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St. Paul Pioneer Press (MN)
March 9, 2000
Author: Kay Harvey, Staff Writer
She watched in horror a few days later as Jim Greiling became furious with her and trashed the family’s Roseville home. Then came another shocker. A policeman who responded to her 911 call explained he couldn’t take Jim Greiling to a hospital for psychiatric treatment unless he agreed to go.
“You mean he could tear the house down, but he has to kill somebody before we can get him help?” his mother asked.
She was told that adults can refuse treatment for mental illness unless their behavior indicates imminent danger to themselves or someone else. In that moment, the fourth-term DFLer’s maternal instincts collided with Minnesota law. Mindy Greiling had just met face-to-face with a mental-health system she now intends to change.
“We shouldn’t be trying to prove people are dangerous,” she argues. “We should be trying to prove they’re sick. In what other area of health care do we wait until people are really ill before they get care?”
Since her son’s violent episode last summer, Greiling has written a proposed bill with state Sen. Don Betzold, DFL-Fridley, that would enable family members to commit loved ones for treatment without the stipulation of imminent danger.
Many other families have felt Greiling’s frustration. While her son now is doing well, some people’s struggles have erupted in heartbreak: homelessness, prison, suicide or other tragedies. But passions run high on both sides of the commitment issue. Some advocates for people with mental illnesses say lowering the threshold for commitment cuts to the core of individual rights.
“We think the bill’s language, in terms of lowering the standard, is unconstitutional,” says Cynthia Nugent Hart, a member of the State Advisory Council on Mental Health. “It could mean that almost anybody with a mental-health issue – somebody who has a reluctance to seek therapy – could be committed.”
A scaled-back version of Greiling’s bill may get a Senate vote this week. The commitment issue won’t be put to the test until next year – a budget session when money can be attached. But reaction to her bill already has brought such former opponents as Bill Conley, lobbyist for the Mental Health Association, to the table to talk about compromise.
It also has triggered talks with organization and advocacy-group leaders that could vastly expand the scope of change in next year’s bill, Greiling says. Proposals could address such sore spots as limited insurance coverage, inadequate housing, delays in treatment, discharge plans that can include family caregivers and money for improvements – issues with universal backing from advocacy groups.
“The details are yet to be worked out,” Conley says. “But we have pledged to each other to look at a comprehensive package.”
Mindy Greiling’s newest crusade has landed her in the middle of growing momentum to create a more effective mental-health system. It all started, she says, with the tug of a mother’s love.
Rage and voices
“He had long, greasy hair,” his mother says. “He wore a ratty hat pulled over his face. He sat with his chin down. He slept a lot and didn’t connect with his friends.”
During that visit, he began seeing a psychologist, who told Jim he was depressed. He began taking Zoloft, an anti-depressant. His spirits lifted, and he showed up at the start of summer vacation sporting a trim haircut and boundless energy.
“He rode his bike all around, talked with friends and couldn’t get enough activities in. He was a pleasure until we noticed he was smoking marijuana. When we confronted him, he went from a calm person into an inferno.”
She blamed his drug use but was baffled by his hot temper. Jim again began seeing the psychologist, who suggested he might have bipolar disorder, typified by extreme mood shifts from high to low. A psychiatric appointment was scheduled in six weeks, a typical wait because of a shortage of psychiatrists.
When Jim spoke with his mother, he often looked not at her but off to the side, “as though he were tuned-in to something else,” she says. He sometimes talked about seeing and hearing things that weren’t there. During a session with the psychologist that included his parents, Jim said he’d like to shoot his mother. She wasn’t surprised; he had said it before.
“He was so different from the normal Jim, who was thoughtful, polite and a real sweetheart. I really began to be nervous about him because he was so easily angered. I felt someone could get punched or worse.”
The psychologist advised calling 911 if Jim became violent. That scene erupted on the Fourth of July, after Jim came home after being out all night. While he was in the shower, his mother flushed his marijuana stash down a toilet.
“He came out fighting mad. He kicked a cat box to smithereens. He was slamming doors, and pictures were falling off the walls. Then, he went downstairs and put a fist through a plasterboard wall. When the police came, he muttered something about hearing voices.”
Cause and effect
In the course of treatment that took Jim to three other facilities, three psychiatrists diagnosed his illness as schizophrenia and prescribed Risperdal, an anti-psychotic medication. A fourth pegged Jim’s illness as “drug-induced schizophrenia” or “psychosis not otherwise specified.”
Inside the system, both Jim and his mother took issue with practices that treated him and others more like criminals than patients. In three court hearings that were part of the commitment process, Mindy Greiling felt forced into a role as her son’s accuser, she says. And during Jim’s 2 1/2-week stay at Anoka Regional Treatment Center, the family spoke with nurses through a Plexiglas shield.
“With the clanking of doors and jangling of keys, it felt like a reformatory,” Mindy Greiling says. “It was not a pleasant place to be. Jim thought if he had to be there, it wasn’t worth living.”
But seven months later, Jim Greiling appears to be a testament to his mother’s cause. For him, early treatment worked to end the ordeal that transformed him into a stranger. He is back at college, where he has changed his major to psychology. He has weaned himself from drugs prescribed last year to treat his mental illness. He may never know exactly what went wrong inside his head.
“I had used a lot of (recreational) drugs in the past,” he says. “I think that mixed with Zoloft – a combination of that and smoking marijuana – had a lot to do with it.”
In hindsight, he supports his mother’s charge to make it easier to get treatment for people with mental illnesses who refuse it, he says.
“I think, if you could look at yourself from a healthy point of view,” he says, “you would want to be helped.”
Mental-health bill proposes change
- Notice to families. Health providers would be obligated, when family members inquire about a patient who is being evaluated for mental illness, to inform them of a patient’s right to sign a form releasing information about his or her care to designated individuals.
- Treatment for minors. A parent could give consent for mental-health treatment of their 16- and 17-year-old children in cases where health professionals agree treatment is appropriate but the child will not agree to it. Current law calls for the consent of patients who are 16 or older.
Source: Research Department, Minnesota House of Representatives
Kay Harvey covers aging and family issues and can be reached at firstname.lastname@example.org or (651) 228-5468.