In fatal Adam Howe case, a flawed system left gaps in protection

Short-term supports, siloed services contributed to his descent into violence

Your story about the failure of interventions to prevent the death of Adam Howe and his mother (“Tragedy foretold: Adam Howe’s descent into illness, addiction, and final acts of violence,” Page A1, Oct. 16) usefully draws attention to the background of these tragic circumstances. But the article does not name two problems — structural factors that are all too evident in the story itself — that contributed to the failure.

One is the hyperautonomy of the services, private and public, that tried to help Howe. There is no evidence that the psychiatric, substance use treatment, and judicial systems saw a need for developing a shared service plan, one that would support recovery but also track relapses, share recognition of warning signs, and develop a coordinated response. The way both public and for-profit services are licensed and reimbursed contributes to this dysfunctional hyperautonomy.

The other factor is the short-term focus of most of the services. Acute symptoms are reduced but with little attention to how the person will function over the long term. Reducing immediate symptoms cannot be confused with recovery.

The approach need not be so limited. Consider how Alcoholics Anonymous takes the long view, or the way medical services provide acute care — whether for coronary symptoms or joint replacement surgery — while considering and planning supports for the individual’s functioning over time.

We need to set up our services differently.

DR. GORDON HARPER Brookline

The author is a psychiatrist.