Paralysis Prevents Mental
Health System From Responding
to Help Those in Distress
Burden Put on Citizens to Mobilize Intervention

Finally, it took several police officers to subdue this man and get him admitted to the Veterans Affairs Medical Center in Leeds.

Now a few weeks after hospitalization, he is back on the street, fending for himself, and living completely unsupervised and unattended in an apartment on Maple Street in Florence. And his condition is as fragile as ever.

The story, which has not yet played itself out, raises troubling questions about the public system we're left with for treating those with mental illness or emotional distress. It is a large and well-funded bureaucracy with trained personnel but it lacks the willingness, ability or even the authority to act.

Question: what is its purpose?

This small incident began more than two months ago, when, after observing the strange and worrisome behavior of a regular face in the downtown Florence scene, I called the Department of Mental Health to share my concerns with a professional.

Once navigating my way through the phone menu options, I actually spoke to a woman who directed my call to a couple of offices, where I was able finally to leave a message on the voice mail of Mark Leibowitz, community services manager, who called me back a few days later.

I explained that I was calling as a citizen concerned about the behavior of a man who had been familiar to me over the last few years; he had even come in the bookstore a few times.

In the past month, I explained, his physical appearance had altered drastically - he had aged 30 years, his face was ashen, his eyes sunken, his clothes in disarray. His behavior was increasingly bizarre; he wandered uncaring through traffic at the busy main Florence intersection; he interrupted his gait while walking to kick at non-existent presences on the sidewalk. Muttering to himself, he seemed unable to concentrate enough to light a cigarette or drink from a container of coffee. He was walking scores of miles a day around the same small piece of Florence geography, and once, when spoken to by a young woman, he burst into a rage, shouting obscenities and yelling incoherently.

I further explained that I was concerned not only that he was a risk to himself, but might pose a risk to others in the Florence community.

While seeming sympathetic to my concerns, Leibowitz said there were two issues that prevented him from promising that he could do much. First was the matter of confidentiality; the man might not be "receiving services" from the Department of Mental Health, possibly he is "VA-connected." Then there was issue of the man's personal rights. "It's a very difficult situation. I cannot simply apprehend the person." My concerns, he said, might be in conflict or "collide" with the rights of the individual I was concerned about. "Our ability to intervene might be limited by his willingness" to cooperate, Leibowitz told me.

I had no interest in forcible treatment of the tortured man who seemed to have gone completely over the edge. I expected the system and its army of social workers, clinicians, psychiatrists, counselors, and emergency personnel might be able to bring professional help and some measure of comfort to him.

"Despite your belief" that the man needs help, Leibowitz said, "there are laws - we can't intervene if he doesn't want us to. I don't want to mislead you."

There was also some bureaucratic jargon about "parameters" and a "Catch 22,'' but in the end he promised: ''We will look into it, no question.''

As the days wore on and as the man's behavior and appearance continued to deteriorate, concerns similar to mine were expressed by others with businesses along Maple Street. Jean Ansinitis at Herlihy's said she even called the police after the man's verbal outburst.

Subsequent inquiries in the neighborhood revealed his name, the address where he lived and that he was, indeed, a former patient at the VA Medical Center.

I reached Lillian Struckus, a social worker at the VA, whose initial response was: 'I don't know if he's a veteran or not. I'm surprised the Police Department has not been involved, that's my experience. Or call the Department of Mental Health.''

She said there are people who do not want help and don't want to take their medication. Because of patients' rights there is nothing that can be done "until something happens," she said ominously.

A few days later, I was visited by the daughter of the woman in whose apartment building the man was lodged. She said her mother was concerned about her tenant, and she was told by a worker at Northampton Emergency Services to encourage people in the community to report their concerns to them. That might help in mobilizing some formal response to the perceived problem.

In other words, the burden was placed on private citizens to make the case that this man, in easily identifiable distress, needed help, before something terrible happened and the finger pointing started.

Meanwhile, I had gone back to Leibowitz to get an update from him but his voice mail told me that he would be out of the office for the next two weeks.

That prompted me to talk to Rose Zerra at Emergency Services and Karen Hanley, a clinician at ServiceNet, who basically confirmed that it was my responsibility and that of others, even though we have no expertise in this area, to make the case for helping this very disturbed man because he was a danger to himself and others. Yet, he can't be forced into getting treatment. "Our hands are kind of tied," Hanley said. "We have to walk a fine line."

I was told by both women that as a consequence of community concern the man had been interviewed and had insisted he was not suicidal and did not need treatment. "People are allowed to walk around and be crazy," one of the social workers told me. "We are bound by legal criteria." She said professionals working in the field are as frustrated as the average citizen that the mental health system does not allow for intervention and treatment for someone unable to make sound judgments for himself.

Thus he is left on his own, unsupervised, no one checking on his well being, even though lots of people are aware that he is poised perilously on the edge, where something terrible could happen.

Hanley said that in the end they rely on the police department to handle to these kinds of cases. "The Northampton police are well trained in dealing with a psychiatric" population. "They are our eyes and ears, we work hand in hand. They are very adept."

I argued in vain that the subject needed professional medical attention, not police scrutiny. Later I talked about the problem with Pablo Rodriquez, community police officer for Florence, who said simply: "The system sucks." Unless or until the police have a specific reason for arresting a person their hands, too, are tied in getting treatment for the mentally ill.

Just back from summer military reserve obligations, Rodriquez expressed sympathy for the man, a veteran who had served in Vietnam and was now being watched by a wary community. This is not his fault, said Rodriquez of the man, who had served the country but now can't get the help he requires.

He and other officers in the department are well aware of the problem in Florence, Rodriquez said, but it was a simply a matter of waiting for the inevitable.

And then the inevitable happened.

After calls on successive nights for the police to respond to trouble at the Maple Street address where the man resided, the "something terrible" came on a Saturday in front of Cumberland Farms store on Main Street in Florence.

On Monday, I got the news from the daughter of the owner of the Maple Street apartment house. "He's in the hospital, they took him. There was a pretty violent episode."

This was confirmed the next day by Officer Rodriquez and by a brief entry in the police log in the Daily Hampshire Gazette: "A 52-year-old Florence man will be summoned to court on charges of open and gross lewdness and indecent exposure after pulling his pants down and touching himself in front of a woman and young girl at the Cumberland Farms Store on King Street (sic) at 4:59 p.m., police said."

A day or so later, Lillian Struckus from the VA called me to report similar information. "He's safe and he's getting help," she said, as if to imply that the system has somehow worked, and that VA had comported itself with distinction.

Now that the man has been returned to his apartment and resumed his ceaseless wandering of Florence, it is once again time to wait to see when something else untoward happens to him or who is there to help him out.