Sunday, August 29, 1999
Families often cope alone with violent mentally ill
BY KAREN SAMPLES
The Cincinnati Enquirer
EDGEWOOD — Just two months before he shot his parents and committed suicide, Kevin Paul Smith was in a Kentucky psychiatric hospital, court records show. But he didn't stay there.
His tragic end illustrates the risk in releasing seriously ill and potentially dangerous individuals, some parents and psychiatrists say.
“We allow people who are psychotic and incompetent to make their own decisions. It's senseless,” said Angie O'Malley, a Lexington mother involved with the National Alli ance for the Mentally Ill.
In most states, the rights of the mentally ill are so thoroughly protected that the sickest individuals get help only after behaving dangerously.
Even then, treatment may have little impact.
At Ohio and Kentucky hospitals, the average patient stays eight to 14 days, records show.
In Boone County, one schizophrenic man has been hospitalized 36 times. In another case this year, a Cincinnati resident was released from psychiatric care at University Hospital, only to be arrested by Covington police who noticed his bizarre behavior. The man died of a heart attack after being re strained in the Kenton County Jail.
Kevin Paul Smith, 30, was manic-depressive, his sister said in a court document. The disorder causes bouts of depression and euphoria.
On April 25, Mr. Smith threw items at his father and punched a hole in the garage door of his parents' home. They were able to get him into the psychiatric unit at St. Elizabeth's Hospital South.
From there he went to Eastern State Hospital in Lexington. After several months, he returned to Edgewood, broke into his parents' home and left two threatening letters.
Paul and Diane Smith reported the July 27 break-in to authorities.
“We believe Kevin is currently too ill to care for himself and are very concerned for his safety and ours,” they wrote in an affidavit seeking his arrest. “If possible, we would like him to be given extended mental-health treatment and not incarceration, which does not address his illness.”
Their wish was not to be.
On Aug. 17, Mr. Smith returned to his parents' home, shot them and committed suicide.
Mr. and Mrs. Smith are recovering from their injuries and could not be reached for comment. Eastern State officials did not return phone calls about Kevin Smith's release.
“We will be talking with them about this and getting access to the reports they do,” said Margaret Pennington, commissioner of the state's Department for Mental Health. “I'm quite sure this would be an incident that (Eastern State) would look at very carefully.”
Illness brings tragedy
Most mentally ill individuals are not violent, experts say.
About 35 percent of the homeless, for instance, have brain disorders, says E. Fuller Torrey, a psychiatrist and author. They are more likely to be the victims than the perpetrators of crime.
Some advocates are alarmed by talk of restricting patient rights.
People who refuse medication may have good reason, says Doug DeVoe, executive director of Ohio Advocates for Mental Health. Pills can have unpleasant side effects, and doctors often seem more interested in medicating people than discussing their concerns, he says.
Thousands of mentally ill Ohioans are living quietly and successfully in their communities, says Mr. DeVoe, who is against restricting the civil liberties of many because of problems caused by a few.
For families in the midst of crisis, however, there is little sense in watching sick people suffer. And some do pose a threat to themselves or others, even after they enter the mental-health system.
Some examples:
• Larry McCarthy, a schizophrenic man from Boone County, has been admitted to Eastern State Hospital 36 times, court records show. He also has faced 39 criminal charges over nine years, with 18 convictions for disorderly conduct, terroristic threatening, indecent exposure and similar offenses.
Last July, Mr. McCarthy struck his father in the head with a hammer, records show. This led to an evaluation at the state's criminal psychiatric center.
While there, Mr. McCarthy made nonsensical comments and appeared delusional. But he also denied his illness. Because he refused to take medication, he often relapsed, the state psychologist found.
The psychologist recommended Mr. McCarthy spend at least a year in a hospital. A judge found him incompetent, and he was committed to a long-term stay at Eastern State.
Boone County Jailer John Schickel remembers Mr. McCarthy's bizarre behavior.
Once, Mr. Schickel said, deputies took him to St. Luke's Hospital West for psychiatric care, but he wasn't admitted.
• Michael Labmeier of Cincinnati died in January at the Kenton County Jail, shortly after he was released from psychiatric care at University Hospital.
Mr. Labmeier ended up in Covington, where he parked sideways in the street, screamed at passersby and stole a car.
After his third arrest in as many days, jailers attempted to transfer him to St. Elizabeth Hospital South for psychiatric evaluation. He had stripped to his underwear and was screaming about Satan, they said.
After deputies tried to restrain the agitated man, he suffered a fatal heart attack. Kenton County police determined the jail was not at fault.
• Terry Todd Wedding of Muhlenberg County, Ky., was charged last month with four counts of murder. Police say the 27-year-old killed his parents, a police officer and the officer's wife.
Shortly before their deaths, Mr. Wedding's parents had been frightened by an altercation with their son, police said. Two officers took the young man to a psychiatric hospital, but he didn't stay long.
Terry Todd Wedding has pleaded not guilty to the killings.
His grandmother told the Louisville Courier-Journal that he had been diagnosed with bipolar disorder about 15 months earlier. When he refused to take medication, his parents got court orders to have him committed to Western State.
Ms. Pennington, the state commissioner, declined to comment on the Wedding case.
Right to refuse
With medication, mental illnesses can be kept under control. But the sickest people often don't take their medication because they don't think they need it. Under Kentucky and Ohio law, this is their right in most circumstances.
The rules differ slightly between the two states. But in general, involuntary hospitalization is permitted only when patients pose a danger to themselves or others and would benefit from treatment.
Once in the hospital, medication can be forced on an individual, but only under limited circumstances.
Ohio interprets “danger” more loosely than Kentucky. A mentally ill person who strips naked in the street might be hospitalized in Cincinnati but would be jailed across the river.
The tough standard sometimes puts Kentucky authorities in a bind. They either can't get people committed or find they are quickly released.
The short stays reflect a shift away from hospitalization since the 1960s. Before then, psychiatric hospitals were more like warehouses, offering little treatment or patient freedom. After civil-rights lawyers took up the cause, hospitals began turning out patients at a furious pace.
Ohio's psychiatric facilities had just 1,849 patients in 1994, compared to 28,663 in 1955, according to Dr. E. Fuller Torrey's research. In Kentucky, the numbers are 645 in 1994, compared to 7,700 in 1955.
Striking a balance
Some families appreciate the need for patient rights but also lament the consequences.
Mary Metzger of Campbell County spent 10 years trying to help her daughter, Rosemary, who is now 43 and successfully managing her schizophrenia.
“You try and try and try, and you feel so frustrated, because you can't get help from anyone. They say, "Well, she has to realize she's sick before anything can be done,'” Mrs. Metzger said.
Rosemary Metzger's symptoms began when she was 29 and studying to be a nurse. She started hearing voices that at first sounded like the devil, then like saints.
As her illness progressed, she totaled her car, lost several jobs and disagreed with her parents about the extent of her illness. In 1995, they had her committed to Eastern State Hospital. But by Rosemary's own account, the short stay did little good because she wouldn't accept medication.
Back in Campbell County, her parents thought they had no choice but to evict her from their home.
“One time I just set her out in front of Welcome House with her belongings and left,” said Mrs. Metzger, referring to the Covington homeless shelter. “My husband and I just couldn't deal with it anymore.”
On another occasion, the Metzgers paid the rent on an apartment for their daughter. But she wasn't eating enough, and on Valentine's Day, 1996, her parents had her committed again.
This time, Ms. Metzger submitted to treatment.
She thought taking medication would help her qualify for disability benefits. Also, “by then I was kind of realizing I probably needed it,” she said. “It seemed like a lot of the people I was around at these homeless shelters needed it, too.”
The treatment she began at Eastern State has given her a second chance. With help from the homeless shelters and NorthKey Community Care, she has found a place to live and a social outlet.
Every day, Ms. Metzger goes to a NorthKey recreation program for former patients. Another organization sponsors parties, and last year on Valentine's Day, she met her boyfriend at a dance.
She looks back on her years of denial with some regret.
The mentally ill should have rights, she says, and she doesn't think forced treatment would work. But she also recognizes that her parents were trying to help.
“When you hurt your parents, you hurt yourself,” she said.
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