Local experts are stitching together a safety net of services for people with mental illness, but for whatever reason, Zachary Cole Weston apparently fell through one of the gaps that still remain.
As his mental illness intensified, Weston grew more violent, assaulting relatives and health staff as he bounced between jail and local psychiatric facilities, according to his family and public records. On Oct. 3, less than a day after being bailed out of jail, Weston allegedly fatally stabbed his 84-year-old grandmother, Joyce Dexter, at her Avenues home.
Walter Weston Jr., his 23-year-old brother, said Friday that he had suggested in the past to their mother that she leave Weston, 21, in jail so he would get help. But, "he just keep getting let out," he said.
In the aftermath of Dexter's death, Weston's father, Walter Weston Sr., blamed the mental-health system for his son "not getting no damn help" with long-term inpatient care.
Weston's uncle, Charles Kulander, expressed frustration with the lack of options for family members who know a relative is "so mentally ill he's a threat."
Health experts say only a small percentage of people with mental illness become violent. But that still leaves this question: Are there adequate services for someone like Weston?
"There is a system in place, and a lot of individuals get very good care, but there are individuals who are not receiving the care that they need," acknowledged Rebecca Glather, executive director of the National Alliance for Mental Illness, Utah (NAMI).
As of this year, Salt Lake County has strengthened links between mental-health providers, police and the judicial system in hopes of getting people like Weston the help they need.
Interventions • In mid-July, University Neuropsychiatric Institute (UNI) opened a home-like receiving center where police and others can bring individuals in the throes of a mental-health crisis for immediate help, rather than taking them to jail and local emergency rooms. Since it opened, approximately 300 people have been seen at the center, which is funded by the county and OptumHealth Behaviorial Solutions.
The hope is, within less than 24 hours, to get the person help whether that is medication, housing or outpatient therapy until the crisis passes. A team can also determine whether individuals need more intensive, inpatient treatment, said Mary Tallboys, a licensed social worker and service director at UNI.
Under Utah law, a physician, police officer or certified mental-health professional can petition to have a person considered a "substantial danger," rather than an immediate danger to themselves or others, receive outpatient or inpatient mental health treatment. That less stringent standard was adopted after Susan Gall was killed by her mentally ill son in 2001. The Salt Lake City woman had called police several times in the months before her death to get her 25-year-old son, who was bipolar and not taking medication, committed to a hospital for treatment.
Short of that, "You can have someone who is ill, psychotic but not threatening, but having problems on multiple fronts" and be unable to do anything about it, said Jackie Rendo, a family and consumer mentor with NAMI and a criminal mental-health court advocate.
Also in 2001, the Salt Lake City Police Department launched a crisis intervention program that trains officers to respond to calls that involve someone experiencing a mental-health crisis. More than 60 law enforcement agencies in the state now have members trained in crisis intervention.
In 2010, Salt Lake police responded to more than 1,200 calls for service in which mental-health issues were a primary or associated problem, said Detective Ron Bruno.
"We can take them into protective custody and take them to a designated mental-health facility," he said either an emergency room or the new receiving center, depending on the situation.
Salt Lake County also has set up a mobile crisis-outreach team, which Tim Whalen describes as the "paramedics of the mental-health system." The team can respond within 30 minutes, at any time, anywhere in the valley when notified of a mental-health crisis. The team includes a mental-health professional and certified peer specialist and, if needed, law enforcement.
It began operating in March and "has been called out a lot," said Whalen, behavioral health director for Salt Lake County.
In fact, the mobile crisis-outreach team, based at UNI, has been called out about 600 times, Tallboys said.
The peer specialist someone who has experienced and recovered from mental illness is key, Whalen added. "It really has been shown to work and is being adopted all over the country as a method we should use with our clients."
The county will add another resource on Oct. 15, when it expects to open a 16-bed Wellness Recovery Center designed for individuals who need two or three days' care while being stabilized after a crisis.
The county also is working more closely with the courts and Salt Lake County Jail to ensure that mentally ill individuals are not just released into the community without a support network in place, Whalen said. The jail now releases offenders with mental illness at a set time that is coordinated with a voluntary shuttle ride to a Valley Mental Health unit, where help getting medication and setting up support services is available.
"The biggest [factor] in making sure they don't go back to jail is connecting them to services in the community," Whalen said. A Jail Diversion Outreach Team also tracks clients who are back in the community in an attempt to ensure mental-health issues don't resurface to the extent that an individual reoffends.
The challenges • But there is a catch to all this: It costs money. Accessing services is easier if a person has private insurance or qualifies for Medicaid.
"The biggest population we are challenged with is treating folks who are not qualified for Medicaid," Whalen said.
The county has a $48 million budget to provide mental-health services for Medicaid-eligible clients but just $3 million for those who don't qualify for the federally-funded program.
Expanding access to Medicaid is "an amazing opportunity to increase access to services for the very folks we're talking about," Whalen said.
When there is a gap in service or a person doesn't have treatment options, they are more likely to end up in costly, less-effective settings such as jails and emergency rooms, Glather added.
"Over and over, we see people fall out of treatment because they don't have a way to pay for it," she said.
That can be a frustration for families who have an adult relative with a mental illness who they know needs help, she said.
"Families have a limited number of options available, especially when cost is an issue," Glather said. And relatives who often are in the best position to fill in service providers about past history and propensity for violence, medications, etc. are sometimes excluded from participating in the treatment process because of health-privacy laws.
"It seems to be more strictly and stringently applied when mental health is in question," said Rendo.
She experienced that hurdle when a family member was in a psychiatric unit in another state. The relative called family to let them know what was going on but inadvertently failed to give them a unit or room number; when family later tried to check with the relative, the facility refused to confirm or connect them.
It's unclear why Weston didn't get long-term inpatient care. LDS Hospital had asked that he be removed from its care because of his "dangerous" behavior. Weston had assaulted staff at UNI, too, while trying to check himself in for treatment.
"Clearly, we try to protect the patient and we try to protect the staff," said Tallboys, who was not speaking directly about Weston's case.
Both his father and brother said Weston's behavior grew violent and more suicidal after recently getting new medications the type of adverse reactions that make taking anti-psychotic drugs a challenge for many people with mental illness.
"Right now, a lot of treatment is focused on medications, and the side-effects of these medications are so horrendous that people don't want to take them," Rendo said. "We need more therapies that don't rely so heavily on medications."
If you or a family member are experiencing a mental health crisis, call Salt Lake County's crisis line at 801-587-3000.
The National Alliance for Mental Illness, Utah, offers a 12-week educational class for individuals with mental illness and their family members. For information, call 801-323-9900.
Utah law also allows a designated examiner, such as a physician, to petition a court to have a person who is a "substantial danger" to themselves or others committed for outpatient or inpatient treatment. You can read the law here: http://1.usa.gov/R6sSQE.
Utah also allows an individual with mental illness to file a Psychiatric Advance Directive, a legal agreement authorizing treatment if he or she is unable to do so. You can find that form here: http://1.usa.gov/OKEHAb.