My daughter EM will be 33 in October. A talented chef and artist, she possesses a huge heart for helping  others. She is a wise, old soul—if you embrace such dispositions. She has thrived on her own, with support from her network and care providers. She studied Art Therapy and Holistic Therapies—with a curiosity and understanding of the mind/body connection, epigenetics, and van der Kolk’s work on trauma—The Body Keeps the Score. Incarcerated at Boulder County Jail since August 9th, 2022 with a brief detour of homelessness after being released on a clerical error. She was re-arrested for failure to appear, taken to Longs Peak Hospital, and returned to jail August 29th.

Our slog through the competency restoration morass starts in April, 2021,

when an ex-boyfriend on probation began smoking meth with EM.

Within weeks, she was failing several college classes. May 8th, I returned

home after a warning call from my partner; EM was yelling at a glass of

water on the floor. I tried to talk with her and called the Longmont

CORE team, whose website states response as soon as possible. An

officer returned my call 24 hours later. By then, EM had hopped in her

car, left home, approached an officer claiming pursuit by the “galactic

core” arrested (DUI), hospitalized “stabilized,” and transported to jail.

(At LUH—I know Katherine, the MH social worker, by name—recite the back-story to her, and beg her to put EM on an M1 hold.) Within a month, EM (now living with a friend in Boulder) received a DWAI after blacking out on fentanyl, hitting another car at a busy Boulder intersection—deeply shaken as she knew pedestrians could been injured. Again, hospitalized and released. 2 days later, EMTs were called to revive her after her friend found her listless his apartment, with blue lips and fingers. Also Fentanyl.

Our advocacy group (Mental Health Colorado) has discussed an acuity scale for serious mental illness or SMI. In our home we have DEFCON. EM starts devolving (decompensating) and the countdown begins. At times, she’s been feeling good and meddles with her medication. Other times, the inability to refill a prescription means reduced dosage until depletion. There is a sweet spot in which she seeks refill. Without meds, psychosis enters within days—delusions return; her life-saving anti-psychotic medication forgotten. We can always see and feel the crisis coming: at best, it’s a trip to the ER for extreme anxiety; at worst, another arrest, additional charges, incarceration and/or institutionalization.

From April 2021 to April 22, EM spent 106 days in the ER, hospitals, jail, detox, the crisis center, homeless shelters, respite care, the TRT program, Centennial Peaks, Highlands Ranch, or Cedar Springs. On numerous occasions, further victimized by the Medicaid trap of early release—because of the IMD limitations of coverage. EM was in Centennial Peaks during the Marshall Fire; patients watched as flames approached the property and the various gas/oxygen storage tanks. Some were evacuated to Highlands Ranch, eventually ending up at Cedar Springs. Released from Cedar Springs during January 2022 inclement weather, clothed only in disposable scrubs with no undergarments, EM was dropped at a bus stop at 7 a.m. by a custodian. There was no shelter. The bus from Dallas on its way to Denver never came.

I left a message for my supervisor and drove from Longmont to Colorado Spring to retrieve my unstable, confused, and vulnerable daughter. People had stopped to share clothing or allow her to use their phone. Wrapped in a blanket covered in dog hair from someone’s back seat and a hodgepodge of shirts, a sweater, and a hat, EM darted through a busy intersection to dive into my car.

 

How could any facility release a vulnerable person in this manner?

Late June 2021, EM was taken to Porter Adventist Hospital after running

down Broadway in Boulder in her socks, flagging cars. Her psychiatrist

paused medication when detoxing EM at a crisis center and neglected

to reinstate her medication prior to entry in the Transitional Residential Treatment (TRT) Program at Warner House in Boulder. On release from Porter, a 3 day waiting period (aka falling off the wagon period) was imposed. The looming 4th of July weekend and Monday holiday turned 3 days into 11 before re-admittance. EM spent 2 nights at a shelter before scrambling through a high window in our living room. Attempting legal action to force residency in our home, I sought a protection order in August.

Failing to appear for charges of DUI and DWAI, EM turned herself in during Sept. 2021, served 10 days in jail; and was sentenced to 2 years probation, UAs, and the PACE program. We engaged the Angel Initiative to facilitate transportation, scheduling, and possible housing. EM remained non-compliant with UAs and PACE attendance. There was no accountability. I spoke with her Probation Officer about imposing consequences and was asked, “What do you want me to do?” “Your job!” I replied. Responding to EM’s condo numerous times for disturbing the peace and a known “high-utilizer,” police eventually don’t even bother talking with her—watching from a distance and leaving. She collected 3 more arrests for drug charges, and trespassing at a grocery store—testing positive for a trifecta cocktail of LSD, ketamine, and meth.

The next 10 months were filled with and fueled by chaos—ER visits, multiple hospitalizations, car impounds, arrests, drug use, homelessness, numerous failed living arrangements, phone calls to come rescue her from one place or another—including a rescue from interviewing with Sister Wives of the Mormons.

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At every opportunity for intervention—the system failed EM. More charges

were accrued, more untreated psychosis permitted, more harm accrued.

 

July 2022. EM was unlawfully evicted from her condo; City of Longmont

Victim Services paid for a motel room until early August. I was with EM

July 29th, 2022 when she attempted to refill her prescription for anti-psychotics at Mental Health Partners in Longmont. She was denied service, released from care for missed appointments. The next  reinstatement interview was August 29th. EM was not informed of her rights as a Medicaid patient to an appointment within 7 days. She did not know to ask for a supervisor, or to call her Regional Accountability Entity for support. Her case manager refused to speak with me—claiming a revoked ROI. In calls to Kaiser PCP, and Kaiser Behavioral Health, EM calmly explained her circumstances and was denied service. She and I both sit stunned with the knowledge that without intervention, within days she will be psychotic and
homeless.

My partner and I left for a planned trip early August. EM was pursuing a sober living vacancy at Oxford House. At the airport for our return flight home, my partner received a call stating his truck was blocking the road heading the wrong direction on a one-way street in our neighborhood. I called the police who went to our home and cleared the site. We met officers upon return and noticed tools, electronics, jewelry, and cameras were taken. The disturbed drawers and cabinets, heavy tools and tanks removed suggest both EM and her boyfriend were involved. My truck was also missing.

Deputies recovered the truck, some tolls, and belongings at a motel. EM was arrested on probable cause August 9th. The boyfriend denied access to the motel room and walked out later in the day. He was  arrested Sept 3rd, sentenced in March and released into the AITC program. Per statute, restitution must be joint and several or not at all. This hardly seems fair. He’s in the community—she’s still in jail. It’s not a crime to be mentally ill, but our system treats individuals with SMI as if it were. I contacted the jail with information on EM’s known medications and dosages, and asked the team to request medical and psychiatric appointments. An automatic protection order prevented them from speaking with me. EM refused the offered medication. This is common and expected with schizophrenia. That sweet spot was far behind us.

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Sept 29th, BoCo Jail; EM was not wearing clothes, refusing to shower, screaming and yelling all day. She had not eaten for days and had been in isolation. A PR bond was issued to send her to the Della Cava Center on an M1 hold.

EM called Oct 2 wanting me to come get her. I called Della Cava to alert them she was trying to leave. They could not confirm or deny she was there. She returned to jail Oct. 4th, or 5th. I called the MH team for information. A MH staff member suggested I contact Representative Judy Amabile. I was doubtful, but sent an email. Representative Amabile called me that evening, briefly shared her story, and asked if she could forward my email. Judy invited me to the weekly Mental Health Colorado SMI Zoom group.
 

EM returned to Della Cava Oct 10th. She called the on 12th wanting her boyfriend’s number to share news  of her pregnancy. Yes, pregnancy. On the 14th she was returned to jail and found incompetent to proceed and restoration ordered for the first time Oct 17th. A BoCo jail trustee told the boyfriend's mother about the pregnancy October 24th. A day later, a covert virtual meeting was arranged between EM, the boyfriend, and their attorneys. They agreed to terminate the pregnancy. I am in shock. How can a trustee violate this degree of privacy? Why can’t I talk with my daughter? If you are incompetent to proceed, how can you make the decision to terminate a pregnancy?

 

The procedure occurred Nov 15th at 12.5 weeks gestation. EM named her Alyssa. I received a gut-wrenching letter from EM describing her pregnant mom body and the trauma of excessive bleeding.

 

December 1st, nearly 4 months after her arrest, the protection order was amended, allowing communication. EM was found incompetent a second time. Letters received from EM in January and February revealed that EM was being coached to answer  competency evaluation questions, and working with housing coordinators to find a sober living vacancy under the auspices of continuing restoration in the community. She’s become more entrenched in her multi-dimensional, intergalactic delusions in which she is Gerbrudesh, Queen of Cassiopeia or a High Priestess working on Venturi to heal the universe. I am grateful her delusions are pleasant and empowering. It could be worse. She complains about her sleep the food, and inability to go outside no more than a twice a month. A Bridges of Colorado Court Liaison was assigned to coordinate services.

 

In February, a conversation with the Clinical Care Coordinator at MHP revealed that the ROI claimed to have been revoked was actually in place—the case manager either did not check records, or decided she didn’t want to deal with me. I eventually filed a complaint, and the case-worker was let go about 6 weeks later. Did I have impact on this outcome? I hope so…

 

In March, EM is found incompetent to proceed a third time. March 14th

the Wall Street Journal contacted me to share our journey on competency

wait times. During March, April and May, EM has quit writing letters.

On rare virtual visits at the jail, her conversation is steeped in fantasy

with no bearing in the real world. I am alarmed with her decompensation.

Moved from general population to a more restricted area, she appears

unwell and most of her time is spent sleeping with the blanket pulled over her head—her coping mechanism to shut out the world. The MH team is also watching her become increasingly debilitated.

 

In May, EM talks of being transferred soon to a spa or a nice resort. A palace in India with good food and lace curtains. Disorganized, her voice drifts off mid sentence. There is talk of transfer to the state hospital; she is moving up the waitlist as decisions are made on a weekly basis. The WSJ story is released online May 29th and front page May 30th.

 

June 6th, found incompetent a fourth time, EM is transported to CIMHHP. A week later, I call to introduce myself and share information. They cannot confirm or deny she is there. June 14th I received a call from her social worker. We schedule a video visit in which EM agrees to sign an ROI for me.

 

I request contact information for EM’s care team. I sent emails to the social worker and ask they be passed on. She tells me EM is good. I don’t understand, she is imprisoned by delusions—the Queen of the white ants. How is this good? Her behavior is good. I thought Pueblo was going to be an improvement. It is—in terms of phone access, and EM can go outside and get fresh air everyday in a concrete enclosure. She has work—a stack of competency evaluation flashcards to memorize. Two months after transfer, August 4th, I connect with her doctor. He made an interesting comment; “We are programmed to receive.” C2 Max has little to do with individual therapies or social workers who assist with programs or placement in the community. It's all about legal competency. There are opportunities for support in a less restricted environment on campus. Without knowledge or hope of change—why would anyone try? EM has been “checked out but can never leave” for months. She is a “prisoner of her own device” steeped in delusional
fantasies. I find this Hotel California reference an apt descriptor. Her doctor was grateful for the detailed information I shared—much more than a paragraph from the jail. Why the delay? Another 60 days of lost time and resources in this very expensive Hotel.

Court-ordered medication treatments began in late July. EM can hold conversations in the real world and believes she passed competency evaluation just yesterday, August 30th. I have written to the DA, her attorney, liaison, doctor, social worker, and forensic navigator with questions about her upcoming transfer. Being incarcerated and entrenched in delusions for so long, she lacks the resilience to recover. Intensive MH treatment, trauma therapy, counseling, career placement, residential, and step-down housing is needed. Recidivism is a real threat. At every turn, new challenges emerge. I don’t have lot of faith in the process. Who is responsible for finding appropriate treatment and residential options? There was only one option posed. I suggested another—are others more appropriate? How is the research approached? Does the location matter? There have been no signposts, landmarks, or landscape with which to navigate on this journey, and I often don’t understand the language.
 

Would the psychosis, the break-in, the hospitalizations, the arrest,

the pregnancy, the ITPC, the year in jail been avoided had EM received

her meds? I don’t have a crystal ball, but harm is done and psychosis

inevitable when access to life-saving antipsychotics is denied. Our story

is familiar to others the system has failed. Loved ones living with serious

mental illness like schizophrenia or bipolar disorder are treated recklessly

and without compassion compared to others with acute illness.

 

Stage 4 cancer patients aren’t refused a bed and given a ride to the homeless shelter. Diabetics who miss a meal or had a drink are not shamed when seeking care in the emergency room. Our loved ones require care; not cuffs. County jails are not equipped with the tools or the authority to function as mental health treatment facilities. The data show incarcerated females are twice as likely to live with mental illness; yet a significant gender disparity exists in the number of beds allotted for evidence-based restoration programs. Warehousing a person who is ill under the guise of legal competency restoration without proper intervention to return them to health is cruel and unusual punishment. The toll in human suffering and cost to taxpayers of continuing this systemic dysfunction is staggering. I call on each of us to address the barrier within our purview to co-create an elegant alternative to homelessness or incarceration for individuals with SMI.

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Bright spots:

I want to thank each of you who take the time to listen and respond to questions or pass along queries to others. While there may be few immediate resolutions, this communication and validation is a lifeline to those traversing unfamiliar territory. A special heartfelt shout out to the weekly SMI Zoom group. I am grateful for your wisdom, generosity, and compassion along this painful and bewildering journey. And finally, If you want to  help your loved one, it's imperative to find support for yourself. To those who are hurting, I encourage you to share your story. Only in sharing have I found empathy; action imbued connection. Thank you.