When treatment is crucial

For Nina McDaniel, one of the worst moments of her seven-year struggle to get her son Michael committed to a mental institution for a sustained time was Valentine's Day 2011. The McDaniel family, who live in Reading, had gone bowling.

"He couldn't handle being out in the community and I volunteered to bring him back home," McDaniel said. "As I was driving, he took my right hand off the steering wheel and he said, 'Mom, please,' and he put my hand on his heart and said, 'Take a gun and shoot me, because I can't take it. I don't know what's real and what's not real anymore. Sometimes I don't even know if you're real.' "

Michael McDaniel, 32, has schizoaffective disorder, a combination of schizophrenia and bipolar disorder. He is in Wernersville State Hospital, west of Reading, and his mother hopes he will eventually lead a normal life. Since the original episode in 2007, he'd been hospitalized five times, four of which came about because the family filed what's called a 302 form, which allows relatives (usually) to begin the commitment process if they believe someone is a danger to himself or others. However, despite her best efforts, McDaniel could not get her son into a psychiatric facility for a sustained stay.

That's hard for anyone to do, a fact driven home in November by what happened to Virginia State Sen. Creigh Deeds, who also could not get his mentally ill son into a psychiatric hospital. Austin Deeds wounded his father in a knife attack before killing himself. Virginia lawmakers have since introduced more than 40 laws that would make it easier for people to keep a loved one in treatment.

Nationally, a bill from U.S. Rep. Tim Murphy (R., Pa.) takes a similar tack. It has garnered 80 House cosponsors - 52 Republicans and 28 Democrats - while spurring debate about how much of a mentally ill person's privacy should be compromised for public safety.

The bill has gotten mixed reviews from the mental health community, where many admire its scope while distrusting its more coercive elements.

Nina McDaniel knows where she stands. "The bill is a life-saver for families. We need to get back to helping the family unit."

For the McDaniels, the turning point was Jan. 23, 2012, when Michael attacked his grandmother Helen Badulak with her cane, breaking her arm and wrists. Badulak has mostly recovered, but Michael spent eight months in Berks County Prison, where he began outpatient treatment at Torrance State Hospital. It took a judge's order to get him into Wernersville on Sept. 10, 2012.

A mentally ill person is seven times more likely to attack a family member than a stranger, said Edie Mannion, director and cofounder of the training and education center at the Mental Health Association of Southeastern Pennsylvania.

She added that lack of psychiatric beds is only one of the obstacles. It used to be that a 302 could lead to hospitalization for maybe a month, "which gave them a little bit of time to let the medications work and whatnot." Insurers won't pay for that anymore, Mannion said. "Now it's like eight days. In many cases, it's not much of a respite for the family, or an opportunity for recovery for the patient."

There's also this: People often don't want to be committed. "A person's civil rights are violated," said Mannion, whose group opposes the Murphy bill. "They are taken against their will. It's very traumatic. Neighbors watching . . . Some people are thankful to their families for having them committed, but there are a lot who are very angry and have a hard time forgiving. Many people, when this is happening, are in a very dark place to begin with and then to be led away in handcuffs . . .. The police are the ones transporting them usually."

Police are trained to do this but, unfortunately, the criminal justice system is too often the last, as well as the first, response. About 356,000 people with mental illness crowd jails and prisons nationally, 10 times the number in state hospitals. Ninety-five percent of inmates return to society, and because many have never been involved with the health-care system, an effort is underway to sign them up for Medicaid under the Affordable Care Act. In Pennsylvania, which has not yet expanded Medicaid, there will be less care. Even fully ACA-expanded state Medicaid falls short, however, reserving most inpatient services for children and the elderly.

But what services? Though the ACA expands coverage, it can't cover what's not available, as McDaniel knows. "Whenever someone in the mental health profession would come out, they would say that there was nothing that they could do," she said. "That broke my heart."

She recalled one conversation in which hospital officials tried to persuade the family to place Michael in an outpatient program. "I told them that he was not coming home."

Other options were not inviting, either. "They then said that we'd have to find him a place to stay. I said, 'Well, where will he be living?' They said, 'For now, he'd be in the homeless shelter.' That devastated all of us."

Mannion said in an e-mail families "face the dilemma of letting their loved one come back to their home (and living in heightened fear especially if the person is angry and choosing not to stay in treatment and abusing substances) or leaving their loved one with options such as homelessness, homeless shelters, or personal care boarding homes."

In Philadelphia, when a 302 is filed, patients are taken to one of five crisis response centers in the city, according to Angela J. Smith, a family support specialist at the Philadelphia Department of Behavioral Health. Then the case gets forwarded to one of the city's mental health delegates for approval. "After that, the loved one is taken to the nearest hospital," Smith said. "They have 120 hours to get them to court."

That's where the family meets someone like Smith. "I tell them what they need, because some of them don't understand the process. I might say, 'Listen, there's a support group that's running at Friends Hospital on Sunday afternoons. How about you take a trip over there and speak to someone who has gone through the same thing?' "

Despite the grim statistics and the trauma surrounding commitment, Smith said there are often happy endings. "The main goal is to get your loved ones the help that they need. There are a lot of tears of joy, contrary to what people think."

Nina McDaniel knows some joy and hope, too.

"Michael is in a good place," she said. "He has told us if he would have known that the medication would have made a difference, he would have taken it a long time ago. He doesn't have the raging thoughts. He isn't angry anymore. Our objective is for him to be independent and to be a part of the community, because the one thing he loves is his independence."

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