
{"id":3943,"date":"2008-11-13T08:41:00","date_gmt":"2008-11-13T16:41:00","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=3943"},"modified":"2011-12-15T12:16:51","modified_gmt":"2011-12-15T17:16:51","slug":"breakdown-difficult-decisions-in-a-void","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2008\/11\/13\/breakdown-difficult-decisions-in-a-void\/","title":{"rendered":"Breakdown: Difficult decisions in a void"},"content":{"rendered":"<p><em>This story is the fifth in a series about mental health care in North Carolina. To read the previous stories in the series, go to www.carrborocitizen.com<\/em><\/p>\n<p><strong>By Taylor Sisk<\/strong><br \/>\n<em>Staff Writer<\/em><\/p>\n<p>The decision to institutionalize or forcibly medicate a loved one suffering from mental illness is clearly very difficult. Balancing the desire to protect that person from harm against the wish to respect his or her free will is a delicate, imprecise calculation, particularly when the loved one is an adult. Opting for involuntary commitment or forced medication requires faith that sustained, comprehensive care will be available.<br \/>\n<!--more--><br \/>\nBut families in North Carolina are losing faith. Because beds and services for long-term care are all but nonexistent, those most critically in need are increasingly becoming the most neglected. <\/p>\n<p>\u00e2\u20ac\u0153The hospitals are too busy,\u00e2\u20ac\u009d says Carol VanderZwaag, a psychiatrist at XDS Inc., a nonprofit mental health care provider in Chapel Hill. \u00e2\u20ac\u0153The stays have gotten ridiculously short, and the rehabilitation beds \u00e2\u20ac\u201c which are the longer-term beds \u00e2\u20ac\u201c are essentially shut down right now.\u00e2\u20ac\u009d<\/p>\n<p>Area mental health care providers say that getting a patient in for more than a week stay is all but impossible \u00e2\u20ac\u201c even in situations when such patients may pose a threat to others or to themselves.<\/p>\n<p>Anita and Larry Shirley of Carrboro know this all too well. Their struggle to come to grips with how much pressure they could exert on a family member to continue seeking treatment was a struggle made immeasurably worse by North Carolina\u00e2\u20ac\u2122s post-reform mental health care system. <\/p>\n<p>David Shirley was diagnosed with bipolar disorder in 1996, at age 11. Over the course of the next few years, \u00e2\u20ac\u0153he muddled through,\u00e2\u20ac\u009d says his mother, Anita. But in 2002, his school work began to deteriorate and he seemed to be suffering more frequently from depression and from the side effects of the drugs he was taking for his disorder.<\/p>\n<p>In 2003, David began having rages in which he would throw things and break windows and get into altercations with his younger brother, Chris. <\/p>\n<p>David asked to be admitted to an institution. What ensued over the next couple of years was what his father, Larry, calls \u00e2\u20ac\u0153this in-and-out thing\u00e2\u20ac\u009d \u00e2\u20ac\u201c in and out of state institutions, a couple of private hospitals and a wilderness program.<\/p>\n<p>\u00e2\u20ac\u0153Basically, the care that he got [at the state institutions] was just to stabilize,\u00e2\u20ac\u009d Larry Shirley says. \u00e2\u20ac\u0153As long as he stopped being violent, then it was just trying to get him out as quickly as possible.\u00e2\u20ac\u009d <\/p>\n<p>At one institution, Shirley says, the chief psychiatrist actually laughed in his face when he asked if his son was going to receive therapy. <\/p>\n<p>\u00e2\u20ac\u0153He said, \u00e2\u20ac\u02dcTherapy? Therapy? Are you kidding me? This is not about therapy. This is just about getting to a point where we can get him out of here and hopefully he won\u00e2\u20ac\u2122t kill himself or anyone else.\u00e2\u20ac\u2122\u00e2\u20ac\u009d<\/p>\n<p>David had a few brushes with the law. One high-speed joy ride, with the police in pursuit, ended when David returned home, sat down and waited to be arrested. He had violent altercations with his mother. His parents involuntarily committed him several times, though his hospital stays generally lasted just a few days at most.<\/p>\n<p>David very much wanted to go to college. When he was accepted at Warren Wilson near Asheville, though, he lasted only a couple of months. He was smoking marijuana and, his parents believe, doing other drugs as well. <\/p>\n<p>One day he was found in his dorm room with the word \u00e2\u20ac\u0153Help\u00e2\u20ac\u009d carved into his forearm. His mother picked him up and David flew into a rage on the drive home, resulting in a call to the police and a trip to UNC Hospitals.<\/p>\n<p>\u00e2\u20ac\u0153I think that he was just really upset that it was all crumbling before his eyes,\u00e2\u20ac\u009d his mother says. \u00e2\u20ac\u0153Because he really wanted [to be in college], but he just couldn\u00e2\u20ac\u2122t control himself.\u00e2\u20ac\u009d<\/p>\n<p>David was now 19 and, says his mother, to meet him at that time, \u00e2\u20ac\u0153Your impression would have been of a young man, kind of sad, a little depressed, not a lot of self-confidence. But you could talk to him. There would be no reason you would think this kid \u00e2\u20ac\u00a6 has a problem.\u00e2\u20ac\u009d<\/p>\n<p>But there was a very serious problem, and nothing was working.<\/p>\n<p>\u00e2\u20ac\u0153Outpatient treatment wasn\u00e2\u20ac\u2122t working,\u00e2\u20ac\u009d Larry Shirley says. \u00e2\u20ac\u0153Visiting the psychiatrist for 15 minutes or 30 minutes of medicine management wasn\u00e2\u20ac\u2122t working. He was a danger to himself and a danger to others, but nobody would take him. There was nothing. A complete void.\u00e2\u20ac\u009d<\/p>\n<p>No one offered any guidance, or a way out.<\/p>\n<p>\u00e2\u20ac\u0153Basically, nobody had a plan for what happens after you stabilize him,\u00e2\u20ac\u009d says Anita Shirley. \u00e2\u20ac\u0153What are we going to do with him? They kept on wanting to discharge him. But discharge him to what? What is he going to be doing?\u00e2\u20ac\u009d<\/p>\n<p>The Shirleys were advised by mental health professionals that they couldn\u00e2\u20ac\u2122t keep rescuing David; they should let him \u00e2\u20ac\u0153deal with it.\u00e2\u20ac\u009d<\/p>\n<p>His father says: \u00e2\u20ac\u0153He was giving signals that \u00e2\u20ac\u02dcI\u00e2\u20ac\u2122m in trouble. I need help.\u00e2\u20ac\u2122 But at that point we were out of options. We didn\u00e2\u20ac\u2122t know what to do.\u00e2\u20ac\u009d<\/p>\n<p><strong>The turning point <\/strong><\/p>\n<p>The point at which society says we\u00e2\u20ac\u2122ve crossed the line and violated a person\u00e2\u20ac\u2122s free will in the interest of protecting them is, says Clay Whitehead, a Chapel Hill-based psychiatrist \u00e2\u20ac\u0153a moving target.\u00e2\u20ac\u009d Societal norms change. <\/p>\n<p>But certain stipulations should always be prerequisite.<\/p>\n<p>If a person is to be forcibly medicated, will an inpatient bed and comprehensive care be provided to see through the effects of that drug and to plot the next stage of treatment?<\/p>\n<p>And if medication isn\u00e2\u20ac\u2122t the preferable option, what is, and who\u00e2\u20ac\u2122s going to provide it? <\/p>\n<p>If we can\u00e2\u20ac\u2122t answer these questions, says Clay Whitehead, \u00e2\u20ac\u0153we\u00e2\u20ac\u2122re all complicit.\u00e2\u20ac\u009d In not demanding that these options be made available, regardless of the cost, he says, \u00e2\u20ac\u0153We\u00e2\u20ac\u2122re just not doing a very good job as citizens.\u00e2\u20ac\u009d<\/p>\n<p>The consequences can be tragic.<\/p>\n<p>In late 2005, after attempting suicide by taking a month\u00e2\u20ac\u2122s medication and walking off into the woods alongside the Warren Wilson College campus, David was transferred to Broughton Hospital in Morganton. There, his diagnosis was changed from bipolar to borderline personality disorder, and he was told that he no longer needed to be on medication, that it wouldn\u00e2\u20ac\u2122t help him.<\/p>\n<p>There\u00e2\u20ac\u2122s no question that David\u00e2\u20ac\u2122s condition was complex, says his father, \u00e2\u20ac\u0153that it wasn\u00e2\u20ac\u2122t a pure diagnosis in any one area. There\u00e2\u20ac\u2122s no question that it was a really difficult case in that regard. <\/p>\n<p>\u00e2\u20ac\u0153But to make that kind of statement to him was just devastating in terms of getting any future treatment for him.\u00e2\u20ac\u009d<\/p>\n<p>David was an adult, so the law allowed him to make his own decisions. Having been shuttled in and out of too many facilities on too many occasions, he\u00e2\u20ac\u2122d utterly lost faith in the public mental health care system. And he felt that private care was a waste of his parents\u00e2\u20ac\u2122 money.<\/p>\n<p>\u00e2\u20ac\u0153He felt bad,\u00e2\u20ac\u009d his mother says. \u00e2\u20ac\u0153It was like, \u00e2\u20ac\u02dcYou guys shouldn\u00e2\u20ac\u2122t spend this money. I\u00e2\u20ac\u2122m not going to get better. It\u00e2\u20ac\u2122s just wasting money.\u00e2\u20ac\u2122\u00e2\u20ac\u009d<\/p>\n<p>David again took an overdose of his medication. He tried school again, at Western Carolina, but was kicked out for being drunk and disorderly in his dorm.<\/p>\n<p>One night in February 2006, he went on a drinking binge. His mother says that he was extremely sad, that he had been jilted by a girl, \u00e2\u20ac\u0153and it was just one of those horrible, horrible, horrible nights that you can have when you want to be with a girl and she\u00e2\u20ac\u2122s with another guy, and it just sucks.\u00e2\u20ac\u009d <\/p>\n<p>After being up all that night, he went the next morning to see his closest friend from high school, a student at UNC who lived in Craige dormitory.<\/p>\n<p>His friend wasn\u00e2\u20ac\u2122t home. David walked across the street to Morrison dorm, which was then closed for renovations. He climbed over the barriers and up the building to the top, the 10th floor. He called his brother and told him that this wasn\u00e2\u20ac\u2122t about him, that it was just something he had to do. Then he jumped. <\/p>\n<p>David somehow survived the fall and was conscious when he was found by construction workers. He was still conscious when he arrived at the hospital, but was then sedated due to his massive injuries. He died a week later, on March 1.<\/p>\n<p>\u00e2\u20ac\u0153What we had wished for,\u00e2\u20ac\u009d says Anita Shirley, \u00e2\u20ac\u0153was that there was a place where we could have taken him where he could have been safe, away from drugs, away from alcohol, a safe environment, for like a month or two, so that they could establish the right medication for him. But that place didn\u00e2\u20ac\u2122t exist.\u00e2\u20ac\u009d<\/p>\n<p>Worse still is the fact that David\u00e2\u20ac\u2122s parents believe the longest, and nearly the last, inpatient treatment he did receive was disastrous.<\/p>\n<p>\u00e2\u20ac\u0153Somehow I wish I could have intervened to keep him from going to Broughton Hospital,\u00e2\u20ac\u009d his father now says. \u00e2\u20ac\u0153That was such a negative thing overall and such a turning point. <\/p>\n<p>\u00e2\u20ac\u0153To have gotten him anywhere else at that point \u00e2\u20ac\u201c whether it would have saved his life, I don\u00e2\u20ac\u2122t know. But it would have given him a better chance.\u00e2\u20ac\u009d Having been told there that he no longer required medication, \u00e2\u20ac\u0153he was much more resistant to care, treatment and hope. <\/p>\n<p>\u00e2\u20ac\u0153I think it took away his hope.\u00e2\u20ac\u009d<\/p>\n<p><em>Next in the series: Finding solutions<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This story is the fifth in a series about mental health care in North Carolina. To read the previous stories in the series, go to www.carrborocitizen.com By Taylor Sisk Staff Writer The decision to institutionalize or forcibly medicate a loved one suffering from mental illness is clearly very difficult. Balancing the desire to protect that&#8230;<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-3943","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/3943","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=3943"}],"version-history":[{"count":3,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/3943\/revisions"}],"predecessor-version":[{"id":22421,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/3943\/revisions\/22421"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=3943"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=3943"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=3943"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}