A failing mental health care system

June 11--Public defender Charles Kovis expressed outrage at the state of mental health care and the criminal justice system as one of his more notorious clients, convicted murderer John Lee, appeared before a judge May 24 and awaited a life sentence to be handed down.

Lee murdered three people, including his adoptive mother.

"Why it takes such acts as this ... to get treatment is beyond me," Kovis said during the hearing.

Kovis told the judge and those sitting in the courtroom -- many of whom were close friends and family members of the victims of Lee's Jan. 10, 2015, shooting rampage -- that Lee's crimes were not committed out of the desire for notoriety or revenge but because his brain is diseased. Lee has been diagnosed with paranoid-type schizophrenia.

"His diseased brain can be treated," Kovis said. "He is untreated. He has been untreated since day one."

Moscow Police Capt. Paul Kwiatkowski said he has known Lee -- formally known as Kane Grzebielski -- and his adoptive family since he was a child. Kwiatkowski said Lee's parents called him in May 2014 and asked him to step in because they thought Lee was having some sort of psychotic episode.

"The issue was he was hearing things that didn't exist and it was to the point it was causing problems within the family," he said. "I talked to Kane and spoke with him about it and told him I would take him to the hospital."

Kwiatkowski said Lee was evaluated at Gritman Medical Center and found to be non-committable. Following the visit, Kwiatkowski said he periodically checked in with Lee.

"It is a terrible, sad thing that happened that could've been avoided, maybe, but it happened," Kwiatkowski said. "If he thought like you and I, I knew the kid, I know he wouldn't have done that."

Kwiatkowski said the majority of the mentally ill people the police come in contact with are not dangerous. Lee, he said, was one of the outliers.

Latah County Prosecutor Bill Thompson agreed, stating that in his experience Lee is an aberration.

"Whether Lee's killing could have been prevented we will never know, but at the same time we do know there are people suffering from mental illness who are not in the position to make good decisions for themselves and there are inadequate resources to help those people out," Thompson said.

He said because of the nature of mental illness, their behavior can contribute to them getting into trouble they would not have had they been stable.

"Law enforcement is a reactive type of environment and these people need proactive intervention," he said. "My perspective is there is not enough adequate community resources to help keep these people stable."

More seeking help

When support services lack emergency departments, local counselors and first responders carry the burden, which has been growing as awareness of mental health issues throughout society has increased.

Mike Berney, executive director for Palouse River Counseling in Pullman, said he views mental health on a continuum, ranging from a situational issue, such as the pain or stress of losing a loved one or job, to people with serious and persistent mental illnesses, such as schizophrenia or bipolar disorder.

Berney said PRC has seen its average of eight to 10 requests a week for adult counseling jump to somewhere between 20 and 25 throughout the past few years. To address the growth the facility has almost doubled its outpatient staff, he said.

In Moscow the same trend has held true. Nicole Wheaton, director of emergency services for Gritman Medical Center, said there has been an increase in the number of walk-in patients seeking mental health-related assistance at the emergency room, and W. Rand Walker, a licensed psychologist at Educational and Psychological Services in Moscow, said his office has noticed an increase in consulting calls from physicians.

"We have a shortage, I think, of a full range of mental health services regionally, which means most mental health providers have a lot of pressure on their schedule," Walker said.

Walker said 20 percent of the U.S. population deals with some form of mental illness, but only 40 percent of them will seek treatment. He said some of that is the result of the misbelief that mental illness is a sign of weakness or failure.

Pullman Police Chief Gary Jenkins said residents struggling with mental health issues are a growing concern for law enforcement, but just how many people are suffering is hard to track because in many cases police are called for a separate report, such as a theft or disorderly conduct, and then discover it is a mental health issue.

Getting help

An individual in need of mental health services can seek out assistance on his or her own or be brought to the hospital for immediate treatment by emergency responders.

Dr. Pete Mikkelsen, medical director for the Pullman Regional Hospital emergency department, said often a friend or relative will call 911 with concerns about someone and police will locate the individual and make an assessment. Jenkins said if officers determine the individual is suffering from some sort of breakdown or acting in a criminal manner because of a mental health issue, he or she is transported to the hospital.

Once at the hospital, Washington and Idaho have different processes, but both states share the same end-goal of getting the individual to a place he or she can receive support.

Mikkelsen said hospital staff first evaluate if there is a non-mental health issue occurring that could be causing the behavior, and "if we feel comfortable that isn't what's going on we refer to the behavioral health providers."

Berney said a counselor's response can range from a crisis situation where someone just needs a plan formulated and to be told there is voluntary help available to an involuntary treatment investigation. Mikkelsen said if the designated mental health provider -- which at PRH is Palouse River Counseling -- finds there is reasonable ground to involuntarily commit the patient, the individual is transferred to either Eastern State Hospital in Medical Lake or another facility that can provide a higher level of service.

PRH also recently began using a tele-psychology service that allows patients to undergo an evaluation by a psychologist remotely, Mikkelsen said. The program was adopted because local providers were becoming so busy with patients at their clinics that it was difficult to get to the hospital, he said.

In Idaho the process is generally the same, as an individual who comes in either voluntarily or in custody is evaluated for safety first, Wheaton said. The individual can be put on a hold by either the physician or police after approval from a judge, which then triggers a designated examiner from the Idaho Department of Health and Welfare to respond for a second opinion, she said.

For every 24 hours patients are at Gritman they have to be evaluated by a designated examiner to ensure they aren't being held too long, she said.

Lack of services

Wheaton said issues with community resources arise if a patient has shown enough improvement to be released but still needs help.

"The biggest issue is that there isn't enough beds for people, so ultimately they are released before they get all the treatment they need," Jenkins said.

Wheaton said just because a hospital has an inpatient unit doesn't mean there is space. A facility may also not have room within a specific need, such as a "calm bed" compared to someone having a psychotic breakdown who needs a secure and private bed, she said.

Berney said because of the shortage of beds, individuals who were once hospitalized for a period of time are now being released and managed in the community.

"It poses kind of a dilemma where you worry that they are going to bounce back and need help," Wheaton said.

Services all come down to money, Kwiatkowski said, and when funding gets cut mental health is often the first to go.

"The experiment that Idaho has engaged in, in privatizing public health services, has been a disaster," Thompson said. "The federal and state government, neither of them seem to be willing to invest the resources needed to properly care for mentally ill people."

Walker said he believes one the biggest issues is a lack of proper diagnostic services. Walker said he has seen cases in which an individual was misdiagnosed and could have been effectively treated with five or six counseling sessions, but instead has become dependant on medication or long-term treatment.

Insurance coverage is also an issue, he said.

"We have people who work for major entities in our community who don't have that access," Walker said. "... I can tell you, as a provider, we are constantly dealing with insurance companies who don't want to provide that and a lot of that starts with the companies."

Berney said the Affordable Care Act has provided people with better access, but many people still don't have proper coverage.

"We try to get people in as quick as we can, but there are a lack of psychiatrists and there are long wait lists," he said. "There is a shortage of doctors and counselors, but more people with access."

Mikkelsen addressing these issues is important to create a healthier community. Wheaton said she believes the community has been working to "beef up" mental health support, but it will take time to see the results.

Samantha Malott can be reached at (208) 883-4639, or by email to smalott@dnews.com.

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