Trying to rescue David from the system.
After five hours, they called me into a tiny scuff-marked conference room. The scowling judge sat behind an ancient computer at the head of the table. I sat across from my brother, who squirmed in arm constraints. Next to me: a lawyer responsible for having David hospitalized. Next to David: a lawyer responsible for his release.
His sour-faced attorney opened with a series of openly incredulous questions: Was my brother dangerous? Did he attack me? Why would I feel unsafe around him? I tried to point to David's 17-year history of institutionalization, but only events in the previous 30 days could be entered as evidence. All I could tell them was what I'd seen on the 12th, from his noontime phone call to our midnight van ride. I walked out, troubled, hoping it was enough.
After a brief, queasy wait, it was ruled that David was indeed "a danger to himself or others"--despite not having done anything to merit a Daily News cover. Now he'd be taken to the Belmont psychiatric hospital off of City Line Avenue, and my family would have three solid weeks to facilitate his transfer. His fumbling New Jersey keepers were freely admitting their mistake, and were still liable for his actions. To return him to New Jersey would be in the best interests of everyone involved.
Despite the antipsychotic administered at Belmont, his delusions persisted. He called two, three times a day, saying that he was a record producer and an Obama confidant; once out, he'd sell his paintings on South Street for $10,000 apiece, easy. His stay was soon extended to the 90-day maximum, as medication, therapy and regular sleep had little effect.
Meanwhile, my mother and I worked the phones, between us making dozens of calls to Essex County doctors, New Jersey lawyers and Belmont administrators. But we were repeatedly told that Pennsylvania's mental healthcare laws are independent from New Jersey's--and with no overarching federal law providing for "the interstate transfer of an uncooperative patient," we had hit an impassable wall. Legally, there was no way to move him. A transfer could only occur if my brother approved it.
Under Pennsylvania law, "patients' rights" empower psychiatric patients to make key decisions in their care. Due to this well-meaning concept, David now held the authority to determine what was best.
And he was more than willing to share what, exactly, "best" would be: He'd remain in Philadelphia, happily homeless, and pursue abstract painting, Democratic politics and European espionage. Constrained by his rights, we could do nothing but let the 90 days expire--then wait for him to resurface and do it all over again.
The cycle of 911 calls, 302 filings and commitment hearings could carry on indefinitely. My family and I were pinned at the juncture of legal omission and bureaucratic indifference.
Compounding the problem, his out-of-state Medicare was worthless here, and Belmont, forced to foot the bill, wanted him out as soon as possible. To lessen our apprehension, his psychiatrist implied that all David needed was the correct medication cocktail. Then my brother would leave the hospital a new man--no Jimmy Stewart, perhaps, but regular enough.
Beneath this assurance, though, lay a sinister truth: Once the heavy, dulling drugs knocked David down to an acceptable "baseline," he'd be off their books and free to roam. During one meeting, I told the doctor, "He's had these drugs before. All you're doing is creating a homeless person."
His response was unconvincing. "No, no," he said. "Once he's properly medicated, you'll see some real improvement. I'm sure of it."
In early November, the hospital called to say that David would be released, weeks before the 90 days were to expire. They planned to give my brother two parting gifts: a SEPTA token and directions to a homeless shelter. It seemed impossible for this to be the official procedure of a state-sanctioned institution. All his caseworkers could say, like that deskbound South Street cop, was that their hands were tied.
My family and I rushed to devise a plan that would prevent David's homelessness. Upon his release, I'd pick him up and drive us to our parents' house in New Jersey, where we'd all have a chance to "talk things over."
David was immediately suspicious: "You're not going to call the police right when we get there, are you?" he asked when I broached the idea. "Because I really can't go back to Essex County. Things are happening for me here." Needing his cooperation, I told him what he wanted to hear--and after a few moments of consideration, he agreed to come along.
On the afternoon of Nov. 11, I picked David up from the hospital. He wore a second-hand ball cap, a Goodwill shirt and a goofy, embarrassed smile. He hadn't been medicated, yet his speech was less rapid, his gestures less pronounced.
Over the next two hours, as I drove out of Pennsylvania and into New Jersey, he still spoke of spies and conspiracy--but was calm enough now to also discuss music, books and our parents. In those ordinary moments, he became the David I adored as a child: sharp, opinionated and eager to impress his little brother. His mind had inexplicably managed to regain order.
PW's Summer Guide 2014