Focus: Adults in the Room - Lost Patients: Against Their Will

Episode Date: March 19, 2024

Across the U.S., efforts are underway to make it easier to involuntarily commit people to psychiatric hospitals. It's a reaction to the sight of seriously mentally ill people on the streets and the cries of families who say it's too hard to get a loved one help when they're in crisis. But this gets at one of the most delicate questions our society has faced: When does our belief about what's best for someone override someone's right to decide for themselves?See omnystudio.com/listener for privacy information.

Call your friends, your partner, and maybe a babysitter, because Seattle Restaurant Week is here. I'm Brandy Fullwood, host of Seattle Eats, and on the latest episode, Seattle writer Harry Cheatel has been doing the math so you don't have to. We'll tell you about the deals, dishes, and drink pairings worth checking out this Seattle Restaurant Week. Listen to Seattle Eats on the KUOW app or wherever you get your podcasts. Lost Patience is about serious. mental illness. This episode mentions suicide and includes some details about violence, so it might be disturbing for some listeners. Hello, my name is Kathleen. I have a son with schizophrenia, and if you would like an

inside look at the frustration of trying to get him help, I just had the police out here for the fourth time. Kathleen is leaving a voicemail for the Seattle Times. She's been trying for a couple weeks to get her son committed to a psychiatric hospital. Imagine for a moment, feeling so defeated, you just want someone there to witness how bad things are going. I have been trying for so long. He's in a psychotic break and they let him go. Please call me. Thank you. Bye. When you're reporting on problems with psychiatric care, this is one of the most common stories you hear. A family member, often a parent, trying to get a loved one, often a grown child, into a psychiatric hospital.

The parent wants their kid to be somewhere safe, where they can get treatment. But the child doesn't want to go, maybe because they understandably don't want to be confined against their will, or because a common symptom of serious mental illness is not believing you're sick. So here's where the parent crashes into our society's legal standard for taking away a mentally ill person's rights. They have to prove their child is so ill they're a danger to themselves, a danger to others, a danger to someone's property, or so unable to care for themselves that their life is in danger. This is a high bar to clear with specific steps to follow. To the parent,

this can feel like being stuck at a rickety doorway to psychiatric care, with a knob that sometimes works if you play with it, or that someone accidentally locked? Later in this series, we'll look deeply at what's behind this door, the institutions of psychiatric care and why they are the way they are. But for now, we're just going to focus on this entryway, because a lot of politicians at the moment agree that a solution to getting seriously mentally ill people off the streets is to fix this door, to make it easier to bring people to psychiatric hospitals against their will and hold them there. Their efforts to do this going on right now from New York to California, the brokenness of

this door is something a lot of Republicans and Democrats actually agree on. But this gets at one of the most delicate questions our society faces. When does our own belief that we know what's best for someone override their rights to decide what happens to their own bodies and minds? All Kathleen knows in this moment is that if her son Vinny is suicidal, his life is at risk. Plus, Vinny's been wandering Seattle, he's well over six feet tall, and he's acted aggressively towards strangers and his neighbors. He's already been arrested for assault and theft at a local supermarket and released

the first arrest of his life. To Kathleen, involuntary commitment is Vinny's best hope. Whether or not she can get this door to open may determine whether he's, he lives or dies. We're getting really confused over here. I don't know how to navigate this system. I'm just hoping that Vinnie's... I'm just trying to keep him alive.

Right now, just trying to keep him alive. I'm Will James. From KUOW and the Seattle Times, this has Lost Patience. Episode two, against their will. Yes, I'm Kathleen. I'm Will. The day after,

Kathleen left that voicemail. I'm sitting across from her in the sunny little house in Seattle where Vinnie grew up. Kathleen and her husband Michael, Vinnie's stepdad, are both retired college professors. Propped up on a table in the dining room, they've got one of Vinny's drawings in a brown frame. It's a cartoon guy on a bike done in Vinny's signature style. Vinny puts pencil to paper and without picking up the point, weaves entire scenes out of a single unbroken line. He would do very large ones of those.

And then when he's symptomatic, he just did thousands of them. Also? Yeah. Some of them are, I mean, they're quite amazing. He has a real artistic ability. When Vinnie was in his late teens, half a lifetime ago, he got a diagnosis of schizoaffective disorder, sort of a hybrid between schizophrenia and bipolar disorder.

It's given him episodes of disorganized thinking and paranoid delusion. Now he's in his 40s. For Kathleen, life with Vinny has meant trying to connect with her son across the barrier of psychosis. His posture changes, his voice changes, and his eye movement changes when he's in a psychotic. Yeah, he smells different. This is a conversation I had with Vinny. His voice goes really low.

He goes, hey, mom, and I said, uh, what did you say? say Vinnie? He goes, you know what I said. And then we kept going on. He goes, he draws a square in the air. He draws a square with his two pointer fingers in the air. And he goes, communication barrier. But after two decades of Vinny's illness, Kathleen has moments. She thinks she can intuit what Vinny's saying, even when his thinking is disorganized. Vinny goes straight to the highest abstraction level and you don't see the steps that got him there. He came in with

an old travel size toothpaste that had a little bit of toothpaste in it goes, this is my retirement plan. I knew what he was talking about. Kathleen thinks Vinnie was referencing the idea of setting aside money a little at a

time, like leaving a little bit of toothpaste in the tube instead of using up the whole thing. That kind of worried me at times that I understood what he was talking about. Look, Mom, this is Vinnie. Throwback, big time throwback.

This is a voicemail. Vinnie left Kathleen a few days after we met while he was still in the middle of his psychiatric crisis. I love you deeply. I appreciate you. You have been the most important person in my life. I'm not making that up. So I say throwback because, you know, I haven't said I love you in a long time. And honestly, we're We make mistakes and I just, I wanted to rethink. As Vinny goes on, his thoughts seemed to scatter. The umbilical court got cut, but I'm still here, you know, so I still have that connection to you. So that's a gamble, but I'm four times a charm, it'll cube it to you and I'll get maybe

exactly what I need. And, you know, there's no crisis. been on medication for years, and it's given him long stretches of stability. He's been able to live on his own in a condo that Kathleen bought for him less than two miles from here. In that respect, at least, Vinnie is lucky. That is not an option for a lot of families. He lives off disability payments, and he's also had jobs like delivering food and working security. But a few weeks ago, Vinnie started to worry Kathleen and Michael. He began showing up at their house sometimes before dawn, Kathleen would wake up and see him on their security camera outside, milling around

in the dark and then leaving. Vinny was paranoid, and when he gets paranoid, no place is safe. And his apartment wasn't safe. People are trying to get in. People come walk in. They steal things, so he won't go back there. And that's sometimes why he comes here then. He would come in, he'd be nice, and then he would just lose it and just be completely irrational

and were stealing money from him, and then he would go away, and then he would come back, and he just couldn't hold it together. So we knew he was on a downward trend. Then Vinny got arrested for stealing a roast beef sandwich from a grocery store, eating it outside, and then squeezing the arm of an employee who confronted him. Kathleen started getting texts from worried neighbors in Vinny's condo complex. One said Vinnie talked about being suicidal and asked for help. Another said Vinnie started punching a window of a car in the parking lot while a couple was inside it.

Complicating all of this is that people in psychosis sometimes direct their paranoia at those closest to them. And for Vinnie, that's Kathleen. For me, one of the hardest things is when Vinny is symptomatic, and this is going to be hard. He is so incredibly awful to his mother. He says things you can't imagine. someone saying, and you know what's going on, but oh my God, it's so hard. I know they're not true, you know.

But it's just so full of hate and anger and vitriol is so painful. I'd said I'd crawl through a burning building on my elbows. I go to the far reaches of the Cosmo and drag them back. Those things he says to me, that's not the hard part. If that's not the hard part, what is the hard part? Seeing him suffer. Seeing him suffer, knowing he's suffering, knowing he's terrified, wondering where he is. That's the hard part. Kathleen and Michael have tried for decades to keep Vinny as stable as possible. Research shows

that after someone's first psychotic break, if you can get them on medication right away and keep them stable, they tend to do better long term. Stability is a positive feedback loop. Psychosis is a negative feedback loop. Each episode of psychosis can cause brain damage, making future episodes more likely and recovery more difficult. As if psychosis carves a groove in the mind. Kathleen and Michael believe the best hope of stopping this negative feedback loop

is to get Vinny into a psychiatric hospital. They've done it before a couple years ago to get through a different crisis. They know to get Vinnie committed they need to play a sort of game and win. It's a game of luck. They need to call a hotline that deploys people called

designated crisis responders, DCRs. These are the gatekeepers, a team of mental health professionals who have the legal power to send someone to a psychiatric hospital against their will. Every state chooses who has this power, and here in Washington, we came up with DCRs. So each time Vinny shows up at their house, Kathleen and Michael call the DCR hotline, and they

wait for someone to show up and evaluate him. They try to keep Vinny there as long as they can, stalling by offering him food and money, but it takes DCRs hours to get there, and by the time they do, Vinny has had an outburst and left. The case is closed and the process starts over. And the question Kathleen and Michael are left with is, why is this so hard? There's got to be an easier way for involuntary commitment. And I understand the complexity of it.

I do because involuntary commitment was used a lot by husbands who didn't want to deal with their wives, and that was effective. And they were locked up in institutions for decades, for who knows what reason. So, yeah, the history is ugly, but part of that ugly history has changed. And so it doesn't have to be the same as it was when people were just warehoused and it was awful. It doesn't have to be that. So why is this so hard? It turns out there are a couple ways to answer that question.

Looking for a great place to stay for that big trip, maybe you just want to find that right restaurant in downtown Seattle. More and more people are turning to social media for these answers. But is that affecting the experiences we're actually having? I'm Dyer-Oxley, and on the next episode of Meet Me Here, I'm chatting with travel expert Rick Steves and two Seattle girls to help navigate a world where everyone can be an online expert. Listen to meet me here on the KUOW app or wherever you get your podcast.

Every time Kathleen calls the DCRs, her cry for help pops up on a computer screen in this county office in downtown Seattle 10 miles away. The call shows up as a line of text with Kathleen's name, Vinny's name, and other bits of basic information. Lauren Richards is one of the people who might see it. She was a DCR for five years and is now a supervisor. My mom has pretty serious mental illness and hasn't been in my life since I was 16. And I'm pretty convinced that I've ended up here trying to help people because I couldn't help my mom. I don't want other people to end up in situations where their loved one isn't in their life anymore because of their mental illness. Lauren used to work a different job in community mental health.

And back then, when she had a client who was in a psychiatric crisis, there was only so much she could do. but then the DCRs would roll in like a Calvary. DCRs were at the top of the food chain of behavioral health. You know, when you had a client who wasn't doing well, the DCRs would show up and they just would take command of the situation and you didn't always necessarily understand or agree with their decisions, but they just seemed like they knew what was going on and they were the folks who actually had the power to get people into treatment and get them help.

I don't know that it always feels that way as much once I became a designated crisis. The way this is supposed to work is that a DCR calls back Kathleen, gets the basic facts of what's going on, and a pair of DCRs drive out to her house. They talk with Kathleen and Michael, talk with Vinny, and try to figure out if Vinny checks one of four boxes that mean he can be involuntarily committed to a psychiatric hospital. Box one, he is a danger to himself. This would mean he is at real risk of suicide. Box two, he is a danger to others.

This would mean his threats to hurt someone are serious, and this is important, a result of his mental illness. You don't have to be mentally ill to want to hurt someone. Box three, he is a danger to someone's property. This usually comes up when someone's psychosis causes them to flood their apartment or set it on fire. Box four, he is gravely disabled. This means he'd have to be so much.

disabled by mental illness that he's basically at risk of dying. When the weather gets really cold, can they find shelter at night? Are they dressed appropriately for the weather? Can they safely navigate the streets? Those are the kinds of things we're looking for. DCRs say no to involuntary commitment in about half of cases. Lauren says their job isn't just to make sure people end up in a hospital. An equally important part of their job is making sure people who legally should not go to a hospital,

aren't forced to. But if Vinnie did check any of those boxes, the DCRs would call an ambulance, call a police officer to help get Vinny onto a gurney, and then have him brought to an emergency room where he'd get checked out. So as for Kathleen and Michael's question, why is this so hard? The first answer, like so much of what's wrong in psychiatric care, is a simple matter of resources. In the county where Seattle is, a county with more than two million people, there are currently 30 DCRs responding to these calls. They're supposed to be 42, but about a third of the jobs in this office sit empty. I believe it probably goes back to funding and we need to pay people more. This job is very difficult. We're a 24-7 program, right? We never close down. So you're

could potentially end up on night shift. You're going to be working weekends. We work holidays. You know, so it's pretty demanding. Back at the height of the pandemic, so many other psychiatric services shut down that pretty much every crisis fell on the DCRs. They were getting 200 to 250 calls a day. Their average response time shot up to 11 days. A lot of DCRs decided they could find better paying less stressful work elsewhere. DCRs are required to respond to calls from hospitals and jails first within a couple hours. But when regular people like Kathleen and Michael call, there's no limit. So they're left waiting. Today, the average response times are down to two to three days, which is better, but still in eternity for people like Kathleen and Michael.

We all wish we were getting out there more quickly. There's nothing worse than someone calling in and you listen to them and you think, wow, these people really need help and you look at the log and realize we're not going to be there for three or four days. It does not feel good. It's not what any of us are aiming for. But one day, Kathleen and Michael finally get a lucky break. Vinny shows up at their house. Kathleen leaves a voicemail for the DCRs and then right away calls the police. The police in some cases can also involuntarily commit someone even without a DCR there. And just as this police officer shows up at the door, Kathleen's phone rings, a DCR calling her back. Kathleen hands the phone to the police officer and suddenly

a DCR is telling the officer which hospitals he could bring Vinny to. After weeks of trying to make this happen, Kathleen and Michael see the door to psychiatric care creaking open. Gosh, we had been stalling Vinny. I mean, stalling. And so, first of all, the officer chided me. He said, I told you not to, if he came back, don't let him in. Then he said, can I talk to Vinny? I said, yes, he's downstairs.

So I go to show him, he goes, I don't like basements. So we call Vinny up. He asked me to leave. The officer did, so I left, kept my ear pointed, and Vinny was masking it. She says Vinny, face-to-face with a police officer, was doing his best to hide his symptoms. He can maintain for a couple of minutes, not very long. Officer said, how you doing, Vinny? And he goes, good.

He goes, what's going on? Vinny says, nothing. And I walk in because I know I'll trigger symptoms. and I wanted them to see. And I walked in and I was asked to leave and then they let Penny go while I was out of the room. I dropped to the floor. First, I'm saying, he's suicidal.

I have proof. Da-da-da-da-da. He's ill. He needs help. And this guy was treating it as a domestic violence issue. I looked at him and he's a kid. And I go, He's doing the best he can with his training.

Because I could see him, you know, when somebody takes dance lessons and you watch him out there and you can see him, they're going, step, left, step, right, turn to slap the back, you know. And I could see him going through his training step, one step. And I just thought, I called him for help. DCRs can rely on witnesses for evidence that someone needs to be involuntarily committed. Kathleen and Michael's word could be enough. But that police officer tells Kathleen for him that's not enough, he needs to witness Vinny's behavior himself. The moment was lost.

Vinny was back out in the world, and Kathleen didn't know when or if she'd ever get a chance like this again. I just dropped to the floor. Why did you drop to the floor like that? I saw Vinny's imminent death. It dropped me. I couldn't be upright. It's just like, not again. It's like how much does it take?

We have a slow motion emergency here. Slow motion is painful. It's painful. If you have an emergency in regular time, boom, it happens. You're in shock. You go into fight, flight or freeze. With a slow motion emergency, you have time in between frames to freak out, to have your heart ripped out of your chest, to look at somebody and go, he has no idea.

Kathleen's talking about the police officer she called for help. This emergency is unfolding so slowly she has time for all these terrifying realization. Like the realization the police officer she called for help won't help her. That maybe no one will. On the latest sound politics, Katie Wilson made some big promises when she ran for Seattle mayor. She's more than 100 days in office and her first big self-imposed deadline is coming up. Can she set up 500 shelter bets in time for the World Cup? Deadlines. Who cares about them, right?

I mean, journalists definitely and voters maybe? Also, why some of Wilson's supporters are not happy with her moves out of the gate, all of that on sound politics wherever you get your podcasts. The game that Kathleen and Michael are playing, the game they are for the moment losing. It was born from a law past half a century ago in the 1970s, Washington State's Involuntary Treatment Act. This is the law that says, as a society, we can only confine someone to a psychiatric hospital and treat them against their will. If certain things are true, those boxes the DCRs have to check.

My whole life has been about freedom, liberty. Richard Emery is one of the reasons Washington State has an involuntary treatment act. He says his fixation with freedom started when he was an uncontrollable kid in New York City, but it got sharpened while he was a law student at Columbia University during the Vietnam War. The draft was a big issue for me. black people being sent off to die, friends of mine being sent off to die. It was an extremely emotional period for me.

And I had empathy, terrible empathy, for anyone who was forced to do anything they didn't want to, basically. After law school, Richard ended up in Seattle, helping poor people with legal problems in the area north of the city. There happened to be a state-run psychiatric hospital up there. For some reason, I went to see a potential client

or somebody who was involved, involved in something at Northern State Hospital. They told me that they were upset about their involuntary commitment. And I said, what's this based on? I got the story. And then I looked into how people were being committed. And it was ridiculous. Richard says back then, all you needed to put someone in a psychiatric hospital against their will

was for two medical professionals to sign off, even if their specialties had nothing to do with mental health. Two doctors had to certify somebody as being mentally insane. I think the words were insane at that point. The criteria wasn't even dangerousness. It wasn't danger to yourself or others or even not able to take care of yourself. I don't know what the words were, but it was like it was mentally abnormal or something, just ridiculously vague.

To Richard, someone who prized personal freedom over everything else, This was a nightmare. He sued in federal court, and his lawsuit morphed into a bill that lawmakers took up in the statehouse. And the legislature passed it. And it was by far the most progressive, most protective statute in the nation. And it became a model for many, many involuntary commitment statutes around the country. Today, across all the states, the boxes you have to check for involuntary commitment are pretty similar. some version of danger to oneself, danger to others, gravely disabled.

But different states have different methods of sorting out who checks those boxes and who doesn't. Here in Washington, DCRs initially decide whether someone meets the criteria and can be held for five days for evaluation. But from there, if doctors want to hold the patient longer, they move to the places where these decisions really get hashed out around the state. involuntary treatment act courts or ITA courts. If everything goes according to Kathleen and Michael's plan, this is where Vinnie is headed. These courts live at the border of the legal and medical worlds. They're often literally courtrooms inside hospitals.

They're not exactly secret, more like quiet. They try to be public in the way that legal proceedings are public, but also private in the way medical decisions, are private. When Nathan Bays started as a public defender in Seattle back in 2015, he didn't even know ITA court existed, but he soon found himself assigned to it. At the time, it was a place where they were starting some of the newer attorneys, and I just seemed like a bizarre world. The court Nathan used to work in back then is tucked away in a corner of Harborview Hospital,

the busiest hospital in the Pacific Northwest. I visited a courtroom there, and it looked kind of like an insurance office, crammed with desks. The judge sits at one desk, at eye level, so close I could see her green jumpsuit sticking out from under her roads. Nathan's job back in 2015 was to sit in this courtroom or another one next door and argue on behalf of people who are seriously mentally ill, sometimes still psychotic. Each case would start with him meeting his client in the psychiatric hospital where they're held. Sometimes you meet with a client. They're very lucid. They're very clear of what they want. Other times they may be a little bit confused. Sometimes they could be quite angry. And sometimes you would meet with people who were in really significant crisis and they were just not able really to communicate effectively.

What are some of the meetings that did not go well? Like, what would happen? Oh, I mean, usually it was people who were mad and they would take out their frustrations on their public defender. I've had juice squirted on me and jello, and I think it just is something that comes with the territory. Then the patient would join Nathan in the courtroom,

sometimes strapped to a gurney or sitting in a wheelchair, or they'd participate remotely. From there, the cases play out basically like criminal cases, except no one in that courtroom is accused of a crime. The prosecutor tries to convince the judge that the patient checks one of the boxes that mean they should stay in the hospital for a set amount of time, anywhere from two weeks to 180 days. The prosecutor uses evidence from medical charts,

from doctors at the hospital, from witnesses who have seen the patient's behavior, sometimes their own family. Nathan, the public defender at the time, tries to convince the judge the patient does not check any boxes, that basically the patient is not as sick as the prosecutor says. I've seen a defense attorney in ITA court argue things like, yes, this patient showed up with a low body weight,

but people who know him say he's always been thin. Yes, this patient showed up with bruises and cuts, but people have been assaulting him, And it's wrong to punish him for that. Or, yes, this patient is homeless, but that's not because of his illness. Is there ever, like, in the position that you're in, arguing sometimes that somebody who is, you know, went to the hospital in a mental health crisis, arguing that they should be released, does that ever put you personally in kind of an awkward position? So I can understand why people would think that. Maybe you're looking at someone who is very ill,

and maybe most people would look at them and think, you know, this person needs to be in the hospital. But we play a very different role in that proceeding, and I think it's a really important role. We are the sole person in that courtroom who is giving a voice to the respondent, to the person who's being detained. Right? These people are not being accused of a crime. But the state is saying, yeah, forget about a crime, but we're going to lock you up.

You can't leave. I mean, that's an awesome power to have. And it's a dangerous power to have if it's not handled responsibly. And so in a lot of these cases, by the time it gets to trial, you have maybe a crisis responder saying the person needs to be detained. Maybe you have a witness who's going to testify that they need to be detained. You have a prosecutor who's going to stand up and argue to the judge all of the different reasons that this person needs to be detained. And it's so important that the person who is going through this have a voice in that process. This gets out a second

answer to the question of why is it so hard to involuntarily commit people? To an extent, it's supposed to be hard. It was designed that way as a correction for an era when it was much too easy. But I can tell you, the reason there are so many mentally ill people on the streets is not because public defenders are winning too many cases. Nathan says he won a tiny fraction of these cases, and that's typical of public defenders in ITA court. It's not like criminal court where prosecutors have the heavier burden,

beyond a reasonable doubt. In ITA court, prosecutors have to clear a lower bar called a preponderance of the evidence. Instead of having to prove the case 99%, they only have to prove it 51%, and the patient gets detained. But Nathan says, for the people he defended, just seeing someone advocate for them

could make that outcome easier to accept. I've had clients who were very mad about having to go through this process, but then I went to court with them and I argued really hard for them and then the judge would rule against me and then we'd go back and the client would say oh man you know that was really good like I'm okay I can do 14

it's fine but I appreciate what you did out there but during the time Nathan worked this job there was something he found he did not like his job often meant standing across from people like Kathleen and Michael, people who had fought to get their loved one into a hospital, arguing against them. ITA court often pits family against family. I had numerous cases where parents were testifying against their kids.

I tried to handle those cases in a way where I would argue, obviously, that the state had not met its burden, that my client should be released. But I tried to do it in a way that recognized. and sort of gave a presence to the love between these people. So maybe a closing argument would be, you know, obviously Mr. and Mrs. Smith loved their son very much, and that's clear. But there's just not grounds for detention in this case. Something like that. But recognizing that this is a horrific process for everyone involved to go through

in trying to preserve as much of that love and care for each other that they had as they're going through. It was something that was always in my mind. I've had, personally, have come very close to the ITA system with someone I've loved. And so it's a thing that was always forefront on my mind that I need to make sure we get through this with as little harm and scarring done as possible. In the middle of Vinny's psychiatric crisis, Kathleen started working out an argument in her head for when she got a chance to stand before a judge and argue for Vinny's involuntary commitment. But that chance never came. A few days after I talked with Kathleen, she learned Vinnie had lost his keys to his condo.

So she drove over to install a pinpad on the door so he could still get inside. She says it was a way of dealing with all the frustration and helplessness she had been feeling for weeks as Vinny's crisis got worse. She says she couldn't do much, but at least she could fix this door. And while she was there, installing the pinpad, Vinnie showed up. Hi, Will. Vinny just got arrested. I just finished talking to the police.

He assaulted me. The police officer I spoke to is going to try to talk to the judge and tell him it's a mental health issue. The police report says Vinnie rammed the door, knocking over Kathleen. When police got there, they found Vinny too confused to understand his rights, so they decided not to interview him at the time.

The whole time, Kathleen and Michael, were trying to get Vinnie through that rickety doorway to involuntary care. It turns out there was another door right next to it, a much bigger door, one that was propped wide open the whole time, the entryway to the criminal system. and Vinny walked right through it.

Once he was in the criminal system, everyone agreed he did not belong there. The psychiatrist who evaluated him in jail, his defense attorney, a prosecutor, a judge, they all agreed Vinny was mentally ill. The judge ordered a DCR to evaluate him, and just like that, Vinny was on his way to a psychiatric hospital. Right after the court hearing,

my phone lit up with a text message. from Kathleen. Michael and I just held each other and sobbed, she wrote, We think we are relieved. Kathleen got what she wanted for Vinny. It just took more than she ever expected. For her to endure an assault, for Vinny to get handcuffed and sent to jail, psychotic,

for them to circle each other, stressed out and afraid for weeks. Do you have an idea in your head of what recovery looks like for Vinny right now? Yes. Yes. He'll be able to express himself easily and freely. He'll feel safer. I'll hear him say things like, Life is good, Mom. I'm content with my condition. He'll be funny and sweet. Well, that means he'll be Vinnie again.

Yeah. But Kathleen is aware of the scientific reality. that every episode of psychosis can cause brain damage that makes future episodes more likely. So she and Michael are waiting to see what life looks like after this hospital stay. Lauren, the DCR supervisor, says some families work so hard to get their loved one into a hospital, they can fall victim to the illusion that their problems are over. And it's great to see the relief, right, to help them and to get their loved one into the hospital. It's a lot of times the first step, right?

but there are a lot of folks who you can see them and their palpable relief and their sort of sense of, oh, this is over finally. When in reality, it's probably just the beginning. This is the cost of a system that only really kicks in once somebody's already at their lowest point.

That's better suited for containment than for recovery. Over the past 10 years, lawmakers here in Washington have widened the involuntary commitment doorway. They've given DCRs the past to detain people for substance use, not just mental illness. And if DCRs decline to detain someone, people close to them now have a right to appeal. In New York, California, and elsewhere,

efforts are underway to give more witnesses, first responders, health care providers, friends, the power to seek involuntary treatment for people they think need it. These are reactions to the site of seriously mentally ill people on the streets and to the cries of families like cats. leans, saying, why is this so hard? But when I talk to people whose jobs touch involuntary treatment, they have different questions. Like, why is this a main doorway to mental health care at all? Shouldn't this be a last resort? And why isn't there more help long before a person and a family are at the brink of disaster? When families were saying it shouldn't be this hard, I think that's probably the wrong place to point the finger of what is making the system difficult.

Usually by the time a family is involved in the ITA process, it's not usually something that just happens, it just pops up one afternoon out of the blue. There is a shortage of care available between the kind of like private, voluntary care that you can get with insurance and appointments and things like that, and then compulsory court-ordered involuntary detention. And there should be a much broader bridge between those two things. I would like to see that part of the system get invested in more heavily. Sometimes it's also about the care before, and then also making sure there's a really good discharge plan and people to support the person after the crisis so that they don't end up back

where they were. they're saying a better question might be, what about all the doorways that might open before this one? Just like how our rules around involuntary commitment took shape half a century ago, the answer to that question lies decades in the past. Coming up on Lost Patience, the system that came before, what was it, and what happened to it? Lost Patience is a production of KUOW Public Radio

in the Seattle Times in partnership with the NPR network. You can support lost patients by investing in the local newsrooms and the specialized beats that make this sort of storytelling possible. Please consider joining and subscribing at KUOW.org in Seattle Times.com. This episode was reported, written, and produced by Esme Jimenez, Sydney Brownstone, and me, Will James. Our editor is Liz Jones. Additional editing by Diana Smy.

Samuels, Jonathan Martin, Brendan Sweeney, and Marshall Eisen. Project Development by Laura Grenius. Our music is by B.C. Campbell. Mixing and sound design by Hans Twight. Logo and branding by Alicia Villa and Michaela Giannati Boyle. Thank you to Kathleen and Michael. So Lauren Richards and Teresa Hape, Richard Emery, and Nathan Bates for sharing your stories and expertise.

Seattle's economy is complicated. Inflation, tariffs, AI, layoffs, it's a lot to keep track of. That's where we come in. I'm Joshua McNichols. And I'm Monica Nicholsberg. We host Booming, a podcast about the economic forces shaping our lives here in the Pacific Northwest. Every week, we dig into the big questions about our economy and where you fit in. Find Booming on the KOWW app or wherever you listen to podcasts.