Man searches city streets for missing mentally ill brother
Sibling questions why clinic didn’t tell of discharge
Stepping carefully through the dusty sand in a homeless camp under the dim overpass of the Southwest Freeway, George Ruano found a glimmer of hope.
Someone may have seen his missing brother recently at Hermann Park.
“Oh, thank you. Thank you,” Ruano replied gratefully Thursday. “We’ve been everywhere. He just disappeared.”
He pivoted on one foot in the moment, as if unsure whether to leave or stay. Then he headed back to Hermann Park, where earlier in the day a police officer had directed him to the congregation of transients among the tents and mattresses near downtown.
His brother — Daniel Almendi, who has been diagnosed as schizophrenic with paranoia — has been missing since Nov. 30, when he was discharged from the UTHealth Harris County Psychiatric Center and disappeared into the urban jungle.
No one notified Ruano that his brother was being released, and Almendi’s whereabouts remain unknown.
It’s an all-too-common problem for the families of mentally ill people: They want to help but often are stymied by the health system, according to mental health advocates. Attempts to balance the privacy of adults and loved ones concerned about their safety can leave individuals unaccounted for and relatives frustrated.
“The family can be so helpful, and the more involved they can be with the hospital and the treatment, the more they can be supportive to their family member,” said Susan Ford-
ice, chief executive of the nonprofit Mental Health America of Greater Houston. “There is no prohibition against the family being very proactive in talking to the treatment provider.”
Almendi, 34, needs his medication. His ID, wallet and cellphone remain at home, and there have been no transactions on his bank account.
There’s been no Amber Alert because he isn’t a minor and no Silver Alert because he’s not an older person with dementia.
For six weeks, Ruano has visited Houston soup kitchens, homeless shelters, bus stops and highway underpasses frantically posting fliers in hopes that someone had seen Almendi.
Almendi had been living with his brother but had stopped taking the medication that helps regulate his condition. Ruano finally obtained a mental health warrant last year to have his brother admitted to the hospital for treatment.
A soft-spoken man who is shorter and smaller than his brother, Ruano, 53, is the eldest of their mother’s four sons. Almendi is the youngest. Their mother cared for her youngest son until her death five years ago. Now the caregiver, Ruano works evenings and tries to keep up with his brother.
“I can’t watch him all the time,” he said.
Law ‘just so strict’
Two weeks after being committed, Almendi was released. With previous hospitalizations, a hospital social worker had called to have family members retrieve him at discharge. This time, however, no one contacted Ruano, though it’s possible that relatives were not listed or had been removed at Almendi’s request from the medical file.
The federal Health Insurance Portability and Accountability Act, known as HIPAA, requires the confidentiality of health care data.
“Patient information cannot be disclosed to anyone without patient consent,” UTHealth spokeswoman Deborah Mann Lake said. She declined to confirm the date of Almendi’s release and referred questions about the psychiatric center’s discharge policy to the organization’s legal office.
Ruano still doesn’t know what changed.
“The HIPAA law is just so strict,” Ruano said. “In this situation, we have a mentally ill person who’s in danger because he has no medicine. He’s just out there, and I don’t know if he’s alive or dead.”
Ruano said he, too, has been unable to get any information from the hospital.
“I don’t understand why the hospital didn’t call me if I got the mental health warrant and put him in the hospital,” he said. “I don’t know if they just listen to the patient. They stabilize him for two weeks, but it takes a whole month for the medication to kick in real well. I don’t understand what happened at the hospital.”
Ruano reached out to police, local media and missing persons organizations. Most of the groups that actively search for missing people place priority on children, women and the elderly, he found.
So Ruano and friends set out on their own manhunt with fistfuls of fliers showing the missing man’s driver’s license snapshot with a second photo that is a rendering of what he would look like with a scraggly beard. They diligently canvassed areas where Almendi might be cocooned.
There is hope that he is surviving on the streets, but his paranoia may make him more difficult to find.
“He’s a very loving person. He’s just very reclusive. He keeps to himself,” Ruano said.
Officials with the Harris County Medical Examiner’s Office said they have received no bodies matching Almendi’s description since Nov. 30.
‘Looking in wrong place’
On Thursday, Ruano learned that there had been a sighting of his brother in mid-December — clothed in the same items he was last seen wearing — in Hermann Park. That’s not far from the psychiatric center, a Texas Medical Center institution on South MacGregor Way.
“I’d been looking in the wrong place the whole time,” Ruano said.
On an unusually warm January day this week, the frustrated-but-hopeful brother continued looking in a different section of Hermann Park but found no sign of Almendi.
The search may be complicated by the recent upheaval of transient residents. There have been city efforts to relocate homeless people in recent weeks, and advocates report having problems keeping track of their loved ones.
The Houston Police Department opened a case on Almendi and entered his information into national databases for missing people.
“We also did a flier for him and that was sent out to law enforcement, transportation services and medical facilities,” said Officer E. Claburn with HPD’s missing person unit.
She and her partner went to Hermann Park after receiving a tip on Dec. 16 about a man who looked like Almendi sitting on a bench near a bathroom wearing the same clothes listed on the flier.
“We have gone out two or three times but were unable to find him,” Claburn said. “We have a lot of people being released from these psychiatric institutions and their families aren’t called.”
Fordice advises people to seek the support, knowledge and experience of other individuals and families as well as resources available through chapters of the National Alliance on Mental Illness, known as NAMI. She also said an advance directive for mental health treatment, which can address medications and notifications, might also assist in maintaining the patient-family link.
“What I’ve heard from people living with a diagnosis is how empowering it was when they created an advance directive,” she said. “I sure hope this family finds their loved one.”
Holding out hope
Almendi was young when his father left the family, Ruano said. Longing for his dad may have contributed to Almendi’s first disappearance, when he was in his 20s.
He caught a flight from Houston to Florida to look for his dad. Relatives coordinated with Florida authorities to have him committed and transported back to Houston, Ruano said.
Ruano said Almendi’s mental health declined after high school. He earned credentials from San Jacinto College to work as a pharmacy technician but never got his career going.
The brothers have been reeling since colon cancer claimed their mother. The loss hit Almendi the hardest, but Ruano hasn’t given up hope of finding his brother.
“Unfortunately,” he said, “his mental illness just kept getting worse and worse over the years.”