Holiday Madness

Looking for quick help, some patients instead found themselves locked in a county mental health unit and not going anywhere.

For Kelly Robertson, it all started stupidly enough with a fight on Twitter with her boyfriend. She wanted to leave town; he didn't. She went home, argued with him face-to-face and had a meltdown.

She'd been diagnosed with depression four months earlier, was in a doctor's care and on medication, but it was clear on Thanksgiving Eve that her emotions were careening out of her control.

Her regular doctor was on holiday, and whoever was on call didn't know her, so Robertson reasoned that she needed to look elsewhere for help.

Kelly Robertson says she was trapped in the mental health care system.
Monica Fuentes
Kelly Robertson says she was trapped in the mental health care system.

The 29-year-old assistant professor and technical director at the University of ­Houston-Downtown called police. They came to her apartment and told her that she should go to the NeuroPsychiatric Center at Ben Taub Hospital, the mental health emergency facility. Her boyfriend, Mike Switzer, took her over and they arrived about 1 a.m. Thanksgiving Day.

Robertson thought she would talk to a doctor, maybe get some different medication and be on her way. During her conversation with an NPC psychiatrist, Robertson agreed to voluntarily commit herself; she thought she'd be in a day at most; her boyfriend heard "two."

Around 9 a.m., when she still hadn't received any medication or treatment and had started feeling better on her own, Robertson wanted to leave.

"They wouldn't let me," she says. Instead, they involuntarily committed her on the spot and ordered her transferred to the Harris County Psychiatric Center, a 250-bed facility. If, as her attorney says, she had just slipped out in all those hours of waiting, what followed never would have happened.

HCPC, like other mental health facilities in Texas, has 72 hours to bring an involuntary commitment before a judge. Robertson thought, okay, worst case scenario, she'd be out in three days.

But weekends and holidays don't count, she found out. Unless HCPC let her go earlier, the first she could be considered for release would be the following Wednesday, a full week after she went in, she says.

"I tried to reason with them, that I was there voluntarily and they should let me go."

NPC, part of the Mental Health Mental Retardation Authority of Harris County, remained adamant. Around 11:30 that morning, Robertson and other patients were transferred in unmarked cars to HCPC. She spent the rest of that day and the four days that followed drawing pictures, playing cards and sleeping; she even made a graphic comic of her adventures. She missed Thanksgiving dinner with her boyfriend's family and hers. Bill Savoie, an attorney friend, tried to intervene on her behalf and basically got nowhere. Her own doctor talked by telephone with the HCPC psychiatrist, Dr. Alejandra Suzuki, who refused to remand her to her custody. (HCPC says this isn't possible; an outside doctor doesn't have privileges).

When she saw Dr. Suzuki again on Monday morning, Robertson was finally released. She got a referral and a 25 mg increase in her Zoloft dosage.

Thirty-nine-year-old Tammie Hatton of New Caney was in at the same time for depression and feels a similar sense of betrayal.

"I went in voluntarily to NPC. They said I would get individual counseling, I would get group counseling. When I got there, the nurse said, 'Oh no, we don't do that; the only thing we do is get you set up on your drugs and we get you out of here.' I was very angry. I told them, 'I came in here voluntarily; I want out.' They said, 'You're here under depression; you're not going anywhere.'"

Over at HCPC it was more of the same, Hatton says.

"I was told by the nurse they put you on your meds and get you level. That's not what I need. I need to talk to someone about why I'm depressed. She said, 'Well, we don't do that here.'"

What they and several other patients say they found out that weekend was:

• Voluntary commitment does not mean you have the right to walk back out if a doctor believes you are a danger to yourself or others.

• NPC and HCPC aren't the best places to head to if you are ­looking for a lengthy heart-to-heart.

• Time spent with an HCPC psychiatrist is usually limited to ten to 15 minutes and falls along the order of medication adjustment.

• There are a lot of rules at HCPC, and they seem to change all the time depending on what tech is working. Most techs are nice, but some are rude and mean and seem to regard HCPC as a military operation or a prison.

• Group therapy at HCPC is worthless.

• If you have any hope of getting out, you'd better discard whatever persona you walked in with and be agreeable, happy (but not too) and definitely a nonaggressive master of disguise.

• Above all, try not to have mental problems right before a holiday unless you're looking forward to a long stay.
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Geri Konigsberg is the longtime spokeswoman for HCPC and, of course, she and her organization see these things from a very different perspective.

Just the fact that former patients are out there complaining about their stay points to the irredeemable truth that they are alive to do so. NPC and HCPC kept these people safe while addressing their most immediate needs.

Dr. Daryl Knox, medical director for MHMRA's psychiatric crisis programs, says NPC doesn't want to hospitalize anyone. "Actually, we're always trying to get people out. The majority of people who come here do not go to HCPC."

"Sometimes we have no option but to hospitalize," Knox says. "The doctor may feel that this person is at some risk of hurting themselves or hurting others."

"Once you're in the hospital, you're our responsibility," Konigsberg says. "If you say you want to go, that you feel all better, but we know you are not all better, then we do the involuntary commitment process for you. It's for your safety."

Attorney Savoie puts it another way: "If you answer one of those magic questions the wrong way, you are no longer free to leave. Many people just don't understand that."

To be fair, depression wasn't the be-all and end-all of the problems Robertson and Hatton were experiencing. Robertson says she was having some "suicidal ideation," and Hatton, who hadn't been on her prescribed medicine for two months, says her older son says she told him she had a gun and was going to kill herself and her family — statements she denies making. But put together the missing meds, the fact that an aunt and uncle of hers had recently died within three days of each other and that she had a big fight with one of her sons — it's understandable that the mental health professionals wanted to take a closer look.

Konigsberg says any patient can ask for the patient advocate. All patients have phone privileges and phone numbers are posted on the wall.

"We've even had patients call the police and tell them they're being kidnapped here, and the police come," Konigsberg says.

But Robertson says she didn't call because she was afraid if HCPC found out, it wouldn't let her out. Her boyfriend agrees. "We had the feeling that if we called the advocacy number, we'd never be allowed to leave," Switzer says. (Konigsberg denies that there would ever be retaliation.)

Instead, what Robertson did was ask HCPC employees about how to get in touch with the court system and how to reach the constable's office that serves the commitment papers. No one had the numbers.

Konigsberg insists that all the information any patient needs to know is included in the patient's information packet handed out upon arrival at HCPC. But a review of that packet shows there are no court or constable numbers listed there.

Tammie Hatton actually stayed in as a voluntary patient. She says she wanted to leave, but figured "if I'd have thrown a fit to leave, then they would have pulled in a judge." Her description of group therapy:

"The group session consists of you sit down, you make a goal for the day and at 8:30 at night you sit back down and you say if you reached your goal. We'd make up anything."

At NPC, Robertson says, she saw one psych tech "violently kicking a patient's cot to awaken him." Knox says his staff isn't perfect, but it's hard to believe that someone would do that on an open floor, in full view of so many other people.

At HCPC, Robertson says, patients were subject to cold showers and wrong dosages of their medicines (she spotted that she was being handed three times the dose she should be receiving), and that "techs frequently walked in on patients without knocking, and I know of one incident where they saw one patient undressing."

She believes everything moved slowly there because HCPC was understaffed for the holidays. (Konigsberg denies this. "We are a 24-7-365. Christmas Day I'll be here. Christmas Day we'll run group. There's no difference between a holiday and a regular day.")

Following her release, Robertson sent a complaint letter to the Joint Commission on Accreditation of Healthcare Organizations. In its reply, the Joint Commission wrote that if there was an investigation, "current public information policy precludes us from providing you with the specific results."
_____________________

Adam Hayes stayed at HCPC during some of the same time as Robertson, and says he had "a positive experience" during a two-week stay.

The 31-year-old administrative assistant put himself in HCPC voluntarily after he had a tough breakup, had been off his prescribed medication and was self-medicating with other drugs.

"I was able to get on the right medicine. I was able to be kind of protected in a little shelter for two weeks up on that floor."

He didn't see the benefits in group, though. "Group therapy is really ridiculous. This was basically, 'Let's get you in a group and baby-sit you for an hour.'"

Robertson and others had a tougher stay, first, because they weren't there voluntarily and, second, because they bucked the system, Hayes says. Caseworkers were nice, but stretched too thin, and techs were really nice, or sometimes not.

"One was rude to me and Kelly. She got an extra set of shoestrings, and she got them for me, and the tech came over and literally snatched them out of my hand and said, 'No, we'll put these up for you, Kelly.' And I couldn't figure out whether the tech was upset with me or if the tech was upset with Kelly."

Konigsberg explains that even if a person is off restriction and able to regain his shoelaces, the laces need to come from HCPC. "Say we give that person the shoelaces. We don't know they have two pair, and if that person becomes suicidal and we only take away the one pair?"

But Hayes still can't figure out how he deserved the treatment he got. "I spent the whole weekend obsessing over that one incident. It was miserable. I still to this day don't know which one of us did something wrong, whether it was me or Kelly."

Hayes says the HCPC doctors are good but "can't spend a lot of time with you. It's like a cattle call. You go in for 15 minutes and basically it's for medicine maintenance only."

All in all, though, Hayes is grateful to HCPC. Not only did routine tests done there discover that he had a chronic illness, but he says HCPC was the right place for him to be when they delivered the news.

"I found out I was HIV-positive in there, and that was one of the good things to come out. I would have never known. That's the best place to be where they watch people for suicides and stuff like that because this is depressing information."

But Christina Gonzales wasn't as happy about her stay. The 28-year-old had been fighting with the father of her two-year-old son and was depressed. It was the Tuesday before Thanksgiving, and she called the cops for help "because I was scared and I didn't know what to do."

She told them she needed to talk to someone and asked for a number, but they said they could take her somewhere.

"So I said, 'Hey, this will be just for a day, right? I'll be able to come back home?' And they said, 'Well, yeah.' So they took me to Ben Taub. When I got there I felt like: Why am I here? I feel like I'm in trouble, and I haven't done anything wrong. And then you're making me stay here. And that's when they admitted me to HCPC. It was involuntary."

She was there for the next week. Gonzales told the doctor that she'd been depressed for a really long time and needed counseling. She got medicine, but not much else.

"They didn't help me with someone to talk to," she says. She's thinking about getting back in touch with MHMRA or a counselor at her mother's church, maybe trying for couples therapy, but for right now, she's just going to keep taking the meds, which are making her feel better.

According to Betsy Schwartz, president of Mental Health America of Greater Houston, a mental health advocacy group, research shows that a combination of counseling and medication achieves the best results. Still, Schwartz says, a lot of primary care physicians prescribe anti­depressants with no therapy, and people get along fine. "It's totally an individual thing."

Still, someone who walks into a mental health emergency room expecting a quick turnaround may be disappointed. Schwartz says there's no silver bullet.
_____________________

Kelly Robertson gets good marks from her students on the UH "rate my professors" Web site. Students say she piles on the work but makes things interesting. One predicts that she should get even better with more experience.

That'll have to wait for a while. She's taking a leave of absence, wants to get things settled down. As she wrote to the Joint Commission, the outcome from her experiences at HCPC and NPC "were episodes of stress and anxiety similar to PTSD," as well as "a distrust of the mental health system."

During the time she was there, she asked Switzer to bring in her students' papers to grade. But they were stapled, and HCPC policy is to restrict access to any potentially hazardous items (someone can use staples to scratch his or someone else's eyes out).

And yet, the patients' rights packet she was handed had several staples in it. ("An error on our part," Konigsberg says).

Robertson is better prepared for Christmas. She finished her shopping early, and both she and Switzer agreed to take a laid-back approach.

But there are landmines ahead. "There's a lot of research that shows that after the first of the year, there's an even greater risk for depression," Schwartz says, "because of letdowns from the holidays or regrets from last year or anticipation of next year. By Valentine's Day, I think it's better."

Robertson and some other people got locked into HCPC over a holiday weekend and are saying it shouldn't have happened. Maybe they're right and maybe they're not. And granted, this isn't a column describing how mental health professionals released a person who then went out and killed himself or others.

But what anyone could figure out is that counseling needs an overhaul at both NPC and HCPC. And that even if people are disturbed, they deserve to be treated with dignity.

And saying that a tech couldn't have kicked a cot because too many people would have seen it flies in the face of the countless lingering cases of bad behavior that have been uncovered in mental hospitals.

In a mental health crisis at an inconvenient hour with no excellent alternatives immediately at hand? Go to NPC, go to HCPC.

Chances are, there will be people working at both those places who are wonderful, dedicated and save lives. Some others, patients will just have to survive. Adam Hayes was occasionally uncomfortable, but profoundly grateful. Robertson got her medication adjusted, even if it did mean she became a prisoner.

Attorney Bill Savoie says anyone "showing up at HCPC and expecting a shoulder to cry on or some sort of therapy to take place, I don't think that's going to happen at all."

But even Savoie, as upset as he is about what his friend Kelly Robertson went through, says: "At the end of the day, the system worked."

Thanks to Robertson and other courageous people like Hatton, Gonzales and Hayes who are forthcoming about their illnesses, we have been accorded a disturbing inside look at a stay at the county's two main facilities for emergency mental health care.

The system worked. It can work better. If you were trapped in there, wouldn't you want it to?

margaret.downing@houstonpress.com

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