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By Blythe Bernhard firstname.lastname@example.org stltoday.com
November 08, 2014 1:30 pm
A lack of mental health care services has created a crisis for millions of families struggling to save their loved ones. Many people with mental illness end up in jails and prisons, which are not equipped for their medical needs.
Josh Francisco, 39, died alone in a cell at Farmington Correctional Center on Oct. 22. Francisco, who grew up in south St. Louis County, had bipolar disorder. For four years, his family desperately tried to get the help he needed.
“I just always had the hope that he would get better,” said Anne Francisco, Josh’s mother. “It was constantly on our minds all day every day. We were just powerless to help. We loved him the most of anybody and our hands were tied.”
Anne Francisco wrote the following essay about her family’s tragedy. It first appeared on a mental health blog by Pete Earley.
My 39-year-old son killed himself today.
Josh hung himself in a solitary confinement cell in a prison south of St. Louis, Missouri. He died alone, afraid, and powerless. Josh needed help. Instead, he got punishment.
Like all mothers, I had dreams for my children — dreams that didn’t include mental illness or prison. My husband and I knew very little about mental illness until four years ago, when we received a long distance phone call from our daughter-in-law telling us that Josh’s behavior had changed and she needed our help to convince him that he should enter a hospital for psychiatric treatment. She explained that Josh was sleeping very little and was having racing thoughts. He’d become hyper-vigilant about national/government affairs and hyper-religious, praying in strange tongues. Josh was 35 years old at the time — a handsome and energetic young man who adored his wife and two children. Always ready to lend a helping hand, Josh would give you the shirt off his back if you needed it. He had a special place in his heart for people who were hurting.
Despite our best efforts, Josh refused to seek treatment. Scared and alarmed, his wife obtained a restraining order against him. She was as much a victim of his mental illness as he was.
Unfortunately, Josh didn’t understand her actions and kept trying to contact her. When he repeatedly violated the restraining order, he was arrested for stalking.
My husband and I flew from our home in California to Missouri when we learned Josh was living in a storage locker. After two days of telephone calls, we found a psychiatric facility that would accept his insurance, but Josh balked while we were driving him there. The hospital admitted him only after I exaggerated his symptoms. It was the beginning of his resentment toward me. He didn’t believe there was such a thing as mental illness. He was convinced that psychiatrists and pharmaceutical companies were in cahoots to dispense medicine and make huge profits.
While hospitalized, he was served with divorce papers so he used a telephone there to call his wife and apologize.
He was released after being stable for only two days. We’d planned to bring him back to California with us. But as soon as he was discharged, he was arrested again because he had called his soon to be ex-wife from the hospital.
Back in jail and without meds for four days, Josh had an outburst when he was taken into the courtroom and his defense attorney wasn’t there. We later were told that outburst had angered the prosecutor. Josh’s bail was raised, and we were told that he couldn’t be released or return with us to California. We suddenly found ourselves fighting the criminal justice system as well as our son’s mental illness and our badly broken mental health system.
It cost us upwards of $40,000 in legal and other fees to get Josh released and finally bring him home with us. My husband, a retired minister, and I would have preferred to spend our savings for Josh’s treatment.
When we finally got him, we felt an initial sense of relief. We were sure we could help our son if we provided the support structure needed for recovery and, at first, everything went well. Then one evening, he told me that he was heading to the gym and needed to borrow my car. Instead he parked by the side of a road, got into the trunk and tried to asphyxiate himself. As he was slipping into unconsciousness, he aborted his effort and agreed to admit himself into the hospital. That was one of two suicide attempts, followed by hospital stays.
Wanting to help, Josh’s older brother and his wife in southern California insisted that he come to live with their family, which included three small children. Josh was happy to be living with peers rather than his parents. For a while things got better. He started seeing a new psychiatrist and therapist. A daily walking route took him by a Lowe’s store, where he applied for a job. When he landed a job as a department manager, we all celebrated. We felt confident the worst was behind us. Josh was going to recover from his losses and rebuild his life.
But that didn’t happen.
Josh would not believe he had an illness and as soon as he got better, it always came back to bite him.
Four months after landing his job, he quit. Two days later his brother found him delusional in a hotel conference room, where he was waiting for people who he’d invited to sit on the board of directors of an international foundation he was forming.
Once again, he agreed to admit himself into a hospital, but after a few days, he checked himself out, insisting there was nothing wrong with him. He became homeless. Soon he was stuck in a vicious cycle. He would be hospitalized and become stable, but would suffer horrible side effects from the medication and ditch the medications when he left the hospital. He would decompensate until he was hospitalized again.
At this point, we persuaded him to return to live with us in northern California, and he embarked on a recovery path that included consulting with a homeopathic doctor and long distance running. He attended recovery groups and Bible studies and soon had a large circle of friends. Even with those supports in place, we saw his mental health begin to decline. He was hit by a car while running one day and fell asleep at the wheel of his car when he was coming home from visiting his girlfriend late one night. He came through both accidents without a scratch and was sure God had saved him. Both accidents were miracles, he told us.
His girlfriend saw his mental health deteriorating and spent hours trying to convince him that if he would just take his medication, he could manage his illness and lead a productive life.
But he insisted he wasn’t ill.
His mental disorder was a cruel one in that the sicker he became, the more convinced he became that there was nothing wrong with him.
He told his girlfriend that he felt better than he had for many years when he was off his medication. He spent many hours each day feverishly scouring the Internet for information about his newest revelation: that the United States would soon fall under martial law. He couldn’t keep himself from talking endlessly about his conspiracy theories.
I reached a point where my own mental health was suffering. I had to move in with a friend for two weeks because I needed a break from the disruption that Josh was causing in our home. I wanted to help my son get well, but he became resentful because he was sure I was wrong about the illness. Our quality of life suffered as we watched him sink deeper and deeper into an alternate reality.
Thankfully, I heard about NAMI (National Alliance on Mental Illness) and began attending local meetings. The other NAMI members were supportive and understood what we were going through. I learned as much in the 12-week Family-to-Family class as I did getting my college degree. NAMI friends became like family to me. They would circle their wagons to support us. They had walked in our shoes. I can’t say enough about the value of this organization. Family members and friends tried to help Josh. They saw our frustration and despair and were concerned that all the stress would cause us to lose our health.
In March of 2013 after many unsuccessful attempts to convince Josh to start taking his medication or voluntarily admit himself for treatment, his Missouri probation officer intervened and set the wheels in motion for his return to St. Louis, where she believed he would get the help he needed. He was persuaded to give up his rights to a preliminary hearing and spent two months in the St. Louis County jail waiting for a psychiatric bed to become available in a state hospital. He refused to take medication and before a mental competency evaluation was completed he called his ex-wife again using the hospital phone. He failed the competency exam, received a court order to take medication and spent nine months in the hospital. The powerful anti-psychotics made him feel miserable and made him feel like a zombie.
In January of this year we flew to visit him. He blamed us for his circumstances. The heartbreak we felt was indescribable.
In February, he was returned to the jail for his probation revocation hearing after he had regained mental competency. It took four months for the hearing to take place. During that time Josh again refused to take medications because he could. He told us the jail psychiatrist said he was doing well, and he didn’t need them.
At the hearing, Josh’s probation was revoked. He was charged with another felony for using the patient telephone at the hospital. He was sent to prison in early July to fulfill his original three-year sentence.
Afraid and mentally fragile, Josh asked to be put in solitary confinement, because he was paranoid about being in the general population. In a cell 24/7 for weeks on end, the illness consumed him. HIPAA laws prevented us from knowing all that was going on. By this time we felt overwhelmed and worn down by all the roadblocks and felt powerless to help our son. Mental illness impacts every person in the family. We were becoming ill, too.
In the late hours of Wednesday, Oct. 22, my husband’s phone rang. It was the Farmington Correctional Center reporting that Josh had hung himself in his cell. Two of our grandchildren were left fatherless. My husband and I have lost a second son (the first son to a wicked childhood cancer). Our three living sons lost a brother.
Josh had a physical illness that manifested in his brain, the most complex organ of the body. He deserved decent medical care, not prison. When we called the prison to speak with the warden the morning after Josh’s death, my husband asked him why Josh—a person with a documented history of serious mental illness and suicide attempts—was not being watched. He said that they don’t have enough staff.
Bipolar disorder destroyed our son’s life in four short years, but it had accomplices: a woefully inadequate mental health system, a judge who saw punishment as a solution and a prison that was unprepared.
As many as 400,000 prisoners in America have severe mental illnesses. The suicide rate in jails is nine times higher than average. My son is now one of those statistics. He shouldn’t have been. There are no words to describe our agony and anger toward the inhumane treatment our son endured.