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Parents of troubled adults face dilemmas

Recent violence highlights issue

By David Abel
Globe Staff / November 19, 2011

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His adult stepson was acting erratically and seemed increasingly volatile, as if he might strike them or do something worse. Guy Beales and his wife mulled seeking a restraining order or asking a judge to order emergency treatment in a hospital, but in the end, they called the police.

“I had become concerned for our safety, and at that point, he was psychotic,’’ said Beales, who now serves as president of the board of directors of the National Alliance on Mental Illness of Massachusetts and whose stepson, suffering from schizoaffective disorder, had stopped taking his medication. “For many parents, it might be very difficult to call 911 on an adult child, but sometimes it has to be done.’’

How parents should respond to threatening behavior by adult children with mental illnesses has long been a quandary, but it has become all the more so in the aftermath of the recent killings in Weymouth and Danvers, in which two young, troubled men allegedly killed a parent and other close relatives.

Advocates for the mentally ill say the challenge of providing the right balance of care for such people is more difficult in Massachusetts because the Commonwealth is one of only six states without a law allowing authorities to require the mentally ill who are deemed to be at risk of harming themselves or others to take medication, undergo therapy, or be treated at outpatient medical facilities.

In arguing for such legislation, the supporters cite studies by the Department of Justice, which found in the 1990s that more than 25 percent of children who killed their parents had a history of untreated mental illness, and that 10 percent of the nation’s homicides were committed by people with untreated mental illness.

“A major predictor of violence is the lack of treatment for the mentally ill,’’ said Kristina Ragosta, legislative counsel for the Treatment Advocacy Center, a Virginia-based group that seeks to remove barriers to care for the mentally ill. “People with schizophrenia and other severe mental illnesses are no more likely to commit acts of violence than the general public, provided they are receiving treatment.’’

But 40 percent of people with schizophrenia and 51 percent of individuals with bipolar disorder are not receiving treatment, according to a study by the National Institute of Mental Health. Many refuse to take medication because they believe they are not sick.

In Massachusetts, Representative Kay Khan, a Newton Democrat and psychiatric nurse, has repeatedly proposed a bill over the past decade that would allow judges to order those with severe mental illnesses to undergo regular treatment at outpatient facilities near their homes.

She said it would increase the likelihood such people would take their medication, reduce the need to hospitalize them for prolonged periods far from their homes, and ultimately result in less homelessness and less violence.

“This bill would target the most high-risk people, those who show signs of behavior deteriorating and lack awareness of their own illness,’’ said Khan, who chairs the Joint Committee on Children, Families, and Persons with Disabilities.

At a State House hearing on the bill last month, Khan said a study of a similar law in North Carolina found that hospital admissions for those with court-ordered outpatient treatment were 57 percent lower and the average length of stay at a medical facility was 20 days shorter than for those without such a court order.

She cited similar results in New York, where she said passage of the so-called Kendra’s Law in 1999 sharply reduced the need to hospitalize people with severe mental illnesses, and cut their substance-abuse rates, homelessness, and violence.

“This legislation would protect people from themselves and from the dangerous situations they find themselves in,’’ she said.

But over the years, the state Department of Mental Health has opposed the bill. Officials have questioned its impact on the civil rights of the mentally ill, as well as the cost of providing outpatient treatment.

The potential costs have presented more of an obstacle recently, as lawmakers have cut the Department of Mental Health budget by more than $50 million, or 8 percent, over the past three years.

State officials have also questioned the need for Khan’s bill when they have other tools, such as a section of the law that took effect in 2000 that allows authorities to commit those with mental illnesses who are at imminent risk of harming themselves or others to hospitals against their will.

But the so-called Section 12 commitments often last for a much shorter period than the treatment that would be required by Khan’s bill.

Last year, the state involuntarily committed 8,520 people, 13 percent more than the previous year. But more than one-third of those patients were released from hospitals within a week.

“Prior administrations have opposed the bill in part related to the lack of data that supports that it works, and the need to develop services to focus on the engagement of clients, as opposed to using the courts to mandate their care,’’ said Debra Pinals, acting deputy commissioner of clinical and professional services and medical director for the Department of Mental Health, referring to the goal of getting mentally ill people to take part in services on their own. “But we are reviewing the bill.’’

It is not clear such a bill would have made a difference in preventing the recent killings.

In one, Stephen Anastasi, 24, of Danvers, allegedly hit his father in the head with a hammer last week and then, after injecting heroin, returned to fatally stab him in the neck. He initially told police aliens killed his father.

In Weymouth, Donald Rudolph, 18, who had been diagnosed with schizophrenia and had a long history of hospitalizations, allegedly used knives and a hammer to kill his mother, sister, and his mother’s boyfriend in their home last week.

Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness and a former medical director of the Department of Mental Health, said it is rarely straightforward when deciding when someone should be involuntarily committed to a hospital or forced to take medication.

“What happened in Danvers and Weymouth were unbelievable catastrophes,’’ he said. “But it’s hard to predict human earthquakes.’’

He said parents of adult children with mental illnesses can find themselves in a very difficult dilemma when their children seem to be spiraling out of control.

Their impulse to protect and nurture may put them and their children in greater peril.

He said parents should consider committing their children against their will if the children refuse to take medication, attend therapy sessions, or take part in other services that might help. Parents might also take such action if the medication and other efforts don’t appear to be working.

One red flag that such a move may be needed, he said, is when a person begins making threats.

“I tell people not to ignore their fears,’’ he said. “I tell them to follow their instincts, and to call police if they feel threatened.’’

For Guy Beales and his wife, the decision to call the police two years ago paid off.

Their son surrendered peacefully, leaving their home without incident. Since then, he has entered a treatment program, regularly takes his medication, and has become a part of the family again.

“He’s doing extraordinarily well,’’ Beales said. “We’re very glad we made that call.’’

David Abel can be reached at dabel@globe.com. Follow him on Twitter @davabel.