New Haven Register (Sunday) (New Haven, CT)
Woman blames lack of hospital beds for son’s death in jail
NEW HAVEN — Carl “Robby” Talbot went to Yale New Haven Hospital more than threedozen times seeking help for his severe bipolar disorder, according to his mother, but he usually was sent on his way, for reasons she still doesn’t fully understand.
The last time, March 19, he got so upset he pulled a fire alarm and was arrested and taken to the New Haven Correctional Center on Whalley Avenue. He was found dead in an isolation cell two days later.
His death has been ruled a homicide. A spokeswoman for the Office of the Chief Medical Examiner said Thursday that Talbot died suddenly due to physical struggle with restraint, atherosclerotic and hypertensive cardiovascular
disease and morbid obesity. He reportedly weighed about 400 pounds at the time of his death.
Colleen Lord, Talbot’s mother, sees his tragic death at age 30 as having roots in the 1960s, when the movement began to close staterun mental health hospitals, known as deinstitutionalization. At the same time, Congress prohibited Medicaid, which was created in 1965, from paying for mental health services in psychiatric hospitals and other facilities with more than 16 beds.
Known as the Medicaid Institutions for Mental Diseases exclusion, it applies to patients between 21 and 64 years old and “was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services,” according to the Legal Action Center.
The intention was to move treatment into the community, where mental health professionals would be able to tailor therapy and other services, such as supportive housing, to the patient’s needs.
To Lord, her son’s death is proof that that intention has failed. Once the large, standalone psychiatric hospitals, such as Fairfield Hills, closed, the number of beds available for psychiatric patients was reduced greatly. She has become an activist on behalf of her son and other people with serious mental illnesses, such as bipolar disorder, which Talbot suffered from, and schizophrenia. Lord believes it isn’t right that inpatient treatment isn’t more available because of psychiatric hospital abuses that were far more common decades ago.
Yale New Haven Psychiatric Hospital is part of the larger hospital and not a standalone IMD, so does not fall under the Medicaid exclusion, according to Dr. Frank Fortunati, medical director of the psychiatric hospital, which he called the “single largest provider of psychiatric services in the state.”
Fortunati said that between January and September, 926 adults on Medicaid were discharged from the psychiatric hospital.
But Lord said the closure of private, standalone hospitals means patients like her son have less chance of being treated.
“People were in institutions. Now they’re just in jails or homeless on the streets,” said Lord, who is pushing for Connecticut to seek a waiver for the IMD exclusion, allowing psychiatric hospitals to open, and to institute courtordered assisted outpatient treatment, which only Connecticut and two other states do not permit. Jails and prisons house more mentally ill people than any other facility, which Lord calls “transinstitutionalization.”
Other advocates for the mentally ill say that large hospitals are not the best places to receive help, and, if the patient isn’t seeking treatment voluntarily, could do more harm, although the National Alliance on Mental Illness has supported modifying the exclusion for shortterm treatment of mentally ill patients.
Community treatment preferred
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, opposes both lifting the IMD exclusion and courtordered treatment. “Why do you want to put the money into the most expensive way to deliver services ... as opposed to the communitybased interventions?” she asked, referring to the large standalone psychiatric hospitals.
Flaherty said that whenever people have authority over others, abuse is possible. She referred to a case at Whiting Forensic Hospital, a maximumsecurity psychiatric hospital that is part of Connecticut Valley Hospital, in which 10 people were fired and dozens fired in an abuse case. A nurse, Mark Cusson, was convicted of cruelty to persons in the abuse of William Shehadi.
“I don’t believe we have magically become better as a society in the last 50 years,” Flaherty said.
The Connecticut Legal Rights Project was a founder of the Keep the Promise Coalition, composed of many social service, justice and health care organizations that formed after the Supreme Court ruled in 1999, in a case known as Olmstead v. L.C., that the Americans with Disabilities Act requires states to treat persons with disabilities in the least restrict way possible.
“For 20 years now we’ve been working toward getting the state to keep the promise that was outlined in the Supreme Court in 1999,” Flaherty said.
Only the most seriously ill
Lord said she isn’t advocating for hospitalization or courtordered treatment for anyone but the most serious mentally ill patients, such as those suffering bipolar disorder and schizophrenia, many of whom are not aware they’re sick. Her son had bipolar disorder and depression, as well as obesity and substance abuse disorders.
“For 3 percent of the population there just really isn’t anywhere for them to go,” she said. Even when they manage to be admitted, “there just isn’t enough time for them to heal,” she said.
Mandating treatment and creating more hospital beds for psychiatric patients is essential for those who can’t find treatment any other way, she believes. “The alternative is death or inpatient or jail for this population … because it’s a revolving door,” she said.
When he was arrested, “Judges would tell Robby to go get treatment and to go into a hospital for three months and the charges would be dropped,” not realizing that such programs weren’t available to him. “People don’t understand that there’s no place to go unless you have a lot of money.”
Lord said she and her husband once spent $36,000 for treatment in Pennsylvania and New Jersey. “It was OK except the meds he was on would make him fall asleep during the program,” she said. “When his apnea was getting worse they put him on a train and that was that.” He had lasted 21⁄2 months of a threemonth program.
Lord also doesn’t accept the argument that courtordered outpatient treatment violates patients’ civil liberties. Jail is worse when it comes to depriving people of their rights, she said.
“The old song of not taking their civil rights away — it just doesn’t apply anymore . ... There’s a phrase known in the industry ... dying with your rights on, and that’s what happened to my son. He had his rights and he died . ... Sometimes you have to help them in order to save them.”
People must be willing to be helped
Flaherty, while not speaking specifically about Talbot’s case, said mandated treatment is not helpful. “If you want people to get well and stay well and live in the community, you do not force treatment because forced treatment leads to trauma, which causes its own set of problems, and the system is not set up to deal with that.”
She said treatment “works better long term when people have the opportunity to engage with services they want.” In other countries “that use fewer medications, people actually recover better,” she said.
She said the idea of returning to psychiatric hospitals is “horrifying. The bottom line ... is that people, regardless of what their disabilities are, they actually have the legal right to be treated in the community.”
“Sometimes the hospital bed is what is needed, but for many people most of the time, being locked up in a hospital is not the longterm solution and it also can be incredibly harmful and traumatic in its own way,” Flaherty said.
The real problem, according to Flaherty and Tom Burr of the National Alliance on Mental Illness’ Connecticut chapter, is that when deinstitutionalization arrived, the money that went to those hospitals was supposed to be used for communitybased care. However, “Connecticut being Connecticut, all that money wound up being in the general fund and it wasn’t being done,” Burr said.
The result was “an increase of people being put into jail or prison for the crime of being sick and it was terrible,” he said. Meanwhile, state money has been cut for services to the mentally ill and those with substance abuse issues.
What are needed besides psychiatric treatment are supportive housing, medication management, supportive employment, aid such as bus passes: “Whatever they need to function and Connecticut … arguably is very much a leader in this space,” Burr said.
Local services available
Miriam DelphinRittmon, commissioner of the state Department of Mental Health and Addiction Services, said there are numerous facilities in Connecticut, and especially in New Haven, for mental health treatment, such as the Connecticut Mental Health Center, a collaboration between her department and the Yale School of Medicine’s Department of Psychiatry.
Others include Fellowship Place, “a social rehabilitation setting in New Haven” with a range of services. Others are Marrakech, which helps clients seek employment and other supports, the Cornell ScottHill Health Center and Fair Haven Community Health Care.
There are also street outreach psychiatrists who go to the New Haven Green or look for homeless people who need mental health treatment.
She said in fiscal 2019 a total of 103,750 people were served by 125 providers in Connecticut who offered 784 communitybased programs.
“One thing we’ve tried to work on is to have no wrong door into treatment,” DelphinRittmon said. The goal is “to create multiple pathways into services and supports because everyone’s recovery journey is different.”
“People were in institutions. Now they’re just in jails or homeless on the streets.” Colleen Lord, referring to people with psychiatric illnesses