time. “At 24, I was told that I would be dead or in an institution, and that certainly I would live on disability for the rest of my life,” Hill says. “By 28, I was back working again. I finished my college degree, and I was living independently in the community. And I could never speak of it because then people would know that I was a mental patient.” Years later, though, she doesn’t hide her past; she embraces it. “I work for a peer-run organization,” Hill says. “Everyone knows that I have ‘crazy.’ Everyone knows I was a drug addict. It’s been liberating.”
Hill is quick to note that recovery looks different for each person. For Michael, it fluctuated. When he wasn’t staying with Judy, in a hospital, or living on his own, he had a few stops in longer-term housing programs. In these homes, he lived with as many as 16 other men and had access to 24/7 help. Michael didn’t like this arrangement, but Judy saw promise in it because she knew he was safe and she didn’t think it was healthy for him to live alone. The trouble? There are very few such options in the state, even with the influx of crisis care choices from the 2013 legislation, which focuses on short-term care. What happens, though, if a person like Michael doesn’t have a Judy to take him in while he recovers from a crisis, adjusts to medications, and prepares to go back to the workforce? Where does that person go?
The simple answer is nowhere. Or everywhere: street corners, underpasses, alleys. If they’re lucky, they’ll crash on a friend’s couch. A century ago, we would have locked them up in Pueblo. Thanks to a landmark 1999 Supreme Court case, commonly referred to as the Olmstead decision, states must make sure people are held in the least restrictive environment possible. This means states should have housing options on the spectrum between crisis care and the state hospitals. Colorado has few. Several states have been sued by the federal government for Olmstead violations. One source told me Colorado could be on the litigation list as well. If that happens, we’ll have no choice: We’ll have to build programs and housing options for the complete coverage of behavioral health care needs.
This doesn’t mean we should wait for a lawsuit—or another Aurora-type atrocity—to pass more mental health legislation. “We made great advances this last year getting crisis support on people’s minds,” says Don Mares, former legislator and current president and CEO of Mental Health America of Colorado. “In addition, we’ve got to look at the next steps. The transition.” That’s one thing state Senator Linda Newell is working on for the current session. She’s juggling a lot of ideas, which she can rattle off in a succinct “to-do” list. One item would have teachers and students taking Mental Health First Aid training for about $25 per person. After all, so many of us know CPR; why not learn how to recognize depression? Newell also is involved in efforts to circle back on some 2011 legislation that merely asked hospitals to provide suicide prevention materials. So far, estimates indicate that only about one-third are actually doing it, so she’s thinking of making those pamphlets mandatory. In addition, Newell says she wants to add suicide prevention and management training as a continuing education option for mental health professionals.
Because of Colorado’s large veteran population, Newell is seeking funds for mental health programs catered to them. She raves about Colorado’s mantherapy.org, a humorous website that encourages men to talk more about mental health issues. The site launched in 2012 and has had more than 300,000 visitors. Basically, she hopes the recent momentum behind mental health causes doesn’t slow. “We’re trying to build the airplane while it is in flight,” she says. “Because of these highly noticeable events, we’re trying to do this as fast as we can but as solid as we can.”
ON THAT SUNNY DAY in July, Judy stood outside her son’s latest residence, wondering if she was too late. She steeled herself, then turned the key in the lock, as prepared as she could be for her life to stop once the door swung open.
But when she looked inside, Judy didn’t see a dead body. All she saw was a decrepit wreck of an apartment littered with old food and trash. Finally, the manager told her what had happened: Michael had been arrested after he followed a neighbor into her apartment, uninvited. He didn’t touch her—he just said hello and started talking—but he freaked her out so much she called the police. While Judy had been worrying that her son was dead and gone, he’d been in jail.
The charges seemed simple enough. If Judy could explain Michael’s diagnosis, it would all make sense: He was in a delusional state, and the hospital was a safer place for him. She was too late, though, because the police had already released him. She talked to Michael on the phone; he was home. He insisted he hadn’t done anything wrong and that the woman had asked him to come over. Judy quickly realized the voice offering the invitation was probably in his head.
A few days later, she couldn’t get in touch with him again, and this time she knew where to look: the Denver jail. Michael had been arrested again after he followed a woman from his building and took pictures of her. This time, he was charged with a felony. Judy returned to her son’s apartment and scooped up Shish, his cat, to take home with her. At first, police put Michael in the general population at the jail, but because he wasn’t doing well with the other men, they soon moved him to solitary confinement. He remained there for the next several weeks.
When Michael showed up for a court appearance, shackled and dressed in jail gray, cuddled under his arm was a stack of journals filled with his poetry. He wouldn’t let the books go. The sight of that—of her artist son clinging to one of the only parts of himself that felt solid—nearly broke Judy. She buried her emotions and focused on what needed to happen. No matter how fragmented the mental health care system was, it was better for Michael than the prison system.
Once again, she knew the statistics: The correctional system has become a holding pen for the mentally ill. Thirty percent of female prisoners and 15 percent of males are severely She didn’t want to
do it, but want
wasn’t the issue. mentally ill. While it costs, on average, about $27,500 annually to imprison an inmate in Colorado, it costs around $62,000 to house an inpatient at a mental health correctional facility. Community mental health programs—crisis lines, therapy groups, peer counseling—cost about $3,000 per person each year. Judy took the $3,500 she’d been saving and retained a lawyer. She didn’t want to do it, but want wasn’t the issue. Michael was her son.
The attorney negotiated away one of the charges, but the second—the felony—remained. Michael would have to leave the apartment building, but Judy had already received an eviction notice for him, so she spent three days lugging furniture out of the apartment with the help of her 13-year-old grandson. The looming felony charge bothered her; Michael didn’t need a Section 8 eviction on his record, too. As it was, he’d probably lose his housing voucher. Then where would he go?
While her son was in jail, Judy slept well. As she explained to me over a bowl of cinnamon ice cream at Poppies Restaurant in south Denver in July, at least he was safe. “The way I look at it is that the nine months of being pregnant is the easiest part of raising kids,” she says with a dry laugh.
She talks about her three other children and their evolving relationships with Michael—an unpredictable mix of anger and bonding. Her eyes go soft when she explains how her six grandchildren treat Uncle Michael as if nothing is wrong with him. She longs for the day the rest of the world might see him that way, too: not as he was, or as a damaged person, but as her Michael, just another person struggling through life.
When I see her a few weeks later, Michael is out of jail and in a three-month MHCD housing program. Despite the determined look on her face, Judy’s eyes betray worry. She talks in a methodical, unrelenting cadence. “The only thing I have to worry about is a year from now, where’s he going to be living?” she says. “Three months from now, where’s he going to be living? Will the MHCD decide they need the bed for someone else? They better not do that. I don’t know what I’m going to do. I don’t want to see him homeless.”
Judy pauses for a moment, as if she’s weighing the choice she’s made so many times before. No matter what the state of Colorado does, no matter if the services dry up, no matter if she has to do it alone, no matter if the world sees Michael as a monster, she knows what she’ll do: “I’m not going to make my son go through this alone.”