Stare as long as you want. Lance's face yields no secrets. Nothing in the eyes or smile of this handsome, dark-haired boy says stop, wait a minute, tread carefully. At least not as his face lies captured in a photograph, restful and calm. He could be any boy from Middle America, any boy who would make any parent proud, any boy with all the promise in the world.
But he isn't just any boy. He's Mark and Kim Lindquist's son gone astray and in desperate need of fixing, and there isn't any money to do that. The Lindquists believe he needs long-term residential care and they don't have the funds. Insurance companies won't pay for the treatment Lance needs. And the state of Texas won't pay for it either.
Lance is on the verge of becoming a lost soul, forever condemned to a purgatory filled with the demons in his mind. The only way out seems to be for the Lindquists to peddle their private problems to the world at large and try to raise money for his treatment.
Or give him up to Children's Protective Services and declare him "abandoned."
Lance is 13 years old.Mark Lindquist thought his eight-year-old son was just strong-minded. The boy would challenge him from time to time, but Mark dealt with that through the usual time-outs, loss of privileges, grounding, extra chores and the occasional spanking.
But things got worse. Any sort of punishment seemed to lose its value. Lance continued to defy his father. He would break things on purpose. He would sneak out of his room at night and take things from his parents' and his sister's rooms. As he grew older, he got into heated confrontations with his father. His grades in school took a dive, and his father believes he purposefully failed the seventh grade. Lance began cutting himself on the hands and arms with razor blades. On one occasion, he threatened to hurt his father. He talked of death. He said one of his friends could get him a gun.
His parents locked him in his room at night and set an alarm on his door. They had his younger sister and a newborn baby of their own to worry about.
Kim Lindquist is actually Lance's stepmother. Unbeknownst to Mark, a former girlfriend had Lance without telling him. When Mark found out more than a year later, they married, but the union didn't last.
Mark got joint custody and eventually he remarried. Five years ago his former wife, saying she couldn't afford Lance and his younger sister, gave the children to the Lindquists.
The Lindquists took Lance to a counselor on and off for two years. In 1998, the counselor diagnosed him as having Reactive Attachment Disorder, an inability to form bonds or attachments with others.
Last March 12, the Lindquists took Lance to a psychologist who said he would not treat Lance on an outpatient basis. They immediately took him to a psychiatrist who told them Lance should be hospitalized that day.
Because Lance refused to sign a contract pledging not to hurt himself or others, he was put in the most intensive care ward at the Devereaux facility in League City, Mark said.
The abruptness of the hospitalization brought relief to Kim, shock and depression to Mark. Looking back, Mark said the family had grown used to the gradual escalation of Lance's bad behavior and it took the grave concern of outside experts to make them realize how truly bad things had become. "The threshold of what you put up with changes," Mark said.
Lance stayed at the Devereaux facility for a month until repeated appeals on the part of Kim to NYL Care and contractor Magellan Health ran their course. At first, Lance was only going to be allowed to stay a week. They appealed and the vice president for medical services reversed the decision "after my wife mentioned to their customer service that our story would soon go public," Mark said.
But when Lance's doctor said the young teen was no longer a threat, Kim stopped fighting the insurance companies. Lance was sent home, which was another disaster because after just three days he wouldn't take his medication. Although he first appeared resigned to returning to treatment, Lance got in a wrestling match with his father after refusing to take off his steel-toed boots for the trip. Police were called and three officers helped contain the young boy.
Emily Akins of Channel 2-KPRC came to the rescue, pulled several strings and got Lance placed in another local facility, Upward Reach, where he is today. A doctor who saw the TV news report on the Lindquists called and offered free help. Lance's parents don't see him getting better there, but it is a safe haven until he can get to a facility that can better help him.
The Lindquists are running out of time, though, because the original offer was for six to eight weeks and he's been there two months.
Kim and Mark have found what they hope is a suitable place in Colorado, but it costs $3,400 for initial therapy for the whole family and then $3,200 monthly after that. They've been told their son probably needs to stay there for two years because his problems are so severe. They don't know how they're going to raise enough money to get him there.
What they do know, Kim said, is that, at present anyway: "Lance cannot come back home."Lance has been diagnosed with severe depression, oppositional defiant disorder and conduct disorder, in addition to the Reactive Attachment Disorder. A person with RAD fights authority, has problems controlling his temper, steals, hoards food, lies and can be destructive to himself and others. People with this syndrome tend to be manipulative and superficially charming.
Reasons for this condition aren't completely understood, but experts believe it is triggered anytime from before birth up to two years of age and is caused by either poor prenatal care or abuse, neglect or unrelieved chronic pain as a very young child.
In Lance's case, he exhibits most of the symptoms of the disorder. Kim said he's never hurt animals as many children with this condition do. He doesn't start fires, but he is obsessed by them, she said.
At Kim's request, psychologist Mark Wernick saw Lance during his stay at Upward Reach.
"The boy was transported here by a large beefy attendant," Wernick recalled. "The attendant wanted to know if I wanted him to come in the room with Lance. I said, no, and reached out my hand to shake hands. His hands were behind his head. He just glared at me."
Wanting to get some sort of reaction from Lance, Wernick waved his hands in front of Lance's eyes. Lance jumped up, went into the inner office with him and told the doctor, "I wanted to punch you in the face out there." Asked why, Lance replied "Well, you startled me. I just wanted you to know I wanted to punch you.' As Wernick recalls: "It kind of went downhill from there."
Because Lance refuses to sign a contract for treatment, Wernick has not seen him since, but he has met with the boy's parents to help them learn how to better deal with Lance.
Lance can be helped, the Lindquists and Wernick believe, if he is placed in an intensive residential treatment specifically designed to handle this attachment disorder. Kim Lindquist searched all of Texas for such a place and there isn't one.
All the places contacted told her they don't want to accept a child with his kind of severe problems. He could end up in Waco State School, but there is a six-month waiting list and it isn't set up to handle the Lances of the world, the Lindquists and Wernick believe.
Children who have Reactive Attachment Disorder have come up with survival skills to handle a world that doesn't meet their basic needs, Wernick explained. For instance, Wernick said, if a young baby cries and cries but no one comes to pick him up, eventually the baby shuts down. People who have gone to orphanages in Romania have told him about seeing 300 completely silent babies. "Three care givers and 300 babies. Do the math," Wernick said. "The kids develop very high pain thresholds. They fall, break a bone and never whimper. The brain kind of goes on auto pilot. There's a certain kind of state they get into that nothing feels better than when they self soothe.
"But it's not healthy," Wernick said. In a lot of cases if these children are adopted they reject normal familial affection and keep people at arm's length.Texas is ranked 43rd in the nation in public support for mental health services, said Betsy Schwartz, executive director of the Mental Health Association of Greater Houston, a private advocacy group for mental illness.
In Harris County, the Mental Health Mental Retardation Association of Houston receives $10 million a year to provide services for severely mentally disturbed children and stretches it as far as it can go, she said. According to a 1997 report from the Mental Health Needs Council, Inc., a consortium of agencies involved with mental health care, about 18,000 local children qualify for mental health services. The $10 million only covers 5,000 children, Schwartz said.
Even if you have insurance coverage, things don't get much better. Historically, insurance policies have discriminated in terms of mental illness coverage, Schwartz said. The same company that would offer a lifetime maximum of $2 million for physical health care coverage, would set a $200,000 maximum for mental health needs. In 1998, Congress passed a bill designed to put an end to these differences, but loopholes allow insurance companies that don't offer mental health coverage and companies with fewer than 50 employees to declare themselves exempt from the law.
Of the $10 million sent to Harris County's children, $250,000 is set aside for residential care. Estimating that it costs on average $60,000 annually to provide residential care for a juvenile, Schwartz said this would mean Harris County could help no more than four or five kids a year who needed this kind of intensive care. The solution? MHMRA has said it is only going to pay for a child for 90 days max.
The state Legislature passed the Children's Health Insurance Program this last session, which does expand children's mental health services, but it doesn't include residential care, Schwartz said.
If a child is turned over to CPS, though, the state has said CPS has to pay for mental health treatment, including residential stays, she said.
Mark and Kim Lindquist are middle class. They aren't poor enough to qualify for help for Lance. They aren't rich enough to pay for his treatment themselves. They don't want to give Lance up to the state. They and Lance remain in limbo. "I don't want to add to the stigma of mental illness," Betsy Schwartz said carefully. The fact is, she stressed, most kids with mental illness don't have these severe problems. "If anything, they are more likely to hurt themselves. Suicide is the second highest cause of death among adolescents."
One the other hand, those kids with severe mental illness problems need society's attention not only for themselves, but for others.
"On one hand we are horrified that Littleton could happen," Schwartz said. "But we have families right now saying my kids are sick enough, they could do this."
A person with Reactive Attachment Disorder is filled with "tremendous rage," Wernick said. "If you grow up in an abusive environment you don't show that. But most of these children will generally trigger the rage under the right frustration."
In intensive treatment, children can learn to handle the rage, the past issues of feeling abandoned, Wernick said.
Young Lance sees shadows and knows there are demons lurking there, his mother said. He hears his name being whispered and thinks Satan is calling him, she said.
"He has said he will kill us and 'wants to kill the world' and 'will end my life,'" Mark said.
"There is no cure for this. There is a 30 to 40 percent chance of survival," Kim said. "Most of them die young or are incarcerated." If they can live to their mid-thirties, their survival chances improve tremendously.
Lance is a 13-year-old boy who knows something is wrong with him. He used to ask to come home. Now he doesn't. "I think part of him wants to be locked up. I think he's scared," Kim said.
Lance is not a horror. But he could become one. We as a society could pay for his treatment now, or his greater sadness later. You pick it.
For information about donations to pay for residential treatment for Lance, e-mail Kim and Mark Lindquist at firstname.lastname@example.org.
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