Mental health: Unanswered calls for help

June 30--OKANOGAN -- "It's insanity to kill your father. It's also insanity to close hospitals, fire therapists and leave families to face mental health on their own."

With the last six words underlined, this was the conclusion of a victim's statement written by Delores Moore, who lost her only son last year at the hands of her grandson.

Last month, Ronald E. Moore, 32, of Okanogan, was sentenced to 25 years in prison for shooting and killing his father, 61-year-old Ray Moore, on March 21, 2013. And although Ronald Moore committed the crime, everyone connected to the case -- the prosecutor, defense lawyers and the judge who sentenced him -- say he is a victim, too, of Washington state's broken mental health care system.

Moore, who suffers from paranoid schizophrenia, asked Okanogan County Superior Court Judge Chris Culp at his sentencing why someone didn't come and take him away so his family would be safe before he killed his father. "And now we all have to pay for it, and that's the saddest thing of all," he said.

Culp told him that funding issues combined with legal constraints that require the "least restrictive" option for people with mental health issues are preventing care for many people who need it. "We're saying to people, 'OK, you're on your own. Go out and make do.' And we know for a fact that they're simply incapable of doing that," the judge said. "As a society, we have dropped the ball."

The reason why some people who need help don't receive it is complicated, advocates and mental health experts say. Reduced funds and legal requirements are partly to blame. And -- especially in rural counties -- there just aren't enough psychiatric beds, interim services, and comprehensive help for people with severe mental illnesses.

Ronald Moore was an adult man who was living with his parents when he went on a frantic search for his missing Taser, found a gun, terrorized his mother and grandmother and shot and killed his father.

Three months earlier, police and mental health professionals knew that he had been off his medications for over a year, and that he thought his food was being poisoned. They knew he had assaulted his mother, and was hiding knives and a Taser under his bed. They knew his parents were so frightened of him that they put a lock on their bedroom door.

Ray and Deborah Moore tried many times to get their son help. But despite their fears, there was nowhere for him to go, and they could not bring themselves to kick him out of their house.

Skip Rosenthal, CEO at Okanogan Behavioral HealthCare said he wasn't here when Ronald Moore killed his father, and isn't familiar with the case. But, he said, it's a mistake to think that the system was better 40 years ago, when many, many more people with mental illness were institutionalized. "Not only can we not do that anymore, but we don't want to do that anymore," he said.

The vast majority of people with mental illness, and with schizophrenia, are not violent or dangerous, he said. And, people with mental illnesses have rights, and those rights need to be respected -- including the right to refuse treatment. He said part of the key is to help them recognize that they need help, and make sure it's available when they seek it. "The reality is, we need to do what we can to make sure these people are in recovery, and living worthwhile lives," Rosenthal said.

Funding and legal issues

The National Alliance on Mental Illness says across the country, the recession has had a huge impact on mental health funding. By 2011, states had cut some $1.6 billion. Washington suffered an 11 percent drop in two years.

Cuts began long before the recession, said Charlene Woodward, who chairs the NAMI Washington Education Committee. She blames lawmakers and budget writers who drastically reduced psychiatric hospital beds before new systems were in place to help people with mental illnesses.

Okanogan County Prosecutor Karl Sloan said the money is being spent -- just not on mental health facilities or treatment -- and that police and jails are now bearing the burden. "We're waiting for a crime to be committed before people are getting treated," he said.

Beverly Zwar, who has a family member with schizophrenia, has called police to send that person to jail, knowing it wasn't the right place for him. "I was shocked and horrified to realize you have to let your loved one deteriorate to such a degree that they're ready to jump off a bridge" before mental health can help, said Zwar, who sits on the board at Okanogan Behavioral Healthcare.

Zwar doesn't blame mental health professionals who are following laws that say someone has to be an imminent danger to themselves or others before they can intervene.

This year, the state's House Judiciary Committee held a hearing on a bill to change the wording from "imminent" danger to "substantial likelihood" of danger. The bill died in committee.

Lack of beds, services

In a 2009 report called "Grading the States," NAMI criticized Washington state's laws on involuntary treatment, saying that family members, who are often in the best position to see an impending crisis, cannot petition for emergency treatment.

In some areas, the report also said, there are no beds for people under emergency commitment orders.

"Services for individuals most at risk are almost entirely lacking in many parts of the state," the report said. It mentioned a significant shortage of acute care facilities due to state hospital reductions and closures, and of not enough general hospital psychiatric treatment units. For several years, NAMI and other advocacy groups have complained that instead of institutionalizing people with mental illnesses in psychiatric wards, we are now sending them to emergency rooms and jails. According to the nonprofit Treatment Advocacy Center, at its peak in the 1950s, there were more than 300 psychiatric beds per 100,000 people in the United States. Today, there are 14 per 100,000. "Instead of motivating improved care, these conditions became an incentive and an economic pretext for policy makers to eliminate hospital treatment altogether," the group's website says.

Without a place to go, people with mental illnesses end up homeless, in hospital emergency rooms, or in prisons and jails.

The Washington State Hospital Association and several other medical associations just joined a lawsuit that asks the state Supreme Court to uphold a recent ruling that psychiatric boarding at hospitals is unconstitutional. It seeks to require the state to do more to provide adequate access to inpatient mental health services.

Jail administrators, too, are pushing for change.

Noah Stewart, Okanogan County's chief corrections deputy, said he's written many letters to lawmakers about the problem. "The jails have become a dumping grounds for the mentally ill," he said.

He's had inmates on suicide watch for 30 days -- checked every 15 minutes -- before there was room at Eastern State Hospital for evaluation. He's also seeing more people arrested and taken to jail for minor crimes, just to get them off the street, or away from their families. Many of them got there because they went off their medications, he said. But unlike mental health facilities, jails can't require them to go back on them.

Melissa MacDougall, Moore's public defender, said she's been involved in cases where comprehensive outpatient services are provided, and it works.

Ronald Moore didn't get those kinds of services until after he was arrested for killing his father. "I kind of feel like, sadly, after the fact, we got a team together to help Ron, which is what should have happened prior to this," she said, adding, "I've heard we're going to spend the money on a person like this at some point, whether it's housing in a prison or a mental institution, so why don't we spend it up front? Then you don't have all the social costs, along with the hurt."

The Moore family paid the ultimate price for the state's broken mental health care system. They can only hope that Ronald Moore will finally get the help he needs now that he's in prison.

Reach K.C. Mehaffey at 509-997-2512 or mehaffey@wenatcheeworld.com. Read her blog An Apple a Day or follow her on Twitter at @KCMehaffeyWW.

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