Editor’s Note: The names and other identifying information of the family in this story have been changed
For family and other onlookers, a psychotic break can look like someone that’s suddenly devolved into delusional thoughts or paranoia, and even hallucinations. Angela Jaffrey puts it this way: “When someone has a psychotic break, you know it, even if they don’t.”
Jaffrey recounts her ex-husband calling to let her know their son Eric had been admitted to the emergency department at Corvallis’ Good Samaritan Regional Medical Center.
“I understood immediately what had happened when Mike called me,” Angela says. They had both seen Eric become progressively more agitated the week or two prior – he couldn’t focus on even the simplest task, and had all but stopped sleeping. The final decision to bring Eric to the hospital came when he talked about people being out to get him, and saying that he would be better off dead.
Angela describes herself as being of two minds that morning – on the one hand, terrified and helpless to do anything for her son, and on the other hand, determined to remain cool headed and do whatever was required to assure the best outcome possible for Eric, no matter what. That determination would prove defining later on.
Angela says, “You can’t entirely blame the hospital or Benton County’s mental health system, but they should be coordinating, and they’re not, and if that hasn’t already been tragic, it will be sometime.”
Broken Procedures
Angela rushed to the hospital, and after several hours of waiting, she got to speak with a nurse who explained Eric was having some sort of psychotic episode, and that they had given him Ativan which had calmed him down. The nurse also explained the drug was a temporary fix, because they didn’t know what was causing the episode.
Indeed, according to the National Alliance on Mental Illness, psychosis is a symptom, not an illness – it can be caused by a range of things, either physical or mental. Whatever the cause, the brain is basically experiencing a stress overload. Although, there is good reason to treat the symptom in this instance, a psychotic break can lead to harming oneself or others, and there is some evidence that an untreated episode can lead to neural degeneration.
Angela revealed to the nurse that members from both sides of Eric’s family had bipolar disorder. She asked the nurse what was next, if Eric would be admitted to Samaritan’s psychiatric unit. The nurse told her a county social worker would be visiting Eric, and then making that decision.
Angela says the social worker didn’t come for several hours, and when she finally visited Eric, she concluded he was calm and lucid – that he could be released the next morning.
Angela was mystified. Did the social worker not understand how Eric was behaving before the Ativan was administered? Did she not understand the emergency room had to deploy three security staff just to keep Eric from hurting himself or others? Was she unaware that Eric’s family had members with a bipolar disorder?
According to Angela, the social worker admitted it was probably the Ativan that calmed him, and that he was probably going to need some kind of further treatment, but she had no idea what he would need. Angela questioned if releasing Eric seemed like the best course, and the social worker only repeated again that there was nothing she could do.
The Hunt for Help
“When I called the hospital the next morning, they said Eric had already been released, so I called Mike, who told me he’d picked him up, but had to get to work, so he dropped Eric downtown,” Angela says.
Eric had been talking about suicide and also about defending himself against people who were out to get him just 24 hours earlier. At this point, she describes herself as both angry with the hospital and Mike, and scared for Eric. So, she felt fortunate when Eric answered her call, and then met her.
She recounts spending the day trying to find help.
The social worker suggested Eric could be seen as a drop-in at the health department, so she tried that, but describes the trip as unhelpful: “Eric was met by both a substance abuse counselor, and an LCSW [Licensed Clinical Social Worker], neither seemed to connect with Eric, and after 15 minutes, he just walked out.”
Next, Angela took Eric to see his primary care physician, who prescribed a sedative. According to Angela, the primary care doctor said it was the most he was comfortable prescribing, and that what Eric really needed was to see a psychiatrist – which Angela had already anticipated. What she hoped for was a referral from the doctor, and he did offer her referrals, but he also cautioned that getting him an appointment would be difficult because there aren’t enough psychiatrists in the area.
The next few days were a blur of Angela calling every psychiatrist in town to find waiting lists of six months or more – and Eric becoming progressively more paranoid, agitated, and even threatening.
Notably, Angela had Eric on her health insurance, a policy that offers fairly generous psychiatric benefits. So with nobody local able to see Eric, Angela called her insurer’s hotline, and the hunt for a psychiatrist turned somewhat statewide, with a psychiatrist identified in Portland that Eric could see.
It Gets Worse
However, not even a day passed and Mike brought Eric back to the emergency room. Worse yet, he had persuaded Eric to exclude Angela from the list of people who could see him. Mike was also trying to persuade hospital staff and the county social worker to withhold information from her, which to their credit they were unwilling to do.
“Mike was doing what he used to do when our kids were younger, when we were getting divorced,” Angela says. “He’d swoop into whatever was going on, whether it was tutoring, wisdom teeth being removed, or anything else, and he’d work to derail whatever was being put into place for Eric – for no reason that anyone could figure out.” She also says their divorce was high conflict, with him taking her to court almost constantly, which she characterized as making single parenting not only hard, but almost impossible.
“Luckily, while the social worker wasn’t willing to hold Eric long enough to get a real diagnosis, she was willing to hold him longer than last time,” Angela says. After talking with the social worker, she had become persuaded that the best thing for Eric would be admission to Samaritan’s Psychiatric ward.
However, her ex-husband, Eric’s father, quickly dashed any thoughts she had that they could present their son a united front and persuade him to voluntarily accept treatment at Samaritan’s Psychiatric ward. In fact, she says, he was totally against it, and at this point, she still had no direct access to her son.
Angela feared Eric was deteriorating fast, and that his only chance at recovery laid in getting sustained attention from the right professional – in this instance, a psychiatrist. She feared the county social worker didn’t have the authority or resources to really help Eric, and she could see a future of temporary fixes at the emergency room leading to a path that could only spiral downward.
She left the hospital that night resolved that she would contact an attorney first thing in the morning – that she would seek guardianship of her 21-year–old son.
Enter a Good Lawyer
The next morning, Angela was referred to several attorney’s offices, and eventually found one willing to move quickly. She let the county’s social worker know what was happening, which she believes helped the social worker decide to continue Eric’s hold another day. The court granted Angela temporary guardianship the next day, and awarded her a longer term guardianship later.
She had Eric moved to Samaritan’s Psychiatric ward, and in a little less than a week they had settled on a cocktail of mood stabilizers and antipsychotic medications. On discharge, they arranged for Eric to start seeing both a Corvallis psychiatrist and a counselor.
And Today
It is three years later, and Angela says Eric is doing just fine. “He’s working, and is busy just being a normal 24-year-old.”
She does say that the first few months were dicey. Eric continued to need medications for some time, but both he and the psychiatrist agreed that he may not have a bipolar disorder, and that he could try going without meds. Once off the meds, it became apparent something else had caused the psychotic break.
“Eric’s recollection of events leading to the psychotic break are still fuzzy. He said some things that could have indicated a trauma, others depression, and others indicating he’d abused some sort of drug – we may never know why he had a psychotic break,” Angela says, adding that he doesn’t take his own wellbeing for granted, like some people his age might, and that the experience may have made him more conscientious of his mental health.
The Takeaways
Angela says, “In fairness, placing someone in treatment against their will probably should involve checks and balances, but the county social worker should have some authority to do that, and should know someone dosed with Ativan is going to act differently than when they were brought to the emergency room.”
She points out that, when Eric was at the ER the second time, and the social worker knew it was the second visit in about a week, that things did change.
Eric’s mother had experience enough to know her son’s situation needed intervention, and the resources to make it happen. But, Angela says, she worries that not everyone would question the decisions of a county official, or have the resources to get help like she did.
Angela says, “What I saw wasn’t going to go away on its own, and to just keep bringing Eric to the emergency room may have kept him temporarily safe a couple times, but eventually, that was going to fail.”
What Angela questions is why good psychiatric care should necessarily have to rely navigating the legal system – and what happens to someone who doesn’t have a family advocating for them.
In today’s part two, we learn the County may not have too many choices in Eric’s case, and what a family can do when the system doesn’t work.
By Andy Thompson
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