dyslimbic
11-07-2007, 07:27 AM
Date: Wednesday, November 07, 2007 03:44 AM
http://www.psycport.com/showArticle.cfm?xmlFile=knightridder%5F2007%5F11%5 F06%5F%5F0000%2D1299%2DTB%2DToo%2Dviolent%2Dto%2Dh old%2Dtoo%2Dsick%2Dnot%2Dto%2D1106%2Exml&provider=Chicago%20Tribune
Too violent to hold, too sick not to: With mental illness, dementia, man falls through the cracks
Chicago Tribune - November 06, 2007
Nov. 6---- Nobody knows what to do about Harold Richards.
Since 2004, he has been forced to move at least two dozen times through a nightmarish circuit of hospitals, nursing homes and psychiatric units where he has been medicated, treated to electroshock therapy and controlled with leather restraint -- then released.
At 68, Richards suffers severe mental illness and a form of incurable disease called Lewy body dementia that causes him to hit, bite or even choke people without provocation.
While doctors agree his violent behavior is caused by an illness over which he has no control, they also offer few options for how to take care of him. Each facility where he has been placed has said it isn't prepared to handle a person with his combination of diagnosis and behavior.
His family now faces a dilemma: Their loved one, who served in the Army, helped raise children and has been employed since 1987 as a sanitary engineer for Cook County, must be accused of doing something even more violent before he can get long-term help, and even then there are no assurances that it will be permanent.
"His best way of getting somewhere to stay is being convicted [or accused] of a crime," conceded Pat Knepler, public service administrator for the Illinois Department of Human Services Division of Mental Health.
"That's not a good option for the family, I realize," he added.
Hole in the system
The case exemplifies a failure in Illinois' system for dealing with people who have complicated brain ailments and who pose a threat to others.
State institutions such as Tinley Park Mental Health Center -- which admitted Richards twice before his last release in November 2004 -- operate with the goal of treating mental illness, then releasing the patient into the community. They are not equipped to deal with problems associated with aging, such as dementia or medical ailments, so they have referred Richards to nursing homes. But nursing homes don't want Richards because he is violent.
A criminal proceeding may be the last resort for Richards, a Chicago native who has been admitted to 18 local, state and federal facilities over the last four years, none of which was able or willing to handle him. On Thursday, he is due in the Lake County Courthouse, charged with battery for hitting a nurse in September while he lived at the North Chicago Veterans Administration Medical Center.
The day he was arraigned, he was brought into court still clad in his hospital gown and adult diaper, according to the family.
"Everyone in the medical profession seems to forget that Harry is a human being," said his brother and legal guardian, Larry Richards, 65, of New Lenox. "It's like it's somebody else's problem -- take him home or put him out on the street."
Knepler said he was aware of other cases in which patients have both mental illness and dementia. Most move into nursing homes with behavioral units, some of which are out of state. But, he acknowledged, "the ones who get violent are very tough to place."
Richards' family has not had much luck with nursing homes, some of which have booted him within 24 hours. Richards was sent to the Tinley Park center by court order after attempting to choke a nurse at one home.
After Tinley, he was sent to the North Chicago VA, where he lived off and on from November 2004 until his September arrest. During that time, he injured others in at least 27 incidents that VA police were called to handle, according to a report by the center's social worker dated Oct. 12, 2006. Each time, he was deemed incompetent, so no charges were filed, according to her report.
Social worker Stephanie James wrote in the report that the medical center "has made several attempts to get state facilities to accept Mr. Richards as a transfer; however, each time has been unsuccessful."
On Sept. 14, police arrested Richards at the North Chicago facility, removing him from a locked-down psychiatric unit and taking him to Lake County Jail. The reason he was arrested this time, and not during previous incidents, is because an individual employee filed a complaint, according to the North Chicago VA center's spokesman, Doug Shouse.
Since then, he has been hospitalized at Vista Medical Center West's psychiatric unit in Waukegan, accumulating bills of $1,400 a day, according to his family. Larry Richards said he is afraid to visit his brother for fear Vista, which offers only temporary care, will release him. The last time he visited, several weeks ago, an administrator told him he should take his brother home, Larry Richards said.
Vista officials declined to comment about Harold Richards' case or allow a reporter to visit with family, citing privacy laws.
Larry Richards recently filed an appeal with the Department of Veterans Affairs, asking officials there to take his brother back.
The VA's Shouse said officials did their best to find Harold Richards a suitable home.
"It's a tough case for everybody," Shouse said. "The VA is not equipped to handle real violent patients. We have always referred anything such as this to the state. ... We have over 300 patients here. We have to worry about everybody's safety."
Harold Richards is insured and has been receiving disability payments through his employer, which will end in April, so money has not been an obstacle in receiving care.
A family's dilemma
Richards, who served in the Army from 1964 to 1966 as a civil engineer but did not see combat, had long suffered bouts of depression, according to his former wife, Mary Richards, 63, of San Antonio, but had never been violent.
The two divorced in the late-1980s after 22 years of marriage. She believes Harold first suffered depression early in the marriage, after the couple learned they were infertile. They adopted three children, one of whom died of complications from cystic fibrosis at 9 months, she said via e-mail.
"He never quite came back to his prior level after each depression," she wrote.
The family realized Richards could no longer take care of himself in spring 2004, when his brother and daughter, Mary Beaumont, 33, of Janesville, Wis., cleaned out one of the last places where he lived independently. Her younger brother is not actively involved in their father's care.
"He was living in squalor. It was just filthy," his daughter said, recalling the Oak Lawn apartment.
The family learned Harold had stopped going to work and rarely left the apartment. He ordered food to be delivered, paid his bills by phone and appeared to spend most of his time in bed.
It became apparent Richards suffered from more than chronic mental illness. He was hospitalized at Little Company of Mary Hospital's psychiatric unit in Evergreen Park in January 2004.
Since then, Harold Richards has become increasingly violent. He has been diagnosed with Lewy body dementia, a terminal disease that has characteristics of Alzheimer's disease but also physical symptoms similar to Parkinson's disease, said Dr. James Mastrianni, associate professor of neurology at the University of Chicago Medical Center.
Mastrianni, who heads the hospital's Memory Center that deals with dementia, said he was not surprised to hear about Richards' story, though it's more typical for younger patients, in their 50s, to be turned away from nursing homes. Not all Lewy body patients are as violent as Richards, he said.
"Caregiving is a real drain on family members, and you not only have to take care of a person but watch them slowly die from these horrible diseases," Mastrianni said.
Larry Richards knows he and his wife are not capable of taking care of his brother.
"I've thought about taking him in," he said. "If I could, I would."
He said the last time he saw his brother Harold tried to hit Larry as he gave him a haircut. In the past, Harold has suffered from hallucinations, reported that he hears voices, is paranoid and suffers from cognitive deficits caused by dementia, according to medical reports.
"He kind of stares out at you, doesn't blink a lot," Larry Richards said. "You don't know what's going on behind the facade. He's there, but not really."
lblack@tribune.com
http://www.psycport.com/showArticle.cfm?xmlFile=knightridder%5F2007%5F11%5 F06%5F%5F0000%2D1299%2DTB%2DToo%2Dviolent%2Dto%2Dh old%2Dtoo%2Dsick%2Dnot%2Dto%2D1106%2Exml&provider=Chicago%20Tribune
Too violent to hold, too sick not to: With mental illness, dementia, man falls through the cracks
Chicago Tribune - November 06, 2007
Nov. 6---- Nobody knows what to do about Harold Richards.
Since 2004, he has been forced to move at least two dozen times through a nightmarish circuit of hospitals, nursing homes and psychiatric units where he has been medicated, treated to electroshock therapy and controlled with leather restraint -- then released.
At 68, Richards suffers severe mental illness and a form of incurable disease called Lewy body dementia that causes him to hit, bite or even choke people without provocation.
While doctors agree his violent behavior is caused by an illness over which he has no control, they also offer few options for how to take care of him. Each facility where he has been placed has said it isn't prepared to handle a person with his combination of diagnosis and behavior.
His family now faces a dilemma: Their loved one, who served in the Army, helped raise children and has been employed since 1987 as a sanitary engineer for Cook County, must be accused of doing something even more violent before he can get long-term help, and even then there are no assurances that it will be permanent.
"His best way of getting somewhere to stay is being convicted [or accused] of a crime," conceded Pat Knepler, public service administrator for the Illinois Department of Human Services Division of Mental Health.
"That's not a good option for the family, I realize," he added.
Hole in the system
The case exemplifies a failure in Illinois' system for dealing with people who have complicated brain ailments and who pose a threat to others.
State institutions such as Tinley Park Mental Health Center -- which admitted Richards twice before his last release in November 2004 -- operate with the goal of treating mental illness, then releasing the patient into the community. They are not equipped to deal with problems associated with aging, such as dementia or medical ailments, so they have referred Richards to nursing homes. But nursing homes don't want Richards because he is violent.
A criminal proceeding may be the last resort for Richards, a Chicago native who has been admitted to 18 local, state and federal facilities over the last four years, none of which was able or willing to handle him. On Thursday, he is due in the Lake County Courthouse, charged with battery for hitting a nurse in September while he lived at the North Chicago Veterans Administration Medical Center.
The day he was arraigned, he was brought into court still clad in his hospital gown and adult diaper, according to the family.
"Everyone in the medical profession seems to forget that Harry is a human being," said his brother and legal guardian, Larry Richards, 65, of New Lenox. "It's like it's somebody else's problem -- take him home or put him out on the street."
Knepler said he was aware of other cases in which patients have both mental illness and dementia. Most move into nursing homes with behavioral units, some of which are out of state. But, he acknowledged, "the ones who get violent are very tough to place."
Richards' family has not had much luck with nursing homes, some of which have booted him within 24 hours. Richards was sent to the Tinley Park center by court order after attempting to choke a nurse at one home.
After Tinley, he was sent to the North Chicago VA, where he lived off and on from November 2004 until his September arrest. During that time, he injured others in at least 27 incidents that VA police were called to handle, according to a report by the center's social worker dated Oct. 12, 2006. Each time, he was deemed incompetent, so no charges were filed, according to her report.
Social worker Stephanie James wrote in the report that the medical center "has made several attempts to get state facilities to accept Mr. Richards as a transfer; however, each time has been unsuccessful."
On Sept. 14, police arrested Richards at the North Chicago facility, removing him from a locked-down psychiatric unit and taking him to Lake County Jail. The reason he was arrested this time, and not during previous incidents, is because an individual employee filed a complaint, according to the North Chicago VA center's spokesman, Doug Shouse.
Since then, he has been hospitalized at Vista Medical Center West's psychiatric unit in Waukegan, accumulating bills of $1,400 a day, according to his family. Larry Richards said he is afraid to visit his brother for fear Vista, which offers only temporary care, will release him. The last time he visited, several weeks ago, an administrator told him he should take his brother home, Larry Richards said.
Vista officials declined to comment about Harold Richards' case or allow a reporter to visit with family, citing privacy laws.
Larry Richards recently filed an appeal with the Department of Veterans Affairs, asking officials there to take his brother back.
The VA's Shouse said officials did their best to find Harold Richards a suitable home.
"It's a tough case for everybody," Shouse said. "The VA is not equipped to handle real violent patients. We have always referred anything such as this to the state. ... We have over 300 patients here. We have to worry about everybody's safety."
Harold Richards is insured and has been receiving disability payments through his employer, which will end in April, so money has not been an obstacle in receiving care.
A family's dilemma
Richards, who served in the Army from 1964 to 1966 as a civil engineer but did not see combat, had long suffered bouts of depression, according to his former wife, Mary Richards, 63, of San Antonio, but had never been violent.
The two divorced in the late-1980s after 22 years of marriage. She believes Harold first suffered depression early in the marriage, after the couple learned they were infertile. They adopted three children, one of whom died of complications from cystic fibrosis at 9 months, she said via e-mail.
"He never quite came back to his prior level after each depression," she wrote.
The family realized Richards could no longer take care of himself in spring 2004, when his brother and daughter, Mary Beaumont, 33, of Janesville, Wis., cleaned out one of the last places where he lived independently. Her younger brother is not actively involved in their father's care.
"He was living in squalor. It was just filthy," his daughter said, recalling the Oak Lawn apartment.
The family learned Harold had stopped going to work and rarely left the apartment. He ordered food to be delivered, paid his bills by phone and appeared to spend most of his time in bed.
It became apparent Richards suffered from more than chronic mental illness. He was hospitalized at Little Company of Mary Hospital's psychiatric unit in Evergreen Park in January 2004.
Since then, Harold Richards has become increasingly violent. He has been diagnosed with Lewy body dementia, a terminal disease that has characteristics of Alzheimer's disease but also physical symptoms similar to Parkinson's disease, said Dr. James Mastrianni, associate professor of neurology at the University of Chicago Medical Center.
Mastrianni, who heads the hospital's Memory Center that deals with dementia, said he was not surprised to hear about Richards' story, though it's more typical for younger patients, in their 50s, to be turned away from nursing homes. Not all Lewy body patients are as violent as Richards, he said.
"Caregiving is a real drain on family members, and you not only have to take care of a person but watch them slowly die from these horrible diseases," Mastrianni said.
Larry Richards knows he and his wife are not capable of taking care of his brother.
"I've thought about taking him in," he said. "If I could, I would."
He said the last time he saw his brother Harold tried to hit Larry as he gave him a haircut. In the past, Harold has suffered from hallucinations, reported that he hears voices, is paranoid and suffers from cognitive deficits caused by dementia, according to medical reports.
"He kind of stares out at you, doesn't blink a lot," Larry Richards said. "You don't know what's going on behind the facade. He's there, but not really."
lblack@tribune.com