Part 3: A Long, Tiring JourneyApril 15, 2014
Story by Martha Rasche
Photos by Dave Weatherwax
As Paul Burrows progressed through his 20s, his rap sheet grew — theft, possession of marijuana, intimidation, receiving stolen property — along with the number of mental health professionals he saw.
His mother, Lynda, who had become his legal guardian the year he turned 18, continued to push for specific diagnoses for her son, who continued to abuse her, and had come to believe that the mentally ill do not belong in jail.
Lynda — who shares an apartment with her son in Jasper — turned 66 last year and was ready to resign her guardianship because of the emotional and physical toll it has taken on her. But if she is no longer in the picture to help protect Paul, 36, she fears for his future. A 2010 study by the National Sheriffs’ Association found that across the country more than three times as many mentally ill people are in prisons and jails as in hospitals.
June 26, 2006 - A debt collector engaged by a bank seeks to collect Paul’s delinquent debt of $1,844.41. He is 28.
Jan. 31, 2007.
From a letter from Lynda to a collection agency; the letter was accompanied by a copy of her guardianship papers:
… Paul’s signature is like a ghost; it is not valid.
… Each bank here in Tell City has my guardianship papers, and each bank was aware not to send Paul Burrows any checks. The bank (sent) Paul’s checks to his girlfriend’s address.
Now, regarding this matter, this has come to the attention of the Perry Circuit Court, Cause No. 62C01-0611-CM-1048. The court and the attorney representing Paul (are) now aware of the situation.
This account will be paid in full before the court date of April 18, 2007.
Aug. 21, 2007. Paul is 29.
From a Southern Hills Counseling Center initial assessment:
Client is a 29-year-old male who was referred to Southern Hills by Dubois Court.
… Patient comment: “Over the past year I had been drinking over a case of beer a day, up till the past five months.”
… Court depicts his past history of drug use to have been extensive and that he has used just about every kind of drug imaginable. “Pot, meth and crack were the main things that I used up till about three years ago.”
… “I still have fits and outbursts that scare others.”
Axis I: Polysubstance dependence, panic disorder with agoraphobia
Paul was in jail in Perry County, on a felony charge of dealing in a Schedule IV controlled substance, from January to April 2010, during which time he turned 32.
When Paul came home from jail after those three months in 2010, his longest incarceration to date and a time during which he did not receive his normal medication, he suffered severe anxiety. He was shaky, drug his feet when he walked and slurred his words.
Presenting paperwork from 1996 documenting that Paul was impaired and in need of supervision, Lynda asked if he couldn’t be admitted to a state hospital.
The answer was no.
The number of state hospital beds had been shrinking during the preceding two decades as the result of a nationwide turn toward deinstutionalization, and by today has shrunk more than 80 percent.
People who used to require placement at a state hospital are now being shifted to community services including group homes, for which there is a waiting list.
“There’s much more of a desire (now) to keep folks in the community and to have families involved,” commented Doug Hayworth, the unit outpatient coordinator for Southern Hills Counseling Center who has been in the business for 35 years.
Paul was hospitalized briefly, and during the eight days immediately following his release back to his guardian’s care, he went to a hospital emergency room three times and Lynda called the inpatient unit multiple times for additional advice. More E.R. visits and phone consultations followed.
“It took me almost a year to get Paul even halfway normal,” Lynda recalls. “I went through beatings, yellings, screamings. (I was) thrown against the wall. And I can’t call the cops. There’s nothing I can do. You learn to hide all this. You have to learn to hide it, because the cops will not help you. And the psychiatrists are strapped” in what they can do because of diminishing funding.
It also has become harder to find certified therapists and psychiatrists to employ, noted Southern Hills Executive Director Joe Kimmel. He said state funding of the 25 community mental health centers in Indiana started decreasing 3 percent annually six years ago and an additional 5 percent annually two years later.
In 2012, more than half of the centers operated at a deficit, and last year nearly one-third of them did, Kimmel said. Southern Hills was in the red both years.
The State Legislature has returned 2.5 percent in funding — that equates to about $50,000 for Southern Hills, according to the agency’s chief financial officer, Rich Whitaker — to the budget this year and has agreed to another 2.5 percent next year.
For 2014, Whitaker said, Southern Hills is receiving approximately $1.5 million in state and federal revenue through the State Department of Mental Health and Addiction.
Dec. 23, 2010.
From a letter to Lynda from her attorney:
My assistant informed me that you were screaming at her on the telephone. My other assistant that was not on the telephone with you could hear you screaming. This is entirely unacceptable conduct.
Lynda can be overbearing.
She raises her voice, issues challenges and doesn’t always listen all the way through. Early on, at least a couple of mental health professionals questioned if Lynda was an enabler in her son’s life. But that was 20 years and many diagnoses ago.
And as those diagnoses emerged, she felt vindicated for having continued to push the mental health community for answers.
Today she pushes for police and the courts and anyone else in her son’s path to recognize that he has a legal guardian and as such he is a “protected person” according to the state. She believes his constitutional rights have been violated time and again.
She has made dozens, probably hundreds, of phone calls — to private attorneys, trying to help her son’s defense; to state and national advocacy organizations, trying to find the guardian’s role in the legal system; and to the media and legislators, trying to raise awareness about a system that she considers broken.
Most of her calls fall on deaf ears.
“Nobody wants to listen. They don’t want to hear it. They want to believe that everything is kosher.”
She has called some of the same attorneys and organizations multiple times. One man she spoke with last May remembered her calling a few years earlier and told her he couldn’t help her then and couldn’t help her now.
Lynda tries to explain what the never-ending cycle of seeking help feels like.
“I feel like there’s this big mirror. I’m on the dark side. I’m on the foggy side. On the outside is the society and they don’t want to look inside because that’s a taboo. I mean, my son has beaten me, he’s hurt me, he’s almost killed me. You can’t go to the police.”
She has come to expect the worst, and often acts from that frame of reference. Some of her abrasive words and impulsive behavior come from passion. Others come from desperation as she anticipates her son will spend more time in jail and realizes that no one else will ever devote his or her life to him as she has done.
“I get furious at times, yes,” she acknowledges.
Behind closed doors, she cries more than ever before.
“I have heard so many times throughout the years — you know what I’ve heard and I’m so tired of hearing it? ”˜He’s a man. He’s over 18. He’s 30-some years old. He has to take responsibility.’ How can you take a man — I’m getting emotional — how can you take a man who’s got the mind of an 11-year-old child? He can’t read beyond fourth grade. He can’t think for himself. His monsters control him. His black shadows tell him what to do. He creates his own things in his own mind.”
Earlier this year when Lynda’s request for a new public defender for her son was not approved, she left the courtroom in a huff.”©“I’m done. I’m going on television,” she said loudly as she walked out.
She calls the charges against Paul “petty-otic” but says she would feel differently if violence were involved. She says she doesn’t excuse what he’s done and wouldn’t be defending him so staunchly if the charges were murder or rape or assault.
It takes an onlooker to call Lynda out on her selective memory and remind her that she has been a victim of his violence.
May 31, 2011.
From a doctor’s report from Paras Harshawat M.D. Comprehensive Mental Health Services in Terre Haute:
Mr. Burrows’ mood is euthymic with no signs of depression or manic process. … He convincingly denies suicidal or self-injurious ideas or impulses. There are no assaultive or homicidal ideas or intentions. Hallucinations and delusions are denied and he has no thought disorder. … There are no signs of anxiety. He exhibits no signs of attentional or hyperactive difficulties. Insight and social judgment are intact.
Axis I: Schizoaffective disorder, bipolar type
Paul had monthly appointments at Harshawat and, according to the doctors’ reports, did well there. At the end of May 2011, he was taking Adderall for attention deficit hyperactivity disorder, Seroquel to help him sleep and Xanax to treat panic disorder and anxiety.
Paul’s treatment there ended as mental health budgets across the country, along with Medicaid match funding, were being cut.
Southern Hills, for example, would have lost half of its Medicaid funding in 2011 if it wouldn’t have restructured its services at that time, Kimmel said.
Lynda left the Harshawat office with two pages of references for a new doctor.
Paul has had other mental health treatment since then, but the absence of the Terre Haute facility left a gap.
And in 2013, he landed back in jail. While he awaits the resolution of his court cases, he sees a psychiatrist and counselor once a month.
January 2014, the month before Paul turns 36.
From a psychiatrist’s forensic evaluation requested by Paul’s court-appointed lawyer to determine whether Paul has mental illness or defect and to determine also if he is competent to stand trial:
Axis I - Bipolar disorder, mixed type, currently depressed, generalized anxiety disorder, attention deficit disorder with hyperactivity, post-traumatic stress disorder secondary to child abuse, panic disorder with agoraphobia
Axis II - Mild mental retardation, personality disorder, not otherwise specified
Axis III - Hypertension, polysubstance abuse, in remission
Axis IV - Impaired mental capacity, chronic mental Illness, recurrent legal problems, dysfunctional relationships, unemployed, financial problems
Axis V - Global Assessment of Functioning Score is 40
Treatment Plan - Paul will most probably need psychiatric treatment for the rest of his life. His poor insight and judgment will persist in spite of medications and counseling. He will most probably need a guardian for life, too. He will not be able to accept this now but if his mother passes on, a residential treatment facility will have to be considered.
Paul needing to live in a residential treatment facility in Lynda’s absence is not news to her.
Southern Hills has four homes in Dubois County, with a total of 24 beds, for residents with mental health diagnoses. With Lynda’s prodding, Paul is going through the process to determine if he would be accepted for such placement or for independent living with in-home services.
“What more can I do?” Lynda asks. “If somebody walked in this door right now and said, ”˜Lynda, you’re done with your guardianship; we got a place for Paul,’ (I’d say,) ”˜Bye, see ya.’
“I love my son, but hallelujah, it’s over.”
Other parts in the series:
Part 1: Lynda Burrows is mother and guardian to her 36-year-old son. The two have moved from city to city and doctor to doctor because of his mental illnesses and brushes with the law. Their story raises the question: How do we treat the mentally ill? It’s an issue often in the news these days. Click here to read Part 1.
Part 2: Lynda has learned that mental illness is shifty. Paul can have a blow-up one day and be as normal as everyone else the next. Click here to read Part 2.
Contact Martha Rasche at firstname.lastname@example.org.
Courts tasked with guardianship issues
Story by Martha Rasche
Lynda Burrows has been son Paul’s legal guardian for half of his life, ever since he turned 18.
In that role, she has gotten mental health treatment for him time and again. She has accompanied him to court dozens of times. And she has been subject to his physical and verbal abuse.
A guardian is court-appointed for a person unable to manage his personal affairs and/or finances; Lynda is the guardian for Paul the person as well as his property.
Minors generally are the ones in need of guardians, but according to work done in 2011 by Notre Dame clinical professor of law Michael Jenuwine, J.D., Ph.D., on behalf of the Indiana Adult Guardianship State Task Force, Indiana had about 7,000 adults under court-ordered guardianships at that time.
Paul continues to be one of them.
Now 66, Lynda says she is ready to “quit” the guardianship — but doesn’t know how. She’d like some reassurance that without her in the picture, her son still will get the mental help he needs.
First, according to Dubois Circuit Judge William Weikert, she needs to write a letter to the court stating her desire to leave the role. Weikert oversees the county’s probate court, which includes guardianship matters.
From 2009 to 2013, Weikert saw an average of 35 guardianship cases a year. From January through March of this year, eight cases were before him, five regarding minors and three regarding adults.
In Lynda’s case, if there were another family member or friend willing to step into the guardianship role, that would be the likely alternative, Weikert said. If that isn’t a possibility, then, depending on a ward’s specific circumstances, replacement options can include Adult Protective Services, the State Bureau of Developmental Disabilities and the mental health system with its state hospitals and community group homes.
The judge also has appointed a professional guardian in some cases and has the option of appointing a lawyer to file for guardianship or act as a guardian ad litem.
Here’s a closer look at how each option works:
Adult Protective Services steps in to help those who would be considered endangered adults if on their own. These people most often end up getting care in a nursing home, but that ceases to be an option if the individual is violent.
The Bureau of Developmental Disabilities helps individuals with developmental diagnoses; it does not assist in cases of mental illness.
The state mental health system is for those who have a mental illness and are gravely disabled or a danger to themselves or others. Of the six state hospitals, ones in Evansville and Indianapolis deal primarily with children. A second one in Evansville and ones in Madison and Richmond care for a general adult population, according to Doug Hayworth, unit outpatient coordinator at Southern Hills Counseling Center, and the hospital in Logansport is the one that houses those committed through the courts.
Southern Hills, which has its central office in Jasper, is one of 25 community mental health centers in the state system and as such is charged with screening for placement in a state hospital and facilitating a patient’s transition back to the community.
The number of beds at state hospitals has decreased over the years. In fiscal year 2011 alone, the Indiana Division of Mental Health and Addiction reduced long-term inpatient capacity by 30 percent.
Today, there are only 132 beds at the nearest state hospital, in Evansville, according to Hayworth, and just 10 beds are allotted for the five counties served by Southern Hills — Dubois, Crawford, Orange, Perry and Spencer. The beds are always filled, and before a new patient can be admitted, an existing patient has to be dismissed. Or a bed must be “borrowed” from another center.
The typical stay at a state hospital by a Southern Hills client averages six months according to Hayworth, but in some cases stays have exceeded 20 years.
Often when a patient leaves a state hospital, or in lieu of going to one, he lives in a group home — Southern Hills has four in Dubois County — or lives in his own home and receives intensive outpatient services such as appropriate therapy, nurses’ visits, psychiatric follow-up and case management to help with budgeting, shopping and other activities of everyday life.
The typical wait for placement in a group home is a month or two, Hayworth said. Anyone convicted of a felony typically is not accepted.
Hiring a professional guardian is another option and one that Weikert has used a few times, employing professional guardian companies out of Terre Haute and Vincennes. A professional guardian helps the individual manage his finances and visits occasionally, Weikert said. A professional generally receives a minimal monthly payment from the ward’s Social Security income.
In cases where the individual is dealing with legal issues, an attorney could be appointed as pauper counsel to file for guardianship. Another way an attorney is used is as a guardian ad litem. If Weikert has “any concerns about the legitimacy of the guardianship,” he appoints a guardian ad litem to represent the ward during court proceedings.
“We deal with (guardianship cases) on an individual basis,” Weikert said, noting that each case is unique. He generally consults with Hayworth, and the first question Weikert asks is, “What does the system have that might provide the right environment for this person?”
Glossary of Terms
An abnormal and persistent fear of public places or open areas, especially those from which escape could be difficult or in which help might not be immediately accessible.
Any physical conditions that affect Axis I and Axis II disorders.
Psychosocial and environmental stressors.
Level of functioning.
A “normal” mood, neither depressed nor elevated.
Generalized Anxiety Disorder
A condition characterized by six months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with generalized anxiety disorder usually expect the worst. They worry excessively about money, health, family or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia.
Global Assessment Functioning Score
This score considers a person’s psychological, social and occupational functioning on a scale of 0 to 100, with 100 being superior functioning. From 40 to 31, according to the scale, reality testing or communication is impaired or major impairments exist in several areas of functioning.
High blood pressure, defined as a repeatedly elevated blood pressure exceeding a systolic pressure above 140 or a diastolic pressure above 90.
An abnormally elevated mood state.
Mild Mental Retardation
This term has largely been replaced with intellectual disability and intellectual developmental disorder. It takes into account not only one’s intelligence quotient but also one’s ability to function in daily life. A low IQ score — less than 70 — alone does not qualify as intellectually disabled.
An anxiety disorder characterized by sudden attacks of fear and panic. Panic attacks may occur without a known reason, but more frequently they are triggered by fear-producing events or thoughts.
A disorder characterized by the chronic use of mechanisms of coping in an inappropriate, stereotyped and maladaptive manner. Personality disorders are enduring and persistent styles of behavior and thought, not atypical episodes.
Schedule IV Controlled Substance
As defined by the U.S. Controlled Substances Act, Schedule IV controlled substances are those that have a lower potential for abuse and are less likely to lead to dependence than Schedule III, II or I drugs. Xanax, Valium and Ativan are among the drugs in this category.
A mood disorder that is coupled with some symptoms that resemble those of schizophrenia, particularly loss of personality (flat affect) and social withdrawal.
Some definitions come from MedicineNet.com.