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The Plain Dealer

January 20, 2002

Reprinted with permission. Copyright 2002 by the author and The Plain Dealer. All rights reserved.

COLUMN
Victims of laws that were made to save them

by Beth Barber

"The system is not only overburdened by sheer numbers of clients; it is also burdened by its insistence that people whose mental capacity is impaired weigh their options and make informed choices. By that reasoning, freezing on the street, stopping medication that enables the ill to function and depending instead on public largess are decisions society must accept. Even if those decisions kill them. Or someone else."

Outraged as many people were by the death of Margaret Bolling, hers was not a simple case of neglect by officialdom.

Hers was one of many cases complicated by the law and the difficulties often inherent in offering assistance.

Margaret died at age 55 in a house fire probably started by the candles she was using for light. She had lost her job, her house had been sold in foreclosure and her utilities had been cut off.

That is, by law, essentially all the public is entitled to know about this woman.

So journalists call neighbors, relatives, whomever to find out more about Margaret. And they call attorneys to find out more about society's laws on helping Margarets.

The answers I've gotten so far may or may not be definitive, particularly about that Silly Putty code called the law: It takes the shape of the person or agency pressed to interpret it. But spurring discussion is my purpose here - discussion of what the law is and what shape it should take when its current form hurts those it was passed to protect.

From neighbors, we learn that Margaret had been to the Center for Families and Children for treatment of mental illness. But she had recently refused any more mental-health services.

From Commissioner Tim McCormack, we learn that she had applied to the state for disability payments because of her mental illness. From the county coroner, we learn that Margaret had cirrhosis of the liver, though Dr. Elizabeth K. Balraj carefully, rightly noted that she doesn't have the "clinical information" to say whether alcoholism was involved.

Many people are both substance abusers and mentally ill, and their disability may be traced more to one than the other.

Currently in this county, the treatment of substance abusers falls more to the Board of Alcohol and Drug Addiction; of the mentally ill, to the Mental Health Board. Both say they cannot confirm that Margaret was a client.

The Center for Families and Children put it this way in a statement released Tuesday:

"Individuals who seek treatment from mental health providers, such as CFC, have rights protecting the confidentiality of their consultations. Ohio law prohibits mental health providers from discussing or releasing information about a patient's treatment, or even identifying an individual as a patient.

"While public interest in stories relating to individuals who have received treatment is understandable, that public interest does not outweigh the protection afforded to mental-health patients under Ohio law."

Maybe so, maybe no. Few rights are so absolute that the public interest never counts. But to the professional mental health community, absolute confidentiality is unquestionable writ.

To laypeople, it's debatable.

Confidentiality rules intended to protect the mentally ill from being "stigmatized" by the label could not keep Margaret's illness a secret from her neighbors. Some, according to McCormack, gave her rides to treatment sessions.

Nor did "confidentiality" protect Margaret from what may well have been the ultimate result of her illness: her inability to protect herself from circumstances that contributed to her death.

And "confidentiality" laws, according to the mental-health community, kept the county's $90 million-plus apparatus for assisting the mentally ill from doing more than it did.

So strict is this interpretation of the law that a year or so ago attorneys told the Mental Health Board not to mail letters to some 900 clients of an agency that abruptly closed its doors to let them know where else to go for services. Some average Joe might deduce that the recipient is mentally ill.

Worse things could happen - such as the world watching a severely mentally ill client slide into dysfunction even though help was available.

If there's a better way to sustain the stigma of mental illness - and exacerbate any doubt about the effectiveness of treatment and the law - may officialdom never stumble upon it.

Margaret could have gotten help with the foreclosure proceedings, other housing, the utility shutoff, even a smoke detector, had she known whom to call and had she been capable of doing so - or had somebody else called on her behalf.

Whether neighbors called a mental-health agency on her behalf is in dispute. But indisputably, some had no idea whom to contact.

And some undoubtedly did not know, or did not want to decide, at what point their intervention would cross that line between busybody and lifesaver.

The person presumably most aware of Margaret's dire circumstances would have been her caseworker. But she had told her caseworker to scram, which the law allows absent a court finding that she was an immediate danger to herself or to others, could not care for herself, or would benefit from treatment.

Apparently, there was no such finding in Margaret's case. That might surprise laypeople. It won't surprise mental-health professionals.

The system is not only overburdened by sheer numbers of clients; it is also burdened by its insistence that people whose mental capacity is impaired weigh their options and make informed choices. By that reasoning, freezing on the street, stopping medication that enables the ill to function and depending instead on public largess are decisions society must accept. Even if those decisions kill them. Or someone else.

From this insistence comes the profession's reluctance to "commit" clients to institutions or to mandated outpatient care, except in the most extreme situations and then only for the briefest periods - a reluctance the professionals and the courts in this county have only recently begun to reconsider.

Under law, I'm told by a mental-health professional, an agency that kept sending a caseworker to offer Margaret services she kept rebuffing would not be paid for those unproductive visits. Nor could the caseworker breach her privacy by calling an agency that could get her electricity turned back on.

So Margaret Bolling lost her mental-health services, her job, her house, her utilities, her beloved dog and ultimately her life.

And it really was nobody's "fault."

It was simply the operation of law.

If that's not reason enough to question the law and its prevailing interpretation, what is?

Contact Beth Barber at [email protected], 216 999 4245.

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