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Involuntary hold laws try to prevent people from hurting themselves. What happens when they don’t work?

Published: 8/13/2022 10:53:25 PM
Modified: 8/13/2022 10:50:04 PM

After a knife-wielding man forced his way into a Northfield, Vt., home last month, the homeowner managed to subdue him, protecting himself and his family.

But while Labor Commissioner Michael Harrington was able to prevent serious physical injuries — or worse — in his own home, the attacker did not share the same fate.

David Young, who lived in the second unit of a duplex shared with Harrington, was released from a Vermont hospital about 12 hours after the attack, police said. Young returned to his home and killed himself.

In the weeks since Young’s suicide, questions remain about the events leading up to his death — including whether and how the process broke down prior to his hospital discharge.

According to Vermont law, if a person is in the midst of an acute mental health crisis, medical professionals can hold the patient for 72 hours for examination before filing paperwork to have them involuntarily committed. Police, judges and clinicians all can have a voice in deciding whether to prevent a person from returning home.

Holding a person unnecessarily strips them of everyday freedoms, but releasing a person in crisis can result in self-harm.

Arriving on the scene after 9 p.m. on July 26, Northfield police officer Logan Potskowski handcuffed the 32-year-old Young, who was eventually transported to Central Vermont Medical Center in Berlin. He was cited on charges of aggravated assault and burglary.

Police Chief John Helfant told VTDigger that officers were concerned for Young’s well-being. Young showed signs of alcohol impairment, as well as a potential acute mental health crisis, Helfant said.

At the hospital that evening, Young was sedated while waiting to be evaluated by a Washington County Mental Health Services screener, who, working alongside other medical professionals, could recommend involuntarily holding Young at the hospital, Helfant said.

Washington County Superior Court Judge Scot Kline issued conditions of release after midnight on July 27 that allowed Young to return home but prevented him from having contact with his next-door neighbors; Kline did not impose cash bail. Young was due in court later that day.

Around 7 a.m., Northfield police returned to the hospital to talk to Young and make sure he understood his court paperwork. Mental health workers had not yet screened Young at that time, Helfant said.

John Caceres, a spokesperson for Washington County Mental Health Services, would not confirm whether one of the organization’s staff screened Young, citing medical privacy law. He declined to comment on Young’s case.

Helfant said Young would not be released until a screening took place.

Later that morning, after Young returned home from the hospital, he died of a self-inflicted gunshot wound, according to the medical examiner’s report.

In a statement following his neighbor’s death, Harrington, the labor commissioner, highlighted the need for mental health care, especially for military veterans like Young.

“The individual who showed up at our door Tuesday night was not the man we knew before that evening,” Harrington said. “Any other day of the week, he was a kind and gentle soul, and only now, after all of this, have we learned that he was a combat veteran experiencing a mental health crisis.”

According to a police affidavit written by Potskowski in support of the assault and burglary charges, Harrington had “no idea” what caused Young’s attack, and the two had a “friendly relationship” before the incident. Young had not had any contact with Vermont law enforcement agencies prior to his arrest, Northfield police said.

In his statement, Harrington said he wanted to “emphasize the importance of readily available mental health services for those in need, especially our nation’s veterans.”

Mental health services were available to Young — but his case demonstrates that unless a person voluntarily chooses to seek help, or fits the requirements for involuntary care, the mere availability of services is not always enough to keep them safe.

Indeed, Young became yet another tragedy in Vermont’s high rate of suicide deaths — a figure that makes Vermont an outlier among its northeastern neighbors. Data from the U.S. Centers for Desease Control and Prevention indicates Vermont had the 17th-highest rate of suicide in 2020 — the most recent year of available statistics.

Defining danger

Some observers believe that Vermont law does not go far enough in specifying when a person can be involuntarily held at a hospital, while others contend that the state’s ability to strip people of their freedoms should be limited.

Helfant, the Northfield police chief, suggested the Legislature should clarify when a person with a mental illness can be involuntarily committed for psychiatric treatment. Current statute permits commitment when a person poses a harm to themselves or others, which he called “vague.”

“The Legislature needs to go in there and literally define what a danger to themselves or others is. And I guess I’ll leave that to them,” Helfant said. He offered a few suggestions, such as cases where a person takes “more than two or three times their prescribed limit of medication,” overdoses on illegal drugs, or is deemed suicidal or homicidal.

Vermont statute provides some explanation for the harm clause: The definition includes a person who has harmed someone, threatened to harm someone, or appears by actions or inaction to pose a risk of harm to someone in their care. Threatening or attempting serious bodily harm to oneself, or displaying behavior that indicates one could not nourish, shelter or protect oneself without risk of serious mental or physical injury, also qualifies a person for involuntary commitment.

Asked about Young’s death, Helfant said the police did all they could.

“From our standpoint, I don’t think there’s anything else we could have done,” Helfant said. “We were going to have him screened by mental health (services), because they are the professionals more than we are.”

Mary Moulton, executive director of Washington County Mental Health Services, said privacy laws prevent her from sharing information about “specific care or treatment rendered to an individual.”

Generally speaking, she said, a person can be held involuntarily only after a rigorous process.

“A person can only be placed on involuntary hold under strict, limited circumstances, and under criteria that must be clearly evident to both the mental health professional and independent medical personnel,” she said.

Alongside a psychiatrist, those providers decide whether a patient requires further care, at which point they initiate an emergency exam, temporarily holding the patient at the hospital.

For some advocates of psychiatric patients’ rights, Vermont statute already allows plenty of leeway for authorities — police, doctors, judges — to involuntarily hold people experiencing a mental health crisis.

They include Rep. Anne Donahue, R-Northfield, who has herself struggled with depression and has long spoken out to protect the rights of people struggling with mental health. After reading Helfant’s quotes about the involuntary hold statute in the Vermont Daily Chronicle, she decided she needed to explain the rules around involuntarily holding patients.

If a mental health professional, a psychiatrist and emergency room physicians all agree that a patient is an immediate and imminent threat to themselves or others, and the patient refuses care, current law allows medical professionals 72 hours after a psychiatrist has seen a patient to hold and evaluate that patient before filing judicial paperwork advocating for involuntary commitment.

That process, known as an emergency examination, gives providers ample flexibility to decide how best to serve the person in their care, Donahue said. And she noted it can take a while for a judge to rule on the matter once such petitioning paperwork is filed. During that interim period, the person is held nonetheless.

“In fact, in the vast majority of cases where a person is initially held involuntarily, the person is actually never committed, because that (judicial process) takes weeks,” she said.

The system is not fail-proof at preventing tragedies. Physicians struggle to predict future behavior, Donahue said, and patients can convince a screener that they don’t pose a risk. She noted that balancing a person’s safety with stripping them of their rights is a weighty equation.

“It’s never going to be a perfect system,” she said.

Young’s mother, who lives out of state, said she did not wish to talk about her son’s death.

Triggering an investigation

In a case like Young’s, in which a person in a mental health crisis died after recently being discharged from a hospital, the state has the opportunity to investigate. Housed inside the Department of Disabilities, Aging, and Independent Living, the survey and certification branch of the Division of Licensing and Protections ensures hospitals follow statutory guidelines.

Suzanne Leavitt, a registered nurse, directs survey and certification, helping to oversee the state’s investigations. Facilities that accept Medicare and Medicaid have to follow certain regulations, she explained, such as laws around discharging patients and the Emergency Medical Treatment and Labor Act. Patients, their families and anonymous tipsters help alert the state to potential violations of federal policies, which may then trigger an investigation.

Leavitt said she could not speak specifically about tips or investigations. But asked if the licensing division was aware of Young’s death, she responded that “if an article makes it in the Digger, and it would allege a health and safety violation of a certified entity, 10 times out of nine we’re going to be aware of it.”

In 2016, the division found that ASSIST, a six-bed crisis stabilization facility run by the Howard Center, had violated state regulations when it allowed a patient to leave the building without supervision. That patient, Burlington artist Darshana Bolt, died by suicide after walking out of the facility.

While Leavitt and her team can investigate allegations of rules violations, she stressed that following procedure alone cannot guarantee safe and satisfied patients. Survey and certification is not in the business of policing negative medical experiences, she said.

“Sometimes that’s not very satisfactory to the complainant, because they might have had an unpleasant experience. But maybe that’s not necessarily against the regulations,” Leavitt said. “The regulations don’t cover everything.”




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