The thing that struck me when I first met my cousin Houston was his size. On the other side of the visitors’ glass, he looked surprisingly small, young for his 22 years. The much more remarkable thing about him turned out to be his vocabulary, vast and lovely, lyrical almost—until it came to an agitated or distracted halt. He seemed altogether unlike a person who had recently murdered someone.
The symptoms displayed by Houston in the year preceding this swift and horrific tragedy have since been classified as “a classic onset of schizophrenia.” At the time, it was just an alarming mystery. Houston had been attending Santa Rosa Junior College in Northern California, living with his mom, and playing guitar with his dad when he became withdrawn and depressed. He slept all day, his band broke up, and suddenly he had no friends. His dad, Mark, and his mom, Marilyn, tried to help. They took him to a psychiatrist, who indicated possible schizoaffective disorder in his notes and put Houston on a changing regimen of antidepressants over the next eight months. It didn’t make any difference. He got fired from multiple jobs. Houston started stealing his mom’s Adderall. He said it helped him feel better. She kicked him out, and he moved in with his father.
“This was not my nephew,” Aunt Annette, Mark’s sister, says of Houston’s behavior then. “He was always solicitous and loving and talkative with me. Now he was anxious, quiet, said very strange things. I asked him how his therapy was going, and he said, ‘Terrible.’”
Toward the end of Houston’s devolution, he started having violent outbursts, breaking furniture; he tossed his mother across a room. Desperate, his parents called the psychiatrist repeatedly and asked what they should do. He told them to phone the police.
But Mark didn’t want to call them. For one, he didn’t think Houston was that dangerous—just upset, despairing. Also, he didn’t think three days of lockdown in a facility would make his son more stable. He was looking for a meaningful treatment plan. “Just let me handle it,” he told Marilyn.
So Mark didn’t call the police, and Houston didn’t get any additional help. He was having delusions, something about telepathic communications and aliens and wireless circuits. Something about his mom and dad—who’d been divorced for a long time—and teenage sister, Savannah, being in a sex ring. Something about an invisible friend, and that he’d been cutting himself to exorcise the evil, and also that Mark was poisoning him with lead and was the source of the evil.
And then Houston came home late one November night in 2011 and stabbed his father 60 times, with four different knives. By the time his sister came downstairs and called 911, it appeared Houston was trying to behead Mark.
Roughly one year after her brother’s death, still mourning, Aunt Annette spoke to me about Houston. She told me that even though what he did was “so heinous,” it didn’t mean that he wasn’t a victim. “Because I love this child. I was there at his birth. I know how sick he was.” And then she asked me to do the talking for a while because she was sobbing.
Psychiatrist E. Fuller Torrey, MD, a researcher who specializes in schizophrenia and bipolar disorder and the founder of the Treatment Advocacy Center, a national nonprofit organization dedicated to promoting timely and effective treatment of severe mental illness, calls a crime like Houston’s “a predictable tragedy.” That’s what he’s also called many other shootings—at Virginia Tech in Blacksburg, the movie theater in Aurora, Colorado, and Sandy Hook Elementary School in Newtown, Connecticut—as well as dozens of other recent homicides. The chances that a perpetrator of a mass shooting displayed signs of mental illness prior to the crime are one in two. Ten percent of U.S. homicides, Dr. Torrey estimates based on an analysis of studies, are committed by the untreated severely mentally ill—like my schizophrenic cousin. And, he adds, “I’m thinking that’s a conservative estimate.”
Obviously, many violent acts in our society are perpetrated by the “sane.” And most of the violence committed by the severely mentally ill is inflicted on themselves. Even in the range of schizophrenia narratives, which commonly end in suicide or dying on the streets, Houston’s took an extraordinarily terrible turn. But happy endings are getting harder for even the nonviolent mentally ill to come by. As states and counties pare back what few mental-health services remain, we’re learning that whether people who need help can get it affects us all.
Next: “Do whatever you have to do to get her in the car” »
Aunt Terri: Same Illness, Different Story
Houston’s schizophrenia was not the first instance of severe mental illness in my family. My Aunt Terri—my mother’s baby sister—had a psychotic break in 1977, when she was 16. She lived near my mom in Ohio and appeared in her backyard one day, pacing, raving in outer-space language, and swinging her arms wildly.
“Do whatever you have to do to get her in the car,” the general practitioner said when my mother phoned him and described the scene. He told her to get her sister to the Woodruff Psychiatric Hospital in Cleveland by any means necessary. So my mom told her sister that she would take her to the airport because the only discernible thing that Terri was babbling about was that Chris Squire, the bass player of the rock band Yes, was sending her messages that she needed to meet him in Canada right away.
It took five white coats to contain Terri as she tried to scream and fight her way out of the hospital lobby. Terri—straight-A’s bright and talented—was schizophrenic.
My grandparents tried bringing her home. They weren’t medical professionals, and for years she was in and out of the hospital as they struggled to get her to take her medication and to care for her when she wasn’t stable. But after several violent episodes, including a fight that ended with my grandmother’s arm broken, Terri was moved to a group home. Within six months, she was thrown out, so my grandparents got her a duplex. She was evicted. She got another apartment—and was evicted again. Two more group homes in Cleveland—evicted. Another apartment—evicted. With the state hospital, Cleveland Psychiatric Institute (CPI), long since closed by then, making hospitalization no longer an option, Terri was running out of places to go.
Fortunately, my aunt lived in a state, Ohio, where leaders at the Department of Mental Health were determined to build a model for post-deinstitutionalized life. It was an excellent case manager who helped solve Aunt Terri’s housing crisis. Eleanor Dockry, a tiny woman with chin-length black hair and black-framed glasses, was assigned Terri’s case through a nonprofit agency supported by the county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) board—essentially the rump of what was supposed to have been the community-services network envisioned by the reformers of the ’60s—and a slew of other local organizations. Eleanor sat my grandparents down. “I think if you could afford to buy something for her, that would be good,” she said. My grandparents pulled together the money for a trailer in a mobile-home community near their house.
A lifesaver, Eleanor took care of my aunt for 23 years. She came by at least once and sometimes twice a week. She took Terri to her favorite restaurant, McDonald’s, to the park, or to the store to buy her nieces presents with money from her Social Security check. Every three weeks, Eleanor took her to get her antipsychotic haloperidol injections. She took her to Neighboring, a local nonprofit organization, which offered field trips, skill-building lessons, art classes, and support groups about medication side effects.
Terri was able to live on her own for almost two decades. In 2012, my Aunt Paula came to pick Terri up for her weekly grocery shopping and found her dead in the cold winter grass. This isn’t as bad as it sounds. It was, in fact, the best-case scenario. She died in her own yard, where she had lived her own life. Young, at 52, yes, but not a terrible age for a body doused in antipsychotics and cigarettes. Yet more and more these days, Aunt Terri’s scenario is an unlikely one. It took a lot of work on the part of my grandma and Aunt Paula and 23 years of dedication by a caseworker. It’s work that nobody wants to do, work that counties and states are increasingly not paying for.
Next: Vanishing mental-health support »
The Vanishing Mental-Health Safety Net
The first hospital my mom checked Aunt Terri into no longer exists. Neither does CPI, where she was taken later. In the 1950s, more than a half million people lived in U.S. mental institutions—one in 300 Americans. By the late ’70s, only 160,000 did, due to efforts by psychiatrists, philanthropists, and politicians to deinstitutionalize the mentally ill.
Today there’s one public psychiatric-care bed per 7,100 Americans—the same ratio as in 1850. The motives behind this trend were varied. Emptying the asylums was going to save money. And who needed hospitals with all the antipsychotic drugs on the market? Deinstitutionalization was going to restore citizens’ rights and protect them from deplorable conditions like those portrayed in movies like One Flew Over the Cuckoo’s Nest, conditions in which a sane person would go crazy and a crazy person was unlikely to be cured. Wouldn’t it be better if the mentally ill were treated at home, given support, therapy, and medication via community clinics? It sounded good, but the reality was quite different.
In 1961, a joint commission of the American Medical and American Psychiatric associations recommended integrating the mentally ill into society. This plan depended on the establishment of local facilities where mentally ill people could receive outpatient care. Congress passed a law providing funding for these “community mental health centers” in 1963, and states, under pressure from the patients’ rights movement, downsized their psychiatric hospitals faster than anyone had anticipated.
Between the Vietnam War, an economic crisis, and a lack of political will, adequate funding for community services never came through. In 1980, the Mental Health Systems Act was passed to fill the gap. But a year later, Ronald Reagan gutted the act, then decreased federal mental-health spending by 30 percent and shifted the burden to state and local governments. The crucial community services that the mentally ill were supposed to receive failed to materialize, and more and more people ended up on the streets. Collectively, states have cut $4.35 billion in public mental-health spending since 2009.
As of 2006, 1.3 million of America’s mentally ill were housed where they used to be until the late 1800s: in prisons. Between 1998 and 2006, the number of mentally ill people behind bars more than quadrupled. In some county jails, rates of inmates with mental illness have increased by nearly 50 percent in the past five years. It’s not uncommon for individual jails to report that 25 to 30 percent of their inmates are mentally ill or that their mentally ill population rises year after year.
“None of us are suggesting that we need to go back to 1930, when a psychiatrist could say, ‘I don’t like the sound of your voice, so I’m going to keep you in my facility—which I also happen to own—for three weeks,’ ” says Dr. Torrey. “You have to have a system of checks and balances.”
What Will Happen to Houston?
The pendulum, however, has now swung far past patients’ rights and well into the territory of wild neglect. The dismantling of the mental-health system has left those willing to undergo treatment with no options and rendered ineffective the laws intended to protect against dangerous scenarios. “Danger to self or others is defined too [stringently],” Dr. Torrey says. In the eight states where danger to self or others is the sole trigger for treatment, “you either have to be trying to kill your psychiatrist or trying to kill yourself in front of your psychiatrist” to receive assistance.
Regardless of what you think about commitment rules, the bottom line is that decent facilities need to exist. “A psych ward in a general hospital that’s set up to see people with eating disorders and depression” is not equivalent to a psychiatric-care facility, Dr. Torrey says. If my uncle Mark could have taken Houston to a well-staffed hospital with an open bed and properly administered antipsychotic medications, maybe his crime could have been not only predicted but also prevented.
“Hospitals are motivated to get people out as quickly as possible. We ignore the mentally ill until they commit a crime that lands them in prison,” says Robin Lipetzky, the chief public defender of Contra Costa County, near San Francisco Bay. “Over and over again, we see situations where the parents of those who commit these offenses … say they’ve been trying and trying to get treatment for their kids, and it’s just not available. And it’s usually young adults. There’s not enough out there in terms of resources for families.” She concedes that calculating the cost of treatment of the mentally ill is not so easy to do. “How do you put the price,” she asks, “on people losing their lives when [someone has] a psychotic break?”
Houston had already been incarcerated for 430 days the first time I visited him back in January 2013, costing the county $49,811 in jail expenditures. He received medication but no therapy. After I identified myself as a cousin who knew Aunt Annette and we settled into our visiting-booth chairs, he explained, without complaining, that he wasn’t exactly thriving there. He talked about his illness a little, how he’d had “some episodes” that had landed him in the most acute cells of the most serious of the jail’s three mental wards—“the dungeon,” which includes rooms with padded walls and no socializing and sometimes sick people yelling and screaming on all sides. “You would have a nervous breakdown,” he told me, “just standing in there for ten minutes.”
We did not talk about Uncle Mark or about how Houston had gruesomely killed him, or, as unspeakable as that was, that sometimes unchecked mental illness can lead to far worse tragedies, when access to guns meets delusions centered on a movie theater or a temple or a school.
The last time I saw Houston was in a courtroom at the end of February 2013. It was yet another hearing to set his trial date for April 5. He didn’t look at me, or at anybody, not even his mother, Marilyn. Houston kept his tortured-looking face pointed at his twitching thumbs, probably wondering, amid his delusions—despite antipsychotics, he still suspects people of being conniving extraterrestrials or robots—whether his NGI (not guilty by reason of insanity) plea will be accepted by a jury.
Ultimately, it was. Ultimately, Houston was not sentenced to prison but was moved to a psychiatric hospital in California. There he’ll remain for years, or maybe forever, occupying one more bed that won’t be available to one more person having trouble until it’s too late.