Original article no longer available
September 13, 1998
Author: Michael Martz ; Times-Dispatch Staff Writer
Two hours before he stabbed his grandfather in the throat with a knife and took the family hostage, Erin P. McKee was at the mental health clinic in Gloucester County trying to get help. “I remember I didn’t want to go back to my grandparents’ house,” he said. “In my head, I wanted to go to the hospital.”
The voices in his head were terrible, he said. “I believed on a daily basis I was going to die. My grandfather was going to hurt me, hurt my parents, or my family, all kinds of strange things.”
Erin McKee ended up in a maximum-security state hospital for the criminally insane because the local mental health clinic didn’t realize how sick he was and sent him home with a family unprepared to cope with him. He wanted help that he didn’t get from the public mental health system, which considered him mildly disabled one day and a threat to society the next. Erin is not alone.
Virginia’s mental health and mental retardation system misses many people who need help most and spends too little time on treating their problems. Getting services often depends on where they live and how they can pay.
As a result, people often depend for care on state institutions that federal investigations have found to be inadequate and sometimes inhumane in their treatment of patients.
In the next eight days, The Times-Dispatch will tell the stories of people stricken by mental disabilities of many kinds, stories about people and families looking for help from a fragmented system that has not always lived up to its promises of treatment and care.
“The basic problem in Virginia is what’s on paper doesn’t match reality,” said Valerie L. Marsh, executive director of the Virginia Alliance for the Mentally Ill, an organization formed by families of people with serious mental illness.
Erin got into the system the hard way. He’s not sure exactly what he said the day he went to the Gloucester clinic, but he knew he was willing to go to a hospital to help him over a bad patch.
Instead, his actions thrust him into a system from which he may never be allowed to go free. He was 19.
“He had come so close to getting help and was willing to get help every step of the way,” his grandmother, Beverly McKee, wrote state legislators.
Local mental health officials said they were handicapped by the absence of a psychiatrist that day but said there was no reason to send Erin to a hospital.
Cost was not an issue, they said. They thought he could be treated in the community with close supervision by his grandparents, who had signed an agreement to hide knives and other dangerous items in their Deltaville home.
“The only thing we did wrong was not being able to predict the future,” said Gerald P. Desrosiers, executive director of the Middle Peninsula-Northern Neck Community Services Board, based in Saluda.
William McKee was not seriously wounded in the attack that followed soon after Erin returned from the Gloucester clinic. Erin allowed him, his wife and daughter to walk away after holding them hostage at knifepoint for more than an hour.
But Erin’s life hasn’t recovered from that terrible December day almost three years ago.
Now 22, he lives in the maximum-security forensic unit at Central State Hospital near Petersburg, where he was returned this summer after an overnight escape from a state mental hospital in Williamsburg.
“He’s not the only one here like that,” said Dr. Daniel J. O’Donnell, Central State’s acting director and former medical director at the forensic unit. “There are a lot of tragedies in that building.”
Bad things happened every time Grant Webb stopped taking his medications for schizophrenia.
Sometimes he threatened his parents. Once, “he took my car and drove for hours to Idaho with practically no money [to see his father],” said Beverly Fleming, Grant’s stepfather. “We didn’t know for days where he was.”
Every time it happened, Lillie and Beverly Fleming girded themselves for the soul-wrenching process of committing Grant to a psychiatric hospital against his will.
It meant a prescreening by local mental health workers, detention for up to 48 hours, and a hearing by a special magistrate, advised by a psychiatrist and the community services board. In Grant’s case, the police or sheriff’s department usually was involved, too.
The scene at the hospital was the part his mother, Lillie Fleming, hated most. “He’s screaming and rolling around the little holding tank,” she said in the living room of her home near Mount Jackson. “It’s not a pretty process for families.”
The Flemings won’t have to go through the process again, because Grant died of a massive heart attack at Western State Hospital in Staunton in mid-1996. He was 39.
A year later, another Western State patient died too young: Maura K. Patten, a 41-year-old schizophrenic with whom Grant had a romantic relationship at the hospital. “She was a lovely person,” Lillie Fleming recalled.
Patten’s death helped fuel public concerns about care at the state hospital. She had told staff she was dying, but her family said her concerns were ignored over the Fourth of July holiday weekend, a contention supported by her medical records. She died early the next week of respiratory failure.
But the Flemings remain strong supporters of Western State and other state institutions.
“We found more [consistent] care at Western State than we did at any hospital,” said Bev Fleming, who is chairman of the Shenandoah County Board of Supervisors and a member of the Northwestern Community Services Board, the regional mental health agency for the northern valley. He also is a former president of the Virginia Alliance for the Mentally Ill.
Lillie Fleming said, “If they closed [Western State], it would be terrible.”
Marsh, executive director of the alliance, says she understands why families support the state institutions. The families have had to provide much of the care as the state pushed to move patients out of public hospitals.
“The families had come through several decades of false promises for community care, so they absolutely see the hospitals as the last resort,” she said. “At some point, it becomes ingrained in you to accept the unacceptable.”
Marsh would like families to recognize the possibility of a system that relies not on state institutions but instead on community programs that work. “Here in Virginia, families settle for far too little. They’ve been too polite.”
Meanwhile, some families, including the Flemings, are supporting a legal approach that is anathema to many mentally ill people and their advocates: a new way to force people to undergo treatment in their communities.
Virginia has debated the idea of “mandatory outpatient treatment” for 10 years. Legislation was carried over this year to test the idea in several communities. The legislative sponsor is Del. Glenn M. Weatherholtz, R-Harrisonburg, a former Shenandoah County sheriff and childhood friend of Bev Fleming.
The idea is to force treatment of people “who are not yet an imminent danger or so deteriorated they cannot care for themselves,” said Richard J. Bonnie, head of the Virginia Institute for Law, Psychiatry, and Public Policy at the University of Virginia. People who are an imminent danger to themselves or others may be committed to a hospital or outpatient treatment under current state law.
But Bonnie thinks critics of the idea may have a point when they say it is unfair to force treatment when communities have so little to serve people freely.
“It becomes a service issue,” he said. “What do you have available in the community and do you really need coercion?”
The big problem is money.
Weatherholtz’s proposal would require the state to assure “adequate and appropriate resources” in the communities that would test mandatory outpatient treatment. The implication is that most communities don’t have those resources.
“There is no substitute for investing in adequate community care,” Bonnie said. “It’s just that simple.”
This is what mental health workers knew about Erin McKee when he walked into the Gloucester clinic on Dec. 11, 1995, hoping to go to a hospital:
He was seriously depressed, staring vacantly and hearing threatening voices, which were signs of some level of psychosis. He didn’t threaten to hurt himself or anyone else.
Three days earlier, he had overdosed on an antidepressant drug, but the local hospital staff concluded he was seeking attention, not trying to kill himself.
His mother in Michigan said he had been living on the street because he had spent all his money on drugs and alcohol. He would cut his arms with razor blades. She had rescued him, but he ran away to Virginia when she and his stepfather tried to take him to a psychiatric hospital.
This is what local mental health officials said later about Erin’s condition that day:
“Given what we all knew at the time, it appeared likely that the family would be able to manage the needs of a mildly disabled young man,” Desrosiers wrote to Sen. Joseph V. Gartlan Jr., D-Fairfax County. “There was nothing in his history or in his presentation to us that indicated that he was other than mildly disabled.”
Part of the problem was timing, Desrosiers said. Erin had gotten immediate attention from an emergency services counselor when he first came to the clinic the previous week.
But a sudden snowstorm forced cancellation of a follow-up appointment the next morning. The counselor wouldn’t be back in the office until Monday, the 11th.
No psychiatrist was available when the McKees returned on Monday. The weekend had been harrowing. The grandparents had taken Erin to a Gloucester hospital emergency room after he swallowed 20 tablets of Zoloft, an antidepressant prescribed by a local doctor soon after he arrived from Michigan in October.
“I remember thinking I would really like to go to the hospital .*.*. but I’m not sure if I expressed that,” Erin said of that Monday visit to the clinic. His grandmother said he did. Community officials said he was agreeable but not emphatic about being admitted to a hospital.
They scheduled an appointment with a psychiatrist the next morning. Erin and his grandmother signed agreements to help prevent attempts at suicide or other violent behavior. The agreements committed the McKees to 24-hour supervision of their grandson and to hiding knives, guns, drugs and alcohol from him in the home.
“On this issue, they didn’t do what they said they’d do,” said Dr. J. Patrick Dorgan, now director of inpatient and family services for the board. “I don’t know what we could have done differently.”
Erin was surprised when his grandparents drove him back to Deltaville instead of the hospital, according to a summary by a Central State psychiatrist who evaluated his sanity at the time.
Beverly McKee was late for work, so she asked her husband to watch Erin until she returned in a couple of hours. About two hours later, Bill McKee was watching television when he saw Erin walk into the kitchen and pick up a knife. He told his grandson to put it down.
Erin made wild, karate motions with the knife and put it to his grandfather’s throat. He stabbed him and made him lie on the floor.
When his grandmother returned, he refused to let her call for help. Their daughter, Debra, got the same treatment when she walked in. After letting them go more than an hour later, Erin went on a rampage, smashing the television set, throwing rugs on the bed, and stuffing clothes into the toilet.
Sheriff’s deputies arrested him and took him to jail. The next day, he was sent to Central State for psychiatric evaluation.
Erin pleaded not guilty by reason of insanity to three counts of abduction and one of malicious wounding on Oct. 8, 1996. He was committed to the custody of the state mental health commissioner for indefinite confinement and treatment.
Sitting in a visiting room at Central State, Erin is trying hard to remain positive. He has regained about half of the 75 pounds he lost after the state hospital took him off his antipsychotic medications, which were restored later.
He wants to get out of the hospital and return to Michigan. He got the equivalent of a high school diploma while he was in jail, and he’s good with computers.
“I’ve been in the system since 1995,” he said. “I’d really like to get a job or something, or go to school.”
Erin doesn’t remember much about what happened that day in Middlesex County. He remembers “the offense,” but said, “I don’t like to think about that.”
His grandparents visit him regularly.
“They always have been very kind to me,” he said. “They always told me if I ever needed help or a place to stay, they would provide that for me.
“That’s what they did. That’s what’s so tragic … ” he said, his voice trailing away sadly.
Schizophrenia: Interferes with ability to think clearly. Can include delusions, hallucinations, belief that others hear one’s thoughts.
Bipolar disorder: Also known as manic-depression. Mood swings from deep depression, sometimes suicidal, to hyperactive mania, sometimes with delusions.
Major depression: Chronic melancholy so deep that it affects concentration, sleep, appetite and social behavior.
Obsessive-compulsive disorder: Involves involuntary thoughts, impulses, worries and purposeless repetitive behaviors.
Record Number: 9809130166
Copyright 1998 Richmond Newspapers, Inc.