Parents see hope for son’s troubles
Facility appears good option for mentally ill man
Fourth in an occasional series
The judge and the attorneys gathered around the bench Thursday in Fort Bend County court, puzzling together over how to help Warren Muldrow.
His mother’s quest had now become theirs: Find a way to get this troubled young man the mental health care he needed.
Warren, 22, was back in the county jail for violating his probation after he pled guilty in May to threatening law enforcement officers. But all involved in his case knew the underlying problem was not so much criminal behavior as bipolar disorder that went hand in hand with substance abuse.
He had agreed to go to the Lubbock County Court Residential Treatment Center, one of what his attorney considered the state’s best facilities for people struggling with both drug and mental health issues. But his application had been rejected. So now the judge and the attorneys struggled with what to do next.
Warren was not doing well in jail. If he was suicidal or homicidal, his attorney told the judge, Warren needed to get to a state hospital immediately. All agreed during the courtroom conference that he should be assessed immediately as a crisis case. Their decision put his fate, for the moment, in the hands of an outside evaluator who, they hoped, would make a quick deter-
mination. There was little time to lose. But few things ever went as planned for Warren, and county jails across Texas filled with the mentally ill spoke to how few options existed for meaningful, long-term care.
So they would wait for the evaluation and hope it would get him a scarce bed in a state psychiatric hospital. If it didn’t, Warren’s future most likely would entail state prison — or worse.
Seventeen days earlier, one August afternoon, Warren had shuffled into Fort Bend’s 240th District Court near the end of a line of inmates, their shackles clanking.
Like the others, he wore a dark green jumpsuit. Part of his collar was popped up.
Warren’s divorced parents sat next to each other in the opposite corner of the room from where he went to sit.
“Is that him right there?” asked Warren’s dad, a therapist. “Standing up?”
Tall and muscular, but looking thinner than when his mother last saw him, Warren was moving toward the end of a row of jury box seats. His attorney, Overzenia Ojuri, the mental health division chief for the local public defender’s office, waited there for him.
Ojuri wanted to be sure Warren understood what could happen in court that day: He would be asked to sign papers agreeing to admission to the Lubbock residential facility. He and Ojuri had already discussed the possibility. He asked Ojuri now about what clothes he could wear at the facility and whether he would be able to smoke cigarettes. At one point, Warren looked in his parents’ direction. He scrunched his face.
His mother, Shelia Muldrow, figured Warren couldn’t see them. He’d gone through a number of pairs of glasses. He never kept up with them, just like he never stuck with anti-anxiety or anti-psychotic prescriptions. Shelia wished she could go talk with her son.
Shelia, an information technology risk analyst, refused to give up on her son. She had scrambled so many times before to try to find him lasting aid, only to see him end up in jail.
She is not alone. Across the nation, it’s estimated by the Council of State Governments Justice Center that 17 percent of jail inmates suffer from a serious mental illness, of whom 72 percent also have a substance abuse issue. Two million adults with serious mental illness are believed to enter the nation’s jails each year.
As she watched the court proceedings unfolding, it seemed to Shelia that a plan for him was perhaps finally falling into place.
She had needed to stay involved as Warren’s predicaments escalated, even after so many of her previous efforts had fallen short in the past. She’d driven Warren for weeks after one hospital release to a daily treatment program, until he no longer wanted to go. She’d looked into the idea of guardianship, meaning she could make medical decisions for him, until an attorney told her doing so required his consent.
Recently, feeling Warren slipping out of control, she’d gone so far as to have him detained by sheriff ’s deputies and taken to a hospital for an evaluation.
Shelia would do all she could not to get the phone call that Warren was dead. Now, the hearing marked a new opportunity.
The Lubbock County Court Residential Treatment Center was the best facility Ojuri knew of. Located across from the Lubbock County Jail and surrounded by a barbed wire fence, the treatment center devotes 48 of its 164 beds to probationers like Warren who have a dual-diagnosis. Largely funded by the state, it is one of 29 such residential probation facilities in Texas.
Fort Bend, which was already housing one person in Lubbock, has no place like it.
The prosecutor, Chris DeLozier, supported the plan for Warren to go there.
“If they’re going to help by addressing the drug problem, then I’m all for it,” he later said. “If he can complete his probation, great.”
The other inmates sat largely motionless as Warren formed his fingers into the shape of a gun and mimicked shooting it around the room. A bailiff went to remove him. Shelia wished she could shout Warren’s name to catch his attention as he walked past.
His parents waited in the courtroom as he met with Ojuri in a separate room to sign the admission papers. Warren’s mental condition made him highly unpredictable, even volatile. There was always a chance he would refuse the placement and erupt in a string of profanity. But Ojuri, coming back into court, said the magic words: “He signed.” She walked to the bench holding the forms high.
“Keep praying,” Warren’s father said.
A bailiff retrieved Warren. This time, he saw his parents when he entered the court. He stuck out his tongue, wiggled it and smiled.
A basketball player whose life began to derail in high school, Warren had never received inpatient treatment for more than 30 consecutive days, according to his mother’s records. Rarely did his mother’s insurance provider, Cigna, authorize a stay longer than seven or eight.
Length-of-stay decisions are based on ensuring the care keeps a patient safe, fits one’s insurance plan and manages costs, said Doug Nemecek, chief medical officer for Cigna’s behavioral health unit. They are guided by medical necessity criteria, hospital staff input and patient history. There is no up-front limit.
“The goal is always to help people be managed with only the level of structure or supervision that they require for their safety and for their care,” Nemecek said.
A seven- to 10-day hospital stay is considered lengthy, and 30 days extremely long, said Debra Jackson, CEO of Deblin Health Concepts, which offers behavioral health outpatient treatment.
Less-intensive programs may follow hospitalizations, but the range of what a commercial insurer covers is typically more limited than that provided by Medicaid, which allows for services like skills training or psychosocial rehabilitation that “meet them wherever their level of need is,” Jackson said.
People like Warren, whose pattern of treatment hadn’t been working, can get, as Jackson put it, “stuck between the service gap.” In some cases, they find nowhere left to turn but to the state.
From the bench in the courtroon, Judge Chad Bridges began asking Warren questions. His name? “Monroe,” he offered. (Close to Muldrow.)
Did he sign the paperwork the attorney handed over? “Swear to God I didn’t sign that,” he said.
“He’s acting up,” his father whispered, concern creasing his brow. Both parents leaned forward to listen to the exchange.
Though an evaluation months prior had found him able to stand trial, Bridges wondered whether Warren ought to be tested again for competency. The opportunity for treatment felt at risk of slipping away.
“He just doesn’t know what’s going on, I don’t think,” his mother said, hardly believing herself what was happening.
“It’s just sabotaging treatment,” his father said, having seen his son react like this before. Ojuri, too, felt blindsided. She had been a part of the Fort Bend mental health public defender’s office since it began, in 2010, and she had never seen behavior like this.
But Ojuri didn’t question Warren’s comprehension. He’d been asking her logical questions just moments before.
“He clearly understands,” Ojuri told the judge. “I do think that sending him to Lubbock is in his best interest.”
The attorney reassured Judge Bridges that she and the caseworker saw Warren sign the form.
“It’s signed,” the judge said, referring to the order to send Warren to Lubbock as a new probation condition.
Shelia clenched her fist. “Yes,” she whispered. Warren’s father exhaled.
As the parents turned to leave, a bailiff followed Shelia with a tissue. Ojuri put a hand on her shoulder.
“This is the best possible place for him to go,” Ojuri said.
It was a result the attorney hopes for with all mentally ill defendants: Warren would get assistance without further criminal punishment.
The task of applying for Warren to have a space in Lubbock fell to the probation department. The wait list was usually five to 10 people long, Lubbock County’s probation director Steven Henderson said, and the date of admittance typically hinges on when the home county can find personnel to transport the person to them.
“We don’t want them sitting in jail waiting,” Fort Bend County probation director Michael Enax said. “We want to get them there as soon as we can.”
Shelia tried to visit Warren several days later but was told he did not want to see anyone. Early last week, 15 days after she’d seen him in the courtroom, she spoke with him from her home via video conferencing. He seemed receptive to going to the program, she said. Warren began to sing her a song from his childhood, but the video cut out. Their 15-minute allotment was up.
She’d also called the probation office that day for an update, to no avail. “Can he hurry up and get there?” she wondered. But at least her son was off the streets, awaiting real treatment. She refused to quit, and now they were so close.
The judge and the attorneys huddled around the bench in Fort Bend court on Thursday after they’d been informed that the Lubbock facility had rejected Warren. Ojuri had only learned of the denial that morning. She hadn’t yet told Shelia, who hadn’t even realized rejection was an option. Henderson, the Lubbock County probation director, speaking generally, said applicants may be rejected for not taking medication, for a history of assaultive behavior not related to mental health, for substance abuse issues, or for recent threats of suicide or aggression.
It seemed a cruel Catch-22. Those were all the reasons Warren especially needed help.
The judge and the lawyers felt a crisis approaching in jail. Ordering the outside psychiatric evaluation seemed the logical next move — and a necessary precursor to quick admission to a state hospital. They agreed on this approach and adjourned. The waiting began. Would Warren’s outside assessment end in a similar string of factors that kept him out of the Lubbock facility? If he was unfit for placement in a state hospital, where would he go for help? They set a time to meet Monday afternoon in case they needed to develop a back-up plan.
Ojuri called Shelia after the hearing with the news that Warren’s application to go to Lubbock had been rejected.
His mother felt a familiar disappointment, but also, strangely, a sense of relief: She had been having dreams about Warren wandering off from the facility.
But there was more, Ojuri said: After his application had been denied, the judge had OK’d her request for an outside agency to evaluate Warren. Ojuri emailed the results to Shelia after 6 p.m. that night. The evaluation had come back affirmative: Warren would go to a state hospital for stabilization. Ojuri now expected the transfer to take place within days.
His mother, for the moment relieved, saw it as a last resort — and the right choice.
If only he hadn’t needed to commit a crime to get there.
Coming next: Hopes are high that a state hospital can finally give Warren the stabilization he needs. But the young man faces a long road.