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One family’s mental health nightmare, and what it reveals about our mental health system

One family’s mental health nightmare, and what it reveals about our mental health system

Picture of Nick Welsh
Photo by John Morgan via Flickr.

Patrick Hickey walked in a while back, an explosion of erudite indignation. I’d just written a long bureaucratic story describing how Santa Barbara County mental health administrators had finally — after umpteen years — drafted a major blueprint detailing the vast gap between the mental health facilities the county needed and what they actually had. It may seem basic, but it was the first time such a menu had been prepared. Hickey, a fit, stocky guy in his early 70s with ridiculously blue eyes, wanted to talk about it. A lot. Hickey was sputtering about the Puritans, how the Puritan tradition in the United States was to blame for everything wrong with mental health and addiction treatment in this country. Hickey was from England, where he was a doctor who treated addicts. He let me know how much healthier England was for having gotten rid of the Puritans in the 1600s, cutting off their noses, branding their foreheads, and letting them set sail for Plymouth. It was interesting, but not to any point I could use. He then explained how I was going to help him expose all this. Any interest I had quickly ran out the door. He then got to the point. Hickey told me how his mentally ill and autistic son, Everest, was locked up in solitaire after having tried to strangle his mother, Hickey’s third wife. Her name is April.

I started to pay attention.

It happened just two days after Everest had been released from the ER, where he’d been placed on a 5150 hold. He’d been threatening to kill Hickey‘s wife and two younger children and bury their bodies in the backyard. It wasn’t Everest’s first run-in with mental health. Everest was 17 at the time, 6’4” and weighed about 240 pounds. He didn’t talk much, if at all. He’d been locked up in Vista del Mar in Ventura County, the only psychiatric lock-down that accepted minors, a couple times already.

After 72-hours in the Cottage Hospital ER, Everest’s 5150 hold expired. There was no place to put him that had bed space. The head of psychiatry at Cottage said he needed a second hold. The head of psychiatry for the county said the same thing. Hickey had the paperwork to prove it. But their recommendations were overruled by a high-ranking county administrator for reasons that remain unknown. According to Hickey, he and his wife were told they had two choices. They could take their son home or have him made a ward of the court. But they had to decide right then. They opted to take their son. Shortly after, Everest made good on his threat. He tried to kill his mom. It took five people to peel him off: three adults and Everest‘s two younger brothers. Everest was arrested and charged with attempted murder. He was placed in the south county’s empty juvenile hall. He was the only inmate there. He was getting decent attention, Patrick Hickey said. Everest was no longer eating his own feces, he noted. Everest, I was told, was being charged as an adult, not a juvenile. It sounded crazy to me. Patrick Hickey wanted to take his son home to England. There, he would be treated as a sick soul and not prosecuted as a criminal. He would receive medical therapy, psychological counseling, and medications as needed. He would get better. “The puritans!” Hickey exclaimed. He would do that a lot.

Hickey didn’t ask, but I told him anyway. It would never happen. He was trying to thread a needle that had no eye-hole. They’d never cut his son loose. Everest would soon turn 18. He would be an adult and under no obligation to do anything his parents said. If taken to England, he could get on a plane and fly back to the United States. He had dual citizenship. And if Everest relapsed — refused to take his treatment seriously —someone could get seriously hurt.

Naturally, it’s more complicated. It always is.

In Santa Barbara, the one agency that could have treated Everest’s autism refused to do so. Everest was not really autistic, they concluded. But because the Hickeys had a written diagnosis from a health care specialist saying Everest was, in fact, autistic, that further restricted where the ER doctors could release him. It had to be a facility that handled mentally ill autistic juveniles. There’s only one in the whole state of California — Hoag Hospital in Newport Beach. At the time, Hoag had no available beds.

In the intervening months, Everest Hickey has spent time in the abandoned juvenile hall. The absurdity of his son being the only person locked up in a 100-bed juvenile hall when he couldn’t find a single bed in a mental health facility has not been lost on Patrick Hickey. It’s something else to blame on the Puritans. No doubt he is correct. Perhaps he’s also correct that California’s Petris-Lanterman Act — the Magna Carta of mental health laws — stems in some fashion from the Puritans’ pernicious influence. I don’t know. It’s worth noting that Hickey lost his medical license in England after one of the heroin addicts under his supervision overdosed and died. Hickey would fight for re-instatement and eventually he would win. The scar tissue, however, remains angry and inflamed. One can’t help but suspect that Patrick is projecting onto his son a battlefield on which he can re-fight his own war. 

As someone who’d covered mental health in steady bureaucratic dribs and drabs, Hickey provided me a vehicle to tell the same old story in a new way. First and most obviously, there are the facts themselves. How was his son cut loose when he clearly posed a risk to his immediate family? How in that circumstance does it make any sense to charge him as an adult with attempted murder? Everest, by the way, has subsequently turned 18 and been deemed incompetent to stand trial. That means he’ll be sent to Patton State Hospital, if and when any bed space there opens up. In the meantime, he has been transferred from the juvenile hall to the county’s Psychiatric Health Facility (PHF), which has only 16 beds. They’re supposed to be reserved for people in acute crisis meltdown. Patrick is no longer that. Increasingly though, PHF beds are occupied by people like Patrick, who tend to stay for far longer than the acute care patients for whom they are really intended.

For me, Patrick’s rants are ideological storms I wait out or try — ineffectually — to waive off. I’m much more interested in what kinds of treatment are available in other places, like England, where those with serious mental illnesses get treated, not prosecuted. Do such places exist? Do they do any good? Can they help? Are there ideas — practices — we can learn from? Better yet, are there any we can steal?

I’ll explore these questions as part of my 2017 California Fellowship.

[Photo by John Morgan via Flickr.]

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