Growing up in a small middle-class town in Washington State, I had very little knowledge or understanding about mental illness, our criminal justice system, and the homeless or how these issues were connected. It wasn’t until I was an adult, living in the Houston area, that my eyes were opened to the larger problem. It was not until my own personal experience left me with no doubt that the American mental health care system is insufficient. I believe the inadequate and flawed mental health system plays a large part in why our loved ones end up living on the streets or living in our prisons.
Not long ago, I ran into an old friend, Linda, who lives in a high-rise apartment in downtown Houston. We hadn’t talked in years. Because the topic of my daughter came up, Linda told me about her mornings and walking her dogs at 5:30 am.
Linda talks passionately about the homeless people she chats with. She describes a man who carries a cardboard box that is used for his bed. Many tell Linda about their loved ones but their stories are incoherent. She makes healthy muffins for them because she doesn’t know when they’ll get their next meal. It breaks her heart that she can give them walking directions to a hot meal, warm clothes, and a few other services, but nothing for their mental health needs. Many nights she watches, from her window, as the police escort a homeless person away in a police car.
Those strangers, whom society has written off, belong to someone. What if I lose my own daughter to her mental madness? The optimism in me wants to deny that could happen, but the laws and the mental health system I have lived with remind me it’s a real possibility. Would my daughter be harmed or feared by those rushing past her? Would there be someone kind enough to smile at her and feed her a muffin? It gives a bit of comfort knowing there are more Lindas out there who value all human life. We don’t hear about them because they don’t seek recognition.
My daughter, Raven, is an amazing person whose early childhood was anything but easy. She was removed from her biological family and two foster homes, and was admitted to her first psychiatric hospital before her 4th birthday. She was then placed in my foster home. When the parental rights were terminated, I adopted her. Shortly after, I got married and she was adopted by my husband and we became a family. She brought so much joy to our lives even when things were difficult.
Raven received a bipolar diagnosis before her 4th birthday, but I didn’t believe it. We treated her behaviors as symptoms of post traumatic stress disorder, ADHD, obsessive compulsive disorder and reactive attachment disorder. She went to therapy and family sessions over the years because of the difficulty of raising a child with so many problematic behaviors. Even so, Raven was a cheerful child, who wanted to behave and make the people in her life proud of her. Her quirky personality helped her friends overlook her frequent outbursts, but the peers, who couldn’t understand her, were often unkind. When I saw small improvements in her daily life, I believed, one day, all the past abuse would be behind us.
When Raven was 12, one single event seemed to “awaken” mental illness. Our life was suddenly spinning out of control. During the next nine months she was hospitalized eight times. She began experiencing deep depression which led to manic episodes. Her bipolar diagnosis was confirmed but later changed to schizoaffective disorder. It seemed likely that borderline personality disorder would also be added. Each time the doctors changed her medications and sent her home new symptoms appeared. She began expressing delusional thoughts and her fantasy world was mixed with what was real. When her hallucinations and obsessions became homicidal, we were advised to get her into long-term treatment.
Then came the most perplexing Medicaid law that did nothing but add to the chaos. In my state, Medicaid wouldn’t cover long-term treatment for mental illness unless parents gave up guardianship to the state. Caseworkers who specialized in child abuse (CPS) would determine my child’s medical care. We first turned to a local post-adoption agency for support and funding. When their funding ended, and it was clear my daughter couldn’t return home, we had no choice but to give up guardianship.
CPS agreed to keep Raven in the first residential treatment center (RTC). She lived there for a year, but wasn’t getting better. CPS recommended that she go to a long-term psychiatric hospital. I was told, “Your daughter’s prognosis looks bleak.” While it was hard to hear, it was what I needed to keep me grounded. I knew that it was okay for Raven not to achieve all the dreams I had for her. I was proud of her for working hard and not hating me for sending her away.
The state workers disregarded the recommendation of Raven’s medical team and sent her to another RTC. This was a deplorable facility that specialized in treating teen girls who’d been in trouble with the law, not psychiatric patients. The treatment of Raven and me was anything but nice. Raven lasted about 16 days before she tried to strangle herself and was sent to an acute psychiatric hospital. My husband and I hired a lawyer. Because Texas didn’t have a long-term psychiatric hospital willing to take Raven, the judge granted an intercontinental compact. In this case, Texas negotiated an agreement making it possible for Raven to receive psychiatric care in Florida. This process would take time, but the judge ordered that Raven was not to return to the RTC. CPS ignored the referral.
Raven was returned to the RTC. Despite my warnings that Raven would crack in that environment, CPS workers did nothing. Besides making my outrage clear, my legal rights to act were gone. Raven did crack about 18 days after being returned. She had a psychotic, manic episode. The RTC staffers refused to call the crisis Intervention team to have Raven assessed. They intended to press criminal charges against her and were uninterested in using the Harris County diversion program.
This arrest added more tension as we scrambled to figure out what would happen next. Would Raven go to Florida or would she stay and face criminal charges? Within 72 hours of her arrest, CPS removed my daughter from the juvenile detention center and put her on a plane to Florida. All charges were dropped. She was 13 years old.
With a different kind of treatment and environment, my daughter improved significantly. She faced consequences if she were defiant, but the approach was different for enforcing the rules and consequences. She learned how to calm herself and learned strategic skills for communicating when she was becoming, psychotic. She learned how to express herself when the hallucinations were too loud. Through weekly therapy sessions, my husband and I learned new parenting skills to use when she returned. We were given reasonable expectations to help us set appropriate goals for her.
When Raven returned home from Florida, the transition from being institutionalized for almost two years was extremely difficult. CPS offered little support and, in many ways, made thing more difficult. At times, it looked like Raven wouldn’t survive outside the security of locked doors and 24-hour monitoring. Most of her suicidal attempts were wrapped in psychotic thinking. One day, for example, while she appeared happy, she swallowed a battery and a few trinkets. She thought, if her friend was going to kill himself, she didn’t need to live either. These kinds of thoughts and behaviors were common on her good days.
As my husband and I began to anticipate the obstacles we’d be facing when Raven turned 18, we decided to move to our weekend cabin in the hill country at the end of Ravens 10th grade year. Raven was excited about this move. We set up new school accommodations before moving and made plans to slowly transition her medical care.
It didn’t take long for the police to know us and, for the most part, they understood the seriousness of Raven’s mental condition. One event, which happened several months before my visit with Linda, left me realizing how easy it would be to lose my daughter to her madness.
After 5 months, when Raven’s illness seemed to be in remission, her paranoia became progressively more problematic. When I agreed to a small medication change, I didn’t know it would set off another downward spiral and lead us back to CPS. While an inpatient, Raven’s medication changes happened abruptly. Doctors added and subtracted new medications every few weeks while she was withdrawing from her previous therapeutic combination. Meanwhile, they sent her home even when I expressed my concerns. It was no surprise that, each time she was released from the hospital, she became sicker and more psychotic. I had the first doctor removed from continuing to treat Raven. He told me the therapeutic level of medication wasn’t good for her and he wouldn’t prescribe it, even though it had kept her home for almost two years. The second doctor wasn’t much better. Raven had a total of six hospitalizations in a six month period.
Ravens biological father had contacted her on social media while her life was going relatively well. At first, she expressed no desire in knowing him, but her interest was suddenly peaked during the downward spiral. She was enrolled in the partial hospital program on the day she decided to leave our house on foot. Because she was acting strangely, I called the police. When the police assessed her, they determined she didn’t meet criteria for a commitment, but admitted she didn’t sound coherent.
I’ll never understand why the police drove Raven 15 minutes to a local restaurant so she could use the internet to contact her biological father. She wanted him to pick her up so she could live with him. She hadn’t seen him since she was three years old and CPS had terminated his rights. I was told, because she was 17, I couldn’t stop her regardless of her severe mental illness. Her biological father lived four and a half hours away. He was only thirty minutes away from getting Raven before the hospital administrator, the police in the next county, and I shut down her plans. Soon we learned she was being commanded by her hallucinations to kill my husband, me, and her pets, but she didn’t want to act. The only solution she could think of to protect us was to find a new home. She was committed back to the psychiatric hospital. My daughter could have left with anyone that day and I might have lost her forever.
When the severity of Raven’s symptoms became more dangerous for her to live outside a secure living facility, my husband and I made it clear we could no longer bring her home. Her psychologist agreed. During another psychiatric hospital stay, the doctors finally put in a few requests for long-term hospitals to help get her medications working properly. San Antonio State Hospital did an assessment but declined treating her. Cedar Crest Hospital declined because of “aggression” so Raven was sent home. I was not yet willing to call CPS, so we decided to take another chance, hoping the meds would finally be right.
Less than two weeks later, showing signs of being very sick, our daughter started a fire in our cabin. We were able to put the fire out quickly. When police picked her up, it was clear she needed long-term medical care. They didn’t even hint about pressing charges. Only the doctor treating her asked if we were doing to press charges, suggesting that might be the best way to get her help. He psychologist didn’t agree with the doctor.
That evening, my husband and I went to the hospital to talk to the doctors and to check on Raven. We were shaken by the events of that day, but we weren’t angry with her. She’d been medication compliant. When I entered the hospital room, Raven was entertaining herself with peanut butter and a spoon. After we hugged, I saw that she was behaving like a 5 year old. She showed me her neat trick. She could put the spoon and peanut butter on her nose, and giggled because it wouldn’t fall off. She seemed oblivious to the events that had just taken place. The next morning, I called CPS and explained why I was unable to bring my daughter home. My heart broke.
In spite of everything, I see hope. I see more people, like Linda, who care. I see more of us telling our stories so we can make a difference. I see social support groups available online to give advice and support. I see a movement of people who are tired of fighting a system that fails us and has no accountability, and tired of finding our loved ones incarcerated or homeless. I see people educating our politicians and trying to make improvements. I see change coming.
I’m excited to play my small part in fighting for one of the most vulnerable groups of people in our population. I share my story because it needs to be heard.
UPDATE: Raven is back in an acute psychiatric hospital and the doctors have yanked the medication combo that keeps her from the behaviors that we can’t live with. Again, they claim the medications are not "good for her" — as if being lost in her psychosis leaves her better off. Raven is begging for ECT or brain surgery —anything to prevent her from loosing touch with reality. Anything so she can come home. This brings us full circle as we watch her decline. Her prognosis is looking dim. The meds that keep her functioning the best are being denied to her.
