Exactly one month ago marked 20 years since our children first learned they were not entirely safe in their schools. On that perfect spring day, May 20, 1988, in the North Shore suburbs of Chicago, 30-year-old Laurie Dann walked into Hubbard Woods Elementary School — in one of the safest towns in the world — and shot six young children, killing an 8-year-old boy. She did not know her victims. She left behind a trail of arson, attempted murders, poisonings, shootings and death.
After shooting a neighbor near the school, she then killed herself.
The now familiar phrases, “school shooting” and “lock-down,” were coined in the aftermath of this rampage.
Laurie Dann was severely mentally ill, and a lot of people knew it. It took a village of professionals choosing to ignore her propensity toward violence and flat-out bizarre behavior to create the environment for the bloodbath on May 20, 1988. This story was personal, because my cousin’s son was one of the shooting victims in a town where no one was ever murdered and schools were absolutely safe. Luckily, he survived and recovered.
Another personal experience had me doubtful that the system here and now was any better than it was 20 years ago in my hometown. I have a relative in Los Angeles County who is severely mentally ill. He is not under the care of any single doctor, although he has come in contact with several by way of emergency hospital admissions, often courtesy of local law enforcement. Even when forced to stand before a judge, the court never questioned his claim of mere drunkenness. Typical to those haunted by bipolar illness, my relative refuses to be compliant with treatment and currently self-medicates with alcohol and whatever substance he believes will make him feel less awful. His mother, age 91, desperate for help, was stymied by the steadfast refusal of any and all agencies to get involved.
Is Ventura County as detached as Los Angeles County or the affluent suburbs of Chicago? Is there any functional system of treatment and support for the severely mentally ill in Ventura County? Have local officials found ways to provide vital funding in this era of very real budget cuts?
The answer is a very mixed bag. There are a lot of important people who care deeply about these fragile residents and those people say that we still have a long, long way to go before Ventura County can claim that residents with debilitating mental illness are being adequately cared for through county services.
All in the family
Severe mental illness is far more common than you want to believe. Much of it has not been medically diagnosed. Many of the symptoms play out in the home, affecting the family and close friends. The effect of self-medication through the use of alcohol and drugs provides the perfect alibi for the patient and the perfect platform for denial by embarrassed family members.
Amanda Erwin is a criminal defense attorney with many clients whose mental stability has been seriously compromised. She said she had never officially been exposed to mental illness, however, she acknowledged the bigger picture.
“Everyone has members of their family who they call crazy or who are a little nutty,” Erwin said.
This tendency to downplay a family member’s disruptive, disagreeable, or inexplicable behavior stands squarely between the ill person and meaningful treatment. The difference in behavior between someone who just drinks too much at family events and someone who is seriously ill is sometimes apparent even to the untrained eye. But families with the best intentions often balk at forcing their relative to enter treatment, or to even obtain a diagnosis.
Ventura County Superior Court Judge Kent Kellegrew is the presiding judge of probate court. He oversees conservatorships for adults. A conservatorship is created when someone has a physical or mental impairment which compromises their ability to handle their own affairs. The cause can be medical, mental illness, or any other condition which would require a third party to control that person’s affairs.
“The good news is that people are living longer,” Kellegrew said. “The bad news is as they live longer, they are compromised and conservatorships are becoming more common.” Kellegrew added that Alzheimer’s disease and other forms of dementia are often the cause in his court.
Although a family may recognize the need for legal oversight, the court has a very high standard which must be met before one’s constitutional rights can be overridden. The legislature has included the requirement of a doctor’s medical diagnosis of the compromise in cognition before the courts can grant conservatorship.
There are inherent dangers in the process, Kellegrew said, one being abuse of the process by the state.
“Judges are not doctors,” Kellegrew said. “We can recognize behavior that seems abnormal, but the legislature wants to make sure that we don’t use the courts in a way that they have been used in other countries, where if you disagree with the political ruling party, we’ll just call you insane and send you to Siberia.”
The standard for conservatorship is set intentionally high.
“We make sure that someone who has the knowledge, training and experience and a medical license to make the diagnosis of the medical mental malady,” Kellegrew said.
If the sometimes bizarre behavior is left unchecked by treatment, the person will likely find themselves in the justice system. That could be the first time they ever encounter access to an appropriate treatment program. However, in some extreme cases, they first must survive the encounter with police.
Cops on the front line
For many years, police did not understand the strange and threatening actions by seriously mentally ill people and responded quickly with force. Although the person may be harmless, police had to make split second decisions on safety.
Sometimes that meant shooting and killing the person.
So it was determined that law enforcement agencies in Ventura County needed to train officers how to deal with the severely mentally ill.
“The original intention was to decrease the use of force,” said Joyce Wilde, the administrator of the Crisis Intervention Training (C.I.T.) program in Ventura County.
The C.I.T. program is jointly funded by all of the county’s law enforcement agencies. It is a 40-hour weeklong program which focuses intensely on training frontline officers how to best cope with a mentally ill person who is agitated. They learn how to de-escalate a volatile situation by using words instead of guns. About 45 percent of officers are now trained, enough to always have someone available to respond to a crisis 24 hours a day.
Wilde said the program seems to be making headway.
“It appears there were about half as many use of lethal force incidents in the first five years of the program as there had been in the previous five years before the C.I.T. program,” she said. “That’s a dramatic change.”
Although the training is offered in many jurisdictions outside of Ventura County, Los Angeles officials are not completely on board, said Ratan Bhavnani, executive director of the National Association of Mental Illness for Ventura County.
“In Los Angeles, they have 10 percent of the officers trained,” Bhavnani said. “They are trying to switch to a three-hour online training program. So that is why we are so fortunate in Ventura County.”
Bhavnani has advice to those who are closest to the mentally ill.
“We tell family members if you have a crisis and when you dial 911, tell the operator that you need a C.I.T. trained officer,” Bhavnani said. “They will understand.”
The children shall suffer
Andrew Krause has practiced criminal defense law for seven years. Many of his clients are younger than 18. Even at the first meeting with the client, problems may arise.
“A lot of minors have family members who are in the system themselves or have their own problems,” Krause said, “so they may not always be there for the meeting.”
Krause said experience has sharpened his radar for complications in a case.
“If the client is mentally ill, you kind of get a sense of that from the beginning,” Krause said. “If we get that feeling, we go out and talk to the family to find out what is going on.” The lawyer may ask the court to send someone out to the home for a psychological evaluation. But that can only happen upon the attorney’s request.
Additionally, the lawyer is not a doctor, and his or her job is strictly one of representing a client against the charges in the best way possible.
“We have to be careful not to impact their representation on that aspect,” Krause said.
Krause is familiar with the feelings of frustration and helplessness.
“I’ve got several cases with people who are seriously mentally ill but the system is failing them,” Krause said. “There is nothing set up for them, there is no system for them.”
Krause added that there are now a few staff doctors at the county juvenile facility.
“The quality of care depends on who you get and the time of day,” he said. “Unfortunately, juvenile court systems aren’t really set up to handle people with mental illness.”
It gets even worse as a juvenile moves through the process. Before the courts can begin a trial, the person must be deemed competent to stand trial.
“They have to understand the charges against them, they have to understand their relationship to those charges, and they have to be able to rationally assist counsel in the ability to prepare a proper defense,” Krause said.
Krause said if an adult is found to be incompetent to stand trial, the court orders treatment so as to restore competency, which is not usually medical treatment for the mental illness but coaching on how to meet the standard. For juveniles, it is even worse.
“If they are not competent to stand trial, there is no system at all,” Krause said. “They are not treated, and the law is they have to be released. They are just sent back home and the parents are left to fend for themselves.”
One small ray of hope
Ventura County Superior Court Judge Donald Coleman deals with these problems every day because he is the presiding judge of juvenile court. He said the first issue is determining whether mental illness is causing drug-seeking behavior or whether a drug addiction is causing the mental illness.
“Oftentimes it is a combination of both,” Coleman said. “In the dual diagnosis process, we try to ascertain which one is predominant.”
One program which has been relatively successful is the Adelante program which uses a team of specialists to treat mentally ill juveniles.
“The goal there is to keep them out of custody, quite frankly,” Coleman said. “Oftentimes we’re finding that some of these youngsters are coming from homes where there are unresolved mental health issues as well.”
The Adelante program addresses these problems, also, as the counselors go into the home and can work with the families. “We try to have the parents participate in the Parent Project and we try to give the parents some tools. In therapy, the stronger we make the family, the stronger we make the child.”
Juveniles who get into the Adelante program are the lucky ones.
“Participation in the program lasts as long as we think we’re doing beneficial work,” Coleman said. “It could be as long as a couple of years.” The program currently has about 40 patients who are receiving therapy.
But this kind of long-term team approach is expensive, and budgets are being cut statewide. The program is funded by the county, but that is just not enough. What keeps it running is a congressional set-aside which was obtained by Congresswoman Lois Capps (D-Santa Barbara).
The politics of mental illness
Capps, whose district includes parts of Ventura and Oxnard, has been toiling on the front lines of funding for mental illness treatment for years. She said the budget problems begin at home.
“In California, the downturn of the economy has put enormous pressure on the budgets for the state and local governments,” Capps said. “Often funding for critical programs like mental health services are among the first placed on the budget chopping block.
“I think the access to healthcare needed to treat mental illness is the largest challenge for people in Ventura County,” she said. “We have to make sure that we protect the funding for these critical mental health programs.”
Capps said the Adelante program demonstrates that meaningful treatment is possible.
“This is a remarkable program that takes an innovative comprehensive approach to helping our young people who are in trouble with the law and struggling with mental illness and/or chemical dependency,” Capps said. “This approach has proven to be more successful in rehabilitating these young people than traditional approaches.”
In California, initiatives were passed by voters in recent years which address some of the problems of connecting mentally ill people with the proper services. Prop 63, passed by the voters in 2004, which provides some funding for services for the mentally ill, was intended to supplement the existing budget. But all programs are vulnerable to the budget ax right now.
Bhavnani said despite the “no supplementation” clause of the initiative, he believes the governor is misreading the issue.
“Of course, [Gov. Arnold] Schwarzenegger would have us believe that we’re getting so much extra money from Prop 63, you don’t have a problem, do you?” Bhavnani said.
Caseloads have increased from 20 per case worker up to 50, according to Bhavnani.
“That’s nuts. You can’t really provide service in any reasonable manner,“ he said. “Essentially, the clients are sort of vegetating out there. They are sliding backward, if anything.”
The disappearance of treatment
There is historical explanation of how mentally ill patients in California have ended up with practically no resources.
“In the 1970s [then-Gov. Ronald] Reagan shut down the state hospitals and moved people into the community,” Bhavnani said. “To move the people with mental illness into the communities, the counties were given the funds to do that. But, over the years, those funds have naturally declined.”
Bhavnani said even recently, some effective services were available.
“There used to be an ACT team, Assertive Community Treatment,” he said. It consisted of a team of experts who supported the mentally ill. The teams also ventured out of the hospitals and into the community to help the mentally ill homeless. All of this was funded through Prop 36, an initiative called the Substance Abuse and Crime Prevention Act of 2000. The money was distributed through the county.
But no longer.
“Those programs have been cut so the homeless have no help,” Bhavnani said. “The ACT teams have disappeared.”
Ventura County Supervisor Linda Parks has been working for increased housing funding for the mentally ill and has achieved a measure of success.
“Through the generosity of [businessman, billionaire and Westlake Village resident] David Murdock, the county was fortunate to be the recipient of a new residential facility for the mentally ill,” Parks said. “All together we now have 129 units of housing with 62 more units being considered.”
Parks said there is new funding which places mental health professionals in the jails, “But jails are a poor alternative to a hospital or other facility geared specifically around the needs of the patient,” Parks said. “Many of the inmates in the county jail have a mental illness, including more than half of the women prisoners.”
Parks said she knows a different overall approach is necessary.
“If we address the illness instead of just the actions of the mentally ill in our jails,” she said, “we can begin the healing process.”
Although funding for providing care for the mentally ill has been erratic and miserly, Capps sees some progress.
“I think we’ve made great strides in Ventura County in reducing the stigma surrounding mental illness and in recognizing that this serious disease must be treated just as any other type of physical illness,” she said.