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By Melissa Ford
Feb. 24, 2012
Good news! My mom finally obtained guardianship for Nathanial so maybe this will be the end of his cycling through the system — over a decade of hospital stays and jail time. We've jumped over so many hurdles to get to this point so hopefully we'll have the tools to make a real difference in his life.
I'll keep you posted as things move along.
Welcome to Vanessa Matheny's world where, daily, she and her family struggle to get the proper medical care for her brother, Nathanial, who was diagnosed with paranoid schizophrenia over 11 years ago. When I last wrote about Matheny [Living with Nathanial, LifeLines, Nov. 16, 2011], the challenges posed by the mental health system were daunting, yet she had hoped that guardianship would be their answer, giving her mother the authority to make decisions on behalf of Nathanial so he could get the medical treatment he had refused.
At the beginning of 2012, as Nathanial's downward spiral intensified, both physically and mentally, Vanessa, who is project coordinator for the Community Mental Health Board of Oak Park Township, took a bold step, filing a Petition for Involuntary Admission. Thinking that the legal system might provide some relief, her efforts were met with opposition from officials who were unfamiliar with the process for involuntary admission.
"I went back and forth about six times between the County Clerk's Office and the State's Attorney's Office trying to get questions answered. In fact, I was informed that the last time a Petition for Involuntary Admission had been filed in this particular county was almost 35 years ago," Vanessa explained.
But she persevered, finally filing the petition and appearing before the court where the judge, before taking any action, had to ascertain whether or not Nathanial was a danger to himself or another. Vanessa testified, setting forth all the reasons Nathanial needed medical intervention.
"I told the judge that this petition was our last-ditch effort," she recalls. "I explained that I had even approached the executive director of the county mental heath center to get services for Nathanial but was informed that Nathanial had to personally ask for help." The director was unmoved as Vanessa explained that her brother was incapable of asking for assistance because he is unaware that he is ill and needs help.
She described how her brother dismantles smoke detectors, pulls wires out of walls and extinguishes cigarettes on the floor of his home (which their parents provide him so he doesn't live on the streets). She testified that Nathanial doesn't shower and his health is suffering as a result of a 60-pound weight loss caused by his mental illness.
But the real impetus behind filing the petition? Nathanial had threatened to castrate Vanessa's younger brother with garden shears.
For years, she has been telling her brother's story to anyone who would listen: social workers, hospital staff, police, doctors. This time she got the judge's attention and the court took action.
A judicial order was entered, instructing the police to take Nathanial to a local hospital for an involuntary evaluation. Matheny met the police at her brother's house and when Nathanial was presented with a copy of the order, he became belligerent, directing his tirade at his sister.
"Nathanial says things I can't take personally because he isn't healthy. I don't want to see my brother in handcuffs and put into a squad car, but I also realize this is what's best for him. He needs help!
"My mother breaks down and becomes emotional, but knows that what we are doing is best for him," she says. "It's just hard for her to see Nathanial delusional, confrontational, lost; it's extremely difficult for her to see the police involved. My mom often thinks that if she had done something — anything — differently, maybe my brother's illness never would have happened. But it wasn't her fault; it just happened."
After Nathanial's evaluation, the doctor determined he needed additional psychiatric care. However, because the county lacks a behavioral health facility, it was necessary to transfer him to another hospital outside of the county where the petition had been filed. Unbeknownst to Vanessa, this would create additional barriers for helping him.
Throughout Nathanial's week-long hospitalization, the Matheny family was diligent, calling the hospital staff, the attending psychiatrist and the social workers every day. Then out of the blue, Vanessa received a call from Nathanial informing her that he was going to be discharged from the hospital on Wednesday and asking if she would pick him up. She was unable to speak to any doctor or social worker at the hospital to determine his status because her brother had refused to approve the communication.
Her only option was to go back to court, this time to seek guardianship.
On the day of Nathanial's discharge, Vanessa's attorney informed the judge that he was being released without any communication with the court or the family. In fact, there was no information forthcoming from the hospital about what had transpired during his hospital stay. The attorney asked the court to instruct the hospital to keep Nathanial to ensure his safety and to provide the court with an evaluation. The judge denied the request since the hospital was not located within the court's jurisdiction. Subsequently, Nathanial was discharged without a 48-hour notice being given to Vanessa as required by law.
It was the middle of winter. He had been escorted by police from his home without shoes, a jacket, keys to his home or an ID.
"We had no idea who Nathanial was discharged to; it wasn't any of our family members," she recalls. "We called all of his known friends. We didn't know where to look and the hospital would not tell us who he was discharged to. We were desperate because he was inadequately clothed and missing."
Not knowing what to do, she called the police, frantically explaining the situation. The police responded immediately and, by the end of the day, Nathanial had contacted his mother, informing her that he was home.
"It seems my brother remembered a phone number of a friend, and this friend's mother drove to the hospital and picked him up.
"This was another example of the system letting us down," said Vanessa.
The family continued pursuing guardianship. A public defender was appointed to represent Nathanial, explaining to him the guardianship process and that Vanessa was seeking to become his guardian.
"At that point my brother did not recognize me, and the public defender asked me to leave the room so he could discuss options with Nathanial," she recalled. One of those options was for Nathanial's mother to be guardian, but Nathanial refused.
This led to a Guardian Ad Litem being appointed and visiting Nathanial at his home to discuss other options. At the next court date, after other family members were interviewed as possible candidates, Nathanial willingly consented to his mother's appointment.
"Everyone was jubilant," Vanessa recalled. "Naively, I assumed we could take Nathanial to the doctor, get medication, or enroll him in a day program so he has something to do, be around people. In my mind, everything was perfect."
Instead, guardianship was ineffectual, only allowing Nathanial's mother to be privy to conversations with doctors, hospitals, social workers and, if need be, the police. It still fell short of giving her the authority to enforce medication, the real help Nathanial needed.
Nonetheless, Vanessa and her mother pushed ahead, attempting to schedule an appointment with the psychiatrist, who had evaluated her brother under the Petition for Involuntary Admission. Now the doctor informed them that she did not work with clients who were on Medicaid.
"At times, it feels when we take two steps forward," Vanessa observes, "we are knocked five steps back. So we had to start all over again and find another psychiatrist."
After finding another psychiatrist and scheduling Nathanial's his first appointment, more problems ensued. When Vanessa's mother arrived at Nathanial's home in order to take him to his session, he was agitated. When she didn't leave like he wanted her to, he became even more aggressive, pushing her and spitting in her face.
Every day without medication, Nathanial's behavior worsens so she had to make a decision. Should she call the police and have a wellness check performed or attempt to take him to his counseling session by herself?
She was able to get him to his appointment, but when the counselor discovered that Nathanial had been aggressive toward his mother, she suggested that Nathanial should voluntarily check himself into a hospital. Nathanial became upset and decided to end the session.
He left the psychiatrist's office but decided to remain in the waiting room. At this point, the counselor decided to begin the paperwork to have Nathanial involuntarily admitted and contacted the police station so Nathanial could be escorted to the hospital. Much to their surprise, six squad cars, two ambulances and a fire truck arrived on the scene.
The officers ran into the office, identifying Nathanial, and as an officer tried to grab Nathanial's hand to place him in handcuffs, he scratched the officer's face. He was put in a hold and placed on a stretcher face down.
At the psychiatric hospital, Nathanial was involuntary injected with an anti-psychotic medication. Though no stranger to involuntary admissions, this was the first time he was injected with medication. Over the last 11 years since his diagnosis of paranoid schizophrenia, Nathanial has been in the hospital for 52 days at a cost of $183,338. This does not include ambulance rides, psychiatrist appointments or discharge medications, which he would never take. Because the mental health system does not allow medication if Nathanial does not consent, roughly $3,535 per day was incurred. The Mathenys hands were tied.
After a 10-day hospital stay, Nathanial was once again discharged, but this time exhibiting noticeable improvements.
Slowly, he was beginning to engage in rational conversations, and the Mathenys kept their fingers crossed. Their hope all along was to start Nathanial on medication, which was the only answer to getting his life back. It took an unfortunate altercation with the police officer to get the involuntary injection, but it turned out to work in Nathanial's favor. Two weeks later, he had another counseling appointment, where he consented to a second injection of an anti-psychotic.
Nathanial's long road back to his former life was underway.
It's been five months, his longest period with medication, and Nathanial's life has improved dramatically. He has enrolled in online college courses, is eager to spend time with friends and family, and looks forward to his mother's home cooking, which for years he rejected, believing his family was trying to poison him.
Nathanial has taken road trips with his family and to everyone's surprise, he calls family members just to catch up. Even though these activities seem mundane, the Mathenys are in awe and extremely delighted because Nathanial, unmedicated, avoided family and friends, essentially losing his life these past 11 years.
And now there is another new chapter in Nathanial's life: Just recently, he was arrested and charged with a Type 2 felony (three months after the event) for scratching the officer and advised that he could serve up to seven years in jail with two years of parole or a possible six months in jail with four years of probation. His family is currently working with the prosecutor and judge to resolve the case, since he was not medicated at the time of the offense.
Vanessa Matheny's priority is helping her brother, but as a social worker, she's painfully aware that other families are challenged by similar barriers — waiting and then discovering they didn't make the right choices because they didn't have all the information, dealing with a loved one's resistance, waiting again, experiencing incredible stress, anxiety and worry about their loved one's safety.
"The system needs to change so people can get help before they endanger themselves or someone else," she insists. "No wonder people give up; no wonder hospital staff is always eager to say, 'Your brother is so lucky to have people who care about him.' Of course we do, but we need assistance, not only from medical professionals but police, as well as local and state leaders to fix our broken mental health system. All families with mentally ill loved ones need help and it needs to come now."