When it comes to mental illness, it is often hard to get someone to listen, no matter how loud the cries.
When it is accompanied by terrorist threats, it seems to get people’s attention much more quickly.
That appears to be the case with 18-year-old Keaun Cook of Godfrey, who is being held at the Madison County Jail since his arrest on Aug. 30, pending a mental evaluation after authorities said he communicated with a terrorist organization to plan an attack in the area.
Relatives say Cook has a long history of mental illness, but getting anyone to take his condition seriously was an ongoing and ultimately futile task. The question is raised, does the safety of the community at large have to be threatened before mental illness is addressed?
Cook’s story may have grabbed headlines, but it is not unique. John (not his real name), whose family is from a nearby town, was 21 and working as a commercial fisherman on the West Coast when he had a psychotic break in August 2015. The journey of his psychosis, his experience with the country’s mental health system and the events leading to his eventual treatment inspired his mother to become an advocate for the mentally ill.
Kathy lives in a small town in Missouri. For several months before her son moved away, she’d suspected something was wrong. John was convinced a young woman from the neighborhood who had since moved away was hacking his phone and leaving Facebook posts for him containing the number 14.
“I hoped that if he started fresh, it would all go away,” Kathy said.
Two weeks later, she got the call she was dreading.
“When I picked him up from the bus station, I could see he was wound up tight, watching for every sign of the girl,” she said. “He never really went to bed that night and the next morning, he was pacing, wanting the curtains closed. He couldn’t calm down.”
She called the Missouri University Psychiatric Center but was told nothing could be done because John was an adult.
“Unless he’s a danger to himself or others, (they) can’t do anything,” she said. “That’s a phrase we heard over and over. I was also told an ambulance could be sent, but no one can force him to get in.”
In September, John was finally admitted to the center after he physically assaulted a former co-worker he thought was part of the group of people watching him. His mother called everywhere trying to find a bed in a treatment center, with no luck. He eventually was charged with a felony over the incident and spent time in jail.
The nightmare continued. Drugs such as Abilify that were effective were not covered by health insurance. Saying treatment centers preferred going through Medicaid, Kathy spent six months getting her son on the health care program.
Last December, John, who was on home detention for the prior incident, was arrested again after an altercation with neighbors and spent the next five months in solitary confinement at the county jail, becoming more and more sick. When he came home, his mother said he exhibited the symptoms of post-traumatic stress disorder from his experience behind bars.
“On two different occasions, he was tasered,” Kathy said. “The jail staff were nice young men but did not have the training or the resources to deal with mentally ill prisoners.”
With nowhere else to turn, Kathy asked the public administrator to be John’s guardian, knowing that was her only way to get him out of jail and into treatment.
“It was a hard thing to do,” she said. “I had to give my son up to get him help.”
Approximately 9 months since his first episode of psychosis, John, who was diagnosed with bipolar disorder, was moved to St. Alexius Hospital in St. Louis for comprehensive treatment.
With an admittedly long road ahead of them, Kathy feels a sense of relief that someone is finally listening, but said she is concerned about the people in the community still struggling and desperate for help.
“I honestly don’t know how people who don’t have someone to be their advocate get help,” she said. “(What about) those who don’t understand their rights, or work, or are uneducated? If I didn’t have someone to financially support me, I would have had to quit my job.”
Little funding, fewer answers
Jenna Farmer-Brackett is the clinical manager of access services for Centerstone in Alton and leader of the Intake and Crisis Intervention Team. Acknowledging how difficult it is for family members to navigate the mental health system, she said the lack of resources and state funding cuts is making a bad problem worse.
“We absolutely have seen a reduction in resources. We know someone meets the criteria for inpatient care but when we call, there are no beds,” she said.
An available bed could be as near as Granite City or as far as Champaign, Ill. Many centers want Centerstone to get medical clearance before they will accept a patient, which can add at least an hour to the process.
The long-standing Illinois budget stalemate has hurt social service agencies. Funding for Medicaid services provided by community mental health centers has continued, but many other mental health services have gone unfunded since July 1, 2015. Grants that helped supplement Medicaid reimbursement rates for psychiatry were among the first to be cut.
Between 2009 and 2012, Illinois slashed more than $113 million in funding for mental health services, according to a May 2016 Progressive Illinois article. Over the same period, there was a 19 percent increase in emergency room visits from people experiencing psychiatric crisis.
“It’s a struggle on our end due to the lack of available beds,” Farmer-Brackett said. “It ebbs and flows and waiting in jail or in the ER is not the solution. The longer the person is in jail and the longer the person waits to receive treatment, the less engagement there is. It’s not effective; it’s almost a punishment.”
How many beds do we need?
In a 2014 Chicago Tribune opinion piece, Cook County Sheriff Tom Dart writes the number of beds in Illinois’ state-run psychiatric hospitals has decreased to fewer than 1,500 compared to 35,000 in the 1960s. He estimated one-third of the 10,000 inmates in his custody suffer from serious mental illnesses and most of those are charged with “low-level crimes of survival, such as prostitution, trespassing, disorderly conduct. Many are facing drug charges — for those unable to get medication to make the voices in their heads go away, heroin is often the next best solution.”
In 2010, there was an estimated 43,000 psychiatric beds in the United States, or about 14 beds per 100,000 people — the same ratio as in 1850. In 2016, Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, reviewed previous bed surveys and new bed supply projections and found concurrence around a target of 40 to 60 public psychiatric beds per 100,000 population as the “minimum standard currently needed for reasonable psychiatric care in the US.”
Where does law enforcement come in?
Because of the nature of their work, police officers are often the first to be called during the initial stages of a mental health crisis. They have to quickly assess a situation and determine if the person is a threat to themselves or others.
Wood River Deputy Chief Dan Bunt has Crisis Intervention Training, as do most of the officers in the department. CIT started in Illinois in 2003, but Bunt said there isn’t as much training these days because of statewide funding cuts.
He said the department gets several calls a week.
“We give the person an on-the-spot evaluation, so we might ask them what day of the week it is,” he said. “Most of the time, it’s someone who has gone off their medicine and most are willing to go to a treatment center.”
If they are suicidal, they can be involuntarily admitted to a center such as Gateway Regional Medical Center in Granite City. But if the person is a threat to someone, they are arrested and given an in-jail evaluation by a mental health provider.
Jennifer Roth is the executive director of the Madison County Mental Health Board.
“From my standpoint, the police do a phenomenal job,” Roth said, noting the county has one of the largest number of CIT officers and can offer backup to any municipality that doesn’t have the program.
She said a special housing unit was established 10 years ago to keep mentally ill individuals from the jail’s general population, where they could be more closely monitored. More recently, a mental health court was added to the roster of specialized courts.
“It’s a good option for those arrested on misdemeanors,” she said. “The goal is to prevent people from cycling in and out of jail.”
Last month, Kathy began a new job at the National Alliance on Mental Illness State Office, working as a coordinator for outreach and engagement. With her son currently in a residential care facility in Kirksville, Mo., and receiving treatment, she says the battle is far from over.
“The stigma of mental illness keeps people from asking for and getting help, but it’s common and treatable,” she said.
Earlier this month, a prayer vigil was held in Wood River for people with mental illness.