Few have paid a higher price for the nation’s mental health crisis than the loved ones of severely mentally ill people.
At least 17 parents with signs of mental illness allegedly killed their children from 2005 through 2015, while a similar number of children allegedly killed their parents. But the toll of violence reaches far beyond family.
From 2005 through 2015, 10 percent of all homicides in Massachusetts in which a suspect is known were allegedly committed by people with a history of mental illness or clear symptoms. Many of those deaths might have been prevented had the killers received the mental health care they needed.
Nancy Chiero was making a cup of mint tea in the kitchen of her Uxbridge, MA home that January morning.
It was a small, characteristically kind gesture toward her 35-year-old son, Lee, who had always worried her, and sometimes scared her, too. Also, unfathomably, it was a fatal one.
Lee’s life had been ruled by severe mental illness, the pattern of his repeated unravelings devastatingly familiar to his mother and family. A psychotic episode would send him to an emergency room. Once released, he would refuse to take his medications, the delusions would return, and the cycle would repeat. And repeat again.
Through it all, Nancy had remained devoted and unimaginably patient with him. There was no one else who would. He had been living in a basement bedroom of her home; he had nowhere else to go.
The cycle was repeating again now, in 2007, she could see—and in even more alarming form. Lee had been videotaping his conversations with her, suspecting her in a plot against him.
He suspected everyone. Lately, Lee had disconnected computers and even the electric power in the house to prevent his imagined enemies from spying. He made his mother drive him hours from home for grocery shopping to elude his pursuers. He’d come to believe he’d been abducted by aliens and abused by animals, and feared he would be again.
Finally, just before Christmas, Nancy had Lee rushed by ambulance to Boston’s Tufts New England Medical Center at the urging of his primary care doctor, who agreed that he had become dangerous. But at the hospital, Lee insisted he was fine and a Tufts psychiatrist released him after four days, concluding that he “did not seem to present a danger to himself and others.”
Now, alone in her kitchen, Nancy faced her son’s fevered imaginings armed only with a cup of tea. Mint is soothing, she said, adding that even animals took pleasure in the fragrant herb.
With little warning, Lee lunged at her, knocking her down the basement stairs, convinced that her casual comment referred to the animals that would sexually assault him after his abduction.
He pulled out the knife he carried for protection and began stabbing his mother in the eyes, demanding she confess.
“That’s what you get for following me around,” he said, ranting on, with his camcorder running.
Then, it was over.
In the sudden quiet Lee began to doubt that Nancy was really part of the conspiracy that had taken control of his life. She hadn’t confessed. And if the house was bugged, if his every move was being watched, why hadn’t anyone intervened? Why hadn’t anyone stopped him? Why was he suddenly so alone in the overwhelming silence of his mother’s home?
In the instant of her death at the hands of her son — a deeply troubled man discharged without restrictions from hospital care — Nancy Chiero wasn’t merely failed by the state mental health care system. She was her son’s mental health care system — or at least the only one he could rely on.
In a state that prides itself on leadership in human services and compassionate government, it has come to this, a [Boston Globe] Spotlight Team investigation has found: threadbare policies, broken promises, short-sighted decisions, and persistent underfunding over decades. As a result, the seriously mentally ill, including those at greatest risk of harming others or themselves, are far too often left in the care of parents, police, prison guards, judges, shelter workers, and emergency room personnel — almost anyone, in fact, but professionals trained to deal with their needs.
Families of these sufferers find themselves up against obstacles that earlier generations didn’t have to face. Fifty years ago, Lee Chiero might have been treated — and locked away — in one of the public psychiatric hospitals that once dotted Massachusetts.
Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it.
Even those beset by the most ferocious inner demons, such as Lee Chiero, are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. Chiero was hospitalized at least 10 times in a half-dozen hospitals over two decades before he killed his mother.
“I can’t tell you how many emergency rooms we visited to try and get him in,” said his sister, Gina.
This is the choice Massachusetts has made, a choice with deadly consequences.
The evidence is everywhere. In May, Arthur DaRosa fatally stabbed two people, one of them at a Taunton shopping mall, before an off-duty deputy sheriff shot him dead. DaRosa had been released from a hospital hours earlier, even though relatives said he had threatened to kill himself and said the devil was trying to poison the minds of his children.
Three weeks later, the body of 24-year-old Tyler Hagmaier was pulled from the Connecticut River after he left a suicide note confessing to fatally stabbing a 76-year-old neighbor, for no apparent reason.
“He wasn’t evil. He wasn’t bad,” said Kristine Jelstrup, the daughter of Hagmaier’s victim, Vibeke Rasmussen. “He was mentally ill, and he didn’t get the help he needed.”
Such attacks have come to seem part of the grim staccato of modern life — at times random, often inexplicable, and now stunningly common.
Since 2005, more than 10 percent of all Massachusetts homicides in which a suspect is known were allegedly committed by people with a history of mental illness or its clear symptoms, the Spotlight Team determined by building the first-ever database of such cases. At least 139 people in this state have died violently at the hands of a person with a diagnosed mental illness or strong indications of one during this period.
And last year, the mayhem grew even more frequent, as 14 of the 95 homicides in the state with identified suspects — nearly 15 percent — were allegedly committed by people who were or appeared to be mentally ill.
Few have paid a higher price in this crisis than the loved ones of people with a serious, often undertreated, mental illness — the Nancy Chieros in our communities. At least 18 parents allegedly have been killed by their mentally ill children in Massachusetts since 2005, the Globe review found, and 21 children allegedly were killed by their mentally ill parents. In all, people with a history of mental illness have been accused of killing at least 79 relatives and significant others since 2005.
Often, these victims were the very people who tried the hardest to get help for their mentally ill loved ones. Nancy Chiero was so devoted to her son that she once handcuffed herself to Lee to bring him home off the streets.
Indeed, family members are often all that stand between seriously mentally ill people and disaster — making sure they keep appointments, take their medications, and have a place to stay, while remaining vigilant for the next crisis. At the same time, thousands of those without family members to stand by them are relegated to streets, shelters, prisons, and county jails. They crowd emergency room wards and hallways.
This is, of course, not just a state but a national crisis.
However, it is worse here than most would imagine. Massachusetts spends less per capita on mental health care than any other New England state except Rhode Island, and much less than some states of comparable means and politics — such as New York, according to a Kaiser Family Foundation study. By this and other critical measures, Massachusetts has forfeited the leadership it once was known for in mental health care.
Marylou Sudders, the top official overseeing mental health care in the state, can’t even bring herself to call the state’s patchwork of emergency rooms, group homes, clinics, and therapists a “system,” admitting that mental health care in the state is both poorly organized and grossly underfunded. Though many individual care providers do excellent work, she said, they are islands with little surrounding support.
“Families are the primary caregivers, if the person is lucky to have a family and that family has stayed with them through their journey,” Sudders told the Globe.
The result is not just a public health care crisis but a public safety crisis — one that is largely preventable. Studies show that people with a serious mental illness are no more prone to violence than anyone else — when they get the help they need. But when they do not, drifting away from therapy and medications, often into the grip of alcohol or drugs, the risk of violence sharply escalates.
A Broken Covenant
In a multipart series, the Globe Spotlight Team examined the unintended consequences of 50 years of deinstitutionalization and its often appalling aftermath. It stands, for a state that sets a high standard for itself in human services, as a broken covenant with a population with great needs, spawning heartache and tragedy for nearly everyone involved, from besieged mothers and fathers to police officers who suddenly find themselves confronted by someone with a mental illness determined to commit “suicide by cop.”
Meanwhile, those who try to improve this sorry picture are repeatedly thwarted by a state legislature that routinely turns a deaf ear to calls for change. Earlier this year, a clutch of proposals by state Senator Kenneth J. Donnelly, including a plan to ensure that patients like Chiero take their medications, was sent to a committee for study, effectively killing it.
“We seem to be moving at a snail’s pace, if at all,” said Donnelly, an Arlington Democrat. “We send bills to study while our emergency departments, courts, and prisons take on more and more of the burden that comes when people can’t get the care they need and deserve.”
Mass shootings and other notorious crimes understandably draw the greatest scrutiny, but deadly violence by those with a mental illness is usually a more intimate affair, the Spotlight investigation found, an eruption between family members or friends that usually does not involve a gun.
In Massachusetts, homicides in which mentally ill individuals are accused are far more likely to involve the use of knives, ropes, or even bare hands than a firearm. A gun was the weapon of choice in only 16 percent of the cases analyzed by the Globe. Most of the time, those who turn violent are lashing out at friends, lovers, or family members, using whatever weapon is at hand.
The Spotlight Team investigation found that three key factors were often a prelude to murder by someone with a serious mental illness: lack of treatment, a failure to take prescribed medications, and the abuse of illegal drugs and alcohol, which is common among the mentally ill as they try to assuage their symptoms.
Clinicians refer to it as “self-medicating.”
In many cases, it was impossible for the Globe to determine whether the perpetrators were off their medications or were acting under the influence of illegal drugs or alcohol. But there was evidence that 31 of the accused killers in the Globe’s tally were refusing to take prescribed psychiatric drugs, while 28 had a history of substance abuse.
In only a handful of cases was there evidence that the accused were taking appropriate medication at the time of the crime.
Some perpetrators were never diagnosed or treated at all. They included Kerby Revelus, a young Milton man shot to death by police in 2009 after he had killed two of his sisters and was about to kill a third, and Li Rong Zhang, a Quincy woman found not guilty by reason of insanity after she was charged in 2011 with killing her 8-year-old son by locking him in a room with a smoking, charcoal-fueled hibachi.
The Globe’s findings on substance abuse and mental illness track pioneering research on the connection between mental illness and violence. One widely reviewed study, conducted over several years in the early 1990s, found that people with a mental illness are significantly more likely to use drugs and alcohol, and that those who do so are more likely to be violent than users without a mental illness.
“When first discharged, patients were twice as likely as their neighbors to be abusing substances,” the MacArthur Violence Risk Assessment Study found. “And alcohol and drugs raised the risk of violence for patients abusing them even more than for others.”
In the Spotlight review, the combination of mental illness and substance abuse also played a role in numerous fatal crashes. For instance, in 2013, Benjamin Shealey — who has been diagnosed with paranoid schizophrenia and was driving under the influence — led police on a high-speed chase before running over and killing a 62-year-old man waiting for a bus in Chatham.
The firmly held belief that people with a serious mental illness are no more likely to be violent than others has fueled opposition to new laws that could help families like the Chieros, who struggle to persuade their mentally ill loved ones to accept treatment and take their medications.
For years, some advocates for people with a mental illness have helped block all attempts to require mentally ill people with a history or grave risk of violence to take their prescribed medications, to the point where Massachusetts is one of only four states without such a provision, a gap defended by the advocates as a matter of personal liberty.
“The right to refuse treatment is vital,” said Susan Fendell of the Mental Health Legal Advisors Committee, speaking against a mandatory outpatient treatment bill during a State House hearing last year.
But Lisa Dailey, an attorney for the Treatment Advocacy Center, a nonprofit group that advocates for such treatment for some people with mental illness, was just as adamant.
“This is a cruel and dangerous status quo,” she said.
This is an abridged version of a story published by the Boston Globe’s Spotlight team, as part of a series, called “The Desperate and the Dead”, exploring mental illness, substance abuse and justice issues in Massachussetts. It was written by Michael Rezendes, a 2015-2016 John Jay/Langeloth Health and Justice Reporting Fellow. Additional reporting was done by Jenna Russell, Scott Helman, Maria Cramer, and Todd Wallack.. Readers’ comments are welcome.