Six weeks after she began taking Haldol, Christine Molnar saw a pie slice of sky break loose and crash to the ground.
Suddenly, the cement-and-rebar sky she had been living under was gone, replaced by fresh blue and the desert sun. It was her last hallucination.
Four years later, Molnar, 48, says being forced to take anti-psychotic medication gave her back her life. In April 2007, Tucson police took Molnar on her latest trip to Kino hospital, and she was forced into treatment. This time, after 11 years with schizophrenia, it worked.
"Now I don't have any of those symptoms," Molnar said. "It works for me. I'm lucky."
That's the way Arizona's system for involuntary mental-health evaluations and treatment is supposed to work. Any "responsible individual" can ask for another person to be involuntarily evaluated if that person appears to be a danger to self or others, is gravely disabled or is persistently or acutely disabled.
Social workers, county attorneys, psychiatrists and judges all play a role in deciding whether a person needs to be evaluated or treated against his or her will.
But any system that takes away people's freedom comes with risks of abuse. And Tucsonan Christopher Brown says he had the flipside of Molnar's experience with involuntary treatment.
On Dec. 18, Tucson police officers took him to Kino, saying he was a danger to himself because he was paranoid, delusional and had a gun. The only problem was, he didn't have one, say Brown and his brother Marc, who searched the house with police that day.
Chris Brown spent 13 days in the hospital, over the Christmas holiday, before he was released on New Year's Eve day. He says he never saw a judge even though he was being treated there against his will.
"That's two weeks out of my life I'm never going to get back," said Brown, 63. "Even if I was nuts, what they did to me is not right."
The process
Brown was agitated and asked police for help, and they called two social workers from the Southern Arizona Mental Health Corp.'s Mobile Acute Crisis teams. The social workers showed up at Brown's apartment near Reid Park and deemed his situation an emergency, then filled out forms that facilitated his immediate hospitalization.
In most cases, though, these streetwise social workers respond to formal but less urgent requests that a person be checked on to see if he or she needs a mental-health evaluation.
"We'll go anywhere in Pima County," said Mary Hayward, who oversees the unit dealing with involuntary evaluations and treatment. "We'll go to the jail, go to a tunnel, find them in washes."
When talking to people, they try to avoid having them brought in involuntarily, she said.
"We exhaust all possible alternatives before doing this," she said. "Voluntary treatment always works better than involuntary treatment."
But if the social workers view the person as needing an evaluation and the person won't agree, they forward the request to the corporation's medical director, who may forward it to the County Attorney's Office. That office then takes a petition to a judge. Only after a judge orders the involuntary evaluation do police go out to take the person to the hospital.
None of this happened for Brown, though, because the police and social workers viewed his case as an emergency.
"Scared the hell out of me"
Brown had grown increasingly anxious, he said, because he was having trouble with his computer. Brown, a former props coordinator for theater companies and a children's-book author, had been working on a novel. Despite long efforts, he could no longer bring it up on his computer.
"I was frantic because it was 900 pages worth of stuff, five years' work," Brown said.
What made police suspicious is that he called 911 twice that week, once on the morning of the 18th, complaining that his computer was being hacked and telling other stories that to them seemed delusional.
The turning point came after his 911 call that Saturday morning. He took a walk toward the park, saw a police cruiser and waved it down. Brown said two men whom he knew were outside his house in a pickup truck with a laptop, and that they were responsible for the hacking.
When officers arrived a few minutes later, nobody was there. Police reports say Brown manically pushed buttons on his phone and computer and claimed when they didn't work that hacking was happening. The reports also say he had a gun.
Brown's brother, Marc, said he agreed to go through the apartment with an officer. They found ammunition, Marc said, but not a gun. Chris Brown said he had pawned an old revolver a year before, and produced a receipt as evidence.
"You're essentially taken to jail on the word of social workers," Marc Brown said. "How they have the right to commit somebody scared the hell out of me."
Flaws in the system
A number of checks exist in Arizona's system to keep people from being unnecessarily hospitalized. If a person is not in a mental-health emergency, county attorneys must file a petition for court-ordered evaluation, and a judge must sign off on the petition. Attorneys filed 1,756 such petitions in Pima County last year and are on pace to exceed 2,000 this year.
Once a patient is in the hospital, two psychiatrists must conduct evaluations within 72 hours. If they both agree the person needs to be treated, and if the patient doesn't agree, they ask for a judge to order treatment. Last year, 948 of these petitions were filed in Pima County, but they're on pace to be fewer this year.
The patient can have an attorney at the court hearing, which must take place within six work days after the petition for involuntary treatment is filed.
Brown said his attorney showed up a couple of days before he was released but left when told Brown was going to be let out. A person's stay in the hospital can drag out when it occurs over holidays or weekends because the deadlines don't apply to those days, said Paula Perrera, who heads the health-law unit at the Pima County Attorney's Office.
In most places, abuse of the involuntary-treatment system is not a big problem, said Brian Stettin, policy director at the Virginia-based Treatment Advocacy Center. A much bigger problem, he said, is people who need mental-health treatment but don't have a hospital bed available.
A 2010 study by the center found that Arizona was in 49th place in terms of its ratio of mentally ill people in jails and prisons to those in hospitals. Using 2004-2005 data, the study found that there were nine mentally ill people in Arizona jails or prisons for every one in a hospital. Only Nevada had a worse ratio, 10 to 1.
A success story
Christine Molnar's ratio is about the opposite - she was jailed once but hospitalized "a bunch of times," she said.
Once she walked from Tucson to Nogales, Sonora, in order to pray for a home, she said, symbolically leaving a shoe in each country.
Molnar's last police encounter came after she became angry at the agency that was handling her money for her.
"I was saying they were part of the Antichrist, and ranting and raving and quoting the Bible," said Molnar, who is married with a son.
When the police came that night to take her to the hospital, an officer said something about going to see Satan, Molnar said. In her state, she thought it was true and grew terrified.
Once at the hospital, Molnar told the staff she was allergic to Haldol, a conclusion she'd come to because she had monstrous hallucinations while taking it before. But the truth was, the newer anti-psychotic she had been taking didn't stop her delusions. The doctors decided to give Haldol another chance.
"They gave me the shot against my will," she said. "Three or four people came in and held me down. They didn't need to hold me down, but they did."
This time she stayed on it, now taking a pill daily and a shot monthly. To her surprise, it's worked.
"They weren't trying to hurt me," she said. "They were trying to help me."
Â
Contact reporter Tim Steller at 807-8427 or at tsteller@azstarnet.com
