After Chelsea Thornton, a woman with a history of mental instability, shot her 3-year-old son in the head and drowned her 4-year-old daughter in a bathtub Wednesday, the local mental health community was left searching for answers as to whether, and how, such a tragedy could have been prevented.
"I place the blame on our mental health system for this tragedy to happen," said Cecile Tebo, a crisis-intervention specialist and the former commander of the New Orleans Police Department's Crisis Unit.
Thornton, 23, who suffered from schizophrenia and bipolar disorder, had recently stopped taking her medication, according to her mother, Eleanor Chapman. Thornton's best friend, Oblique Weavers, said Thornton had been hospitalized, and at times shackled to a bed, for a month at Southeast Louisiana Hospital in Mandeville about a year ago after having a mental breakdown that caused her to defecate on herself.
"If you go to a psych ward and you're s--ing on yourself, how are you going to let her come back home? Why didn't you keep her?" Weavers said Thursday. "Chelsea reached out for help so many times. The people kept sending her home. Some help could've saved the children."
The fact that a parent is committed to a mental institution does not automatically get child protection services involved, said Trey Williams, a spokesman for the state Department of Children and Family Services. Williams said Saturday that DCFS had never had any involvement with Thornton or her children.
According to Weavers, Thornton had been known to snap, "turning into a different person in a moment." During her episodes of depression, she at times locked herself and her children inside for entire days.
Just days before Wednesday's slayings, Thornton told Weavers she wanted to return to Southeast Louisiana Hospital or another mental institution. "I guess she felt like she was starting to lose it," Weavers said.
At that point, Thornton should have taken herself to a hospital, said Meghan Speakes, spokeswoman for the state Department of Health and Hospitals. Regardless of whether she had insurance or could pay, she would have received treatment, Speakes said. "If she had walked into any hospital and said, 'I want to kill my kids' or 'I want to kill myself,' she absolutely wouldn't have been allowed to leave the hospital," Speakes said.
But even if services are available for those with urgent needs, Thornton's story does raise the question of how she, and others like her, can slip through the cracks in the area's outpatient mental health system once they are released from a mental hospital.
"This is what, for years, people like me, along with others in the profession, have been screaming about," Tebo said. "The consequences of having fragmented, insufficient care for chronic mental illness are deadly."
Since January 2008, when Bernel Johnson, a man with a long history of institutionalization and severe mental illness, killed NOPD officer Nicola Cotton, psychiatric hospitals have developed better plans for people once they are released back into the community, said Calvin Johnson, executive director of the Metropolitan Human Services District.
When people are released from Southeast Louisiana Hospital, for example, they leave with a referral to outpatient care, he said. Additionally, if patients need intensive assistance in the community, they are often referred to one of three "assertive community treatment" teams run by Johnson's organization. Those teams, made up of social workers, psychiatrists and others, can help up to 300 people with mental illness navigate in the outside world.
An "intensive case management team" offers similar services for an additional 175 patients.
"In most instances there are slots available," Johnson said. He said he couldn't address whether Thornton ever sought assistance through a district program because of federal privacy laws. But friends and family members said they were not aware that Thornton was cared for by such a team.
More critically for relatives of people in crisis, the district six months ago started a "crisis response team" that specifically responds when patients fail to take medication or need direct intervention. "If she was not taking medication, that team of people could have done the necessary things to get medication to her," Johnson said.
The same unit also has five "respite beds" available at a facility on Tulane Avenue where people can get inpatient treatment, he said. Assistance is available by calling 504.826.2675.
"We have resources," Johnson said. "But we haven't done a good job in making people knowledgeable about those resources."
Dr. Elmore Rigamer, a psychiatrist with Catholic Charities, agreed that there are better mechanisms in place now to refer patients to outpatient services when they are discharged from mental hospitals. But he said those referrals remain imperfect, as the follow-up appointment often does not come until two or three weeks later.
Some patients need to be aggressively pursued to make sure they continue treatment after hospitalization, Rigamer said. That might not be in place for all patients leaving hospitals, he said.
"You really have to be proactive with really fragile people. You can't just discharge them," he said. "You have to have a case manager that sticks to them like flypaper."
Tebo said in-patient beds in metropolitan New Orleans have decreased by 60 to 70 percent since Hurricane Katrina.
While it is not clear Thornton was ever denied care, that decline in available beds has "raised the bar" as to who is admitted to a hospital, leaving many out, Tebo said. She said that problem will likely be exacerbated when Southeast Hospital closes due to the state's current round of Medicaid cuts.
Speakes, however, said that assertion was "ridiculous" because even though Southeast's building is expected to be vacated by Dec. 31, all of its mental health beds will be transferred to private hospitals, many of?them in New Orleans. The state is still in the process of determining where the beds will go, she said.
In the days leading up to the killings, Thornton's friends and neighbors said, they noticed she was acting strangely. However, no one called any authorities to report her behavior because they never suspected that Thornton, who had no criminal record and no history of violence, would have been capable of committing such acts.
Stella Adams, an aunt of Thornton's children on their paternal side, said she was horrified about two years ago to learn that Thornton was living with her children in a house where there were drugs. Deciding to forgo part of her own income, Adams said, she insisted on moving the family into one of her rental properties without charging them for it.
But even though some family members said they were concerned for the welfare of Thornton's children, it appears no one ever filed a valid complaint of child abuse or neglect with state child protection services.
"We have never had any prior history with this family," said Trey Williams, the DCFS spokesman.
That type of inaction, while common, can be deadly for children, said Dr. Catherine Taylor, a Tulane University public health professor. Especially in cases of child abuse, people outside the family tend to "diffuse responsibility" from themselves, assuming that if the problem is really serious, someone else will step in, Taylor said.
"This tragic event, sadly like many other stories of child abuse, is plagued by a belief in the privacy of the family bubble -- whatever goes on within families is nobody else's business," Taylor said in an email message.
"In fact, when it comes to the health, well-being and, in this case, survival of children, it is everyone's business," Taylor said. "If a parent that is struggling reaches out for help, seems isolated and stressed, or seems to be losing it, family, friends and community need to step in."
Anyone suspecting a mental health patient has been off their medication or is in need of services can call either of two 24-hour crisis hotlines managed by professionals. The statewide number is 211. The Metropolitan Human Services District manages another hotline at 504.568.3130.
Staff writer Laura Maggi contributed to this report.
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Source: http://www.nola.com/crime/index.ssf/2012/10/chelsea_thorntons_slaying_of_c.html
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