Should state law be changed to make it easier to compel treatment for those who are severely mentally ill? To comment on this issue, please use our forum.
First in an occasional series
Brian Lungren had been on a downward spiral since his mid-teens using street drugs, hearing voices, hallucinating and descending ever deeper into mental illness.
Sometimes, he thought he was Mafia don John Gotti or an undercover agent. Often, he was rapper Tupac Shakur, who was gunned down in Las Vegas in 1996. He once confided to his mother that Tupac's ghost told him to commit suicide so he could become God.
Now 27, he has been in and out of drug and psychiatric treatment facilities and jails more than 30 times, beginning in his teenage years. One night when he was a teenager and had become particularly belligerent, his mother bolted shut her bedroom door and slept with a hammer close at hand.
In 2007, Brian stabbed another patient at a drug treatment home in Auburn. A Placer County judge concluded that he was not guilty by reason of insanity and sent him to Napa State Hospital in 2008.
His path to Napa State illustrates the story of mental illness in our time. With the help of 24-hour care and antipsychotic medication, he has become more stable. But he didn't receive prolonged and intensive care until he committed a crime.
Brian's crime was comparatively minor. He didn't kill six people and wound a congresswoman, or torch the Roseville Galleria, or drown a 3-year-old baby. But for Lungren and the others, help came only after they harmed someone else and that is the crime of the mental health care system.
Mental illness doesn't care about pedigree or partisan affiliation. But if any family could have gotten help to stop his slide, it was the Lungrens. His father, Brian Lungren Sr., is a partner at Platinum Advisors, one of the top lobbying firms in Sacramento, and managed the 1998 gubernatorial campaign of his brother, Dan, then state attorney general and now a congressman.
His mother, Nancy Lungren, has worked for Republican lawmakers, Arnold Schwarzenegger and now the Brown administration. The Lungrens understand how to navigate the system, and could pay for private schools and treatment when their son was a minor. But try as they did, they could do nothing to halt his descent.
The crisis that engulfed the Lungren family has eased now that Brian is in a locked ward behind 16-foot-tall fences at Napa State. They know he is getting care. But his parents wonder if they could have done something earlier or different, and they harbor misgivings about a system that so assiduously protects the civil rights of severely mentally ill people at the expense of effective treatment.
"There wasn't enough help," Nancy Lungren said. "They make you fall before they pick you up."
Ski star on a downhill slide
Over pizza on a recent evening, Nancy Lungren popped cassettes into their video player and watched ski movies filmed in the late 1990s in the Sierra. The plots are thin and the acting isn't great. But shots of the skiers are stunning.
Extreme skiers speed down steep slopes, take dizzying leaps, flip, twist, turn and somehow land right side up. One of the extreme skier-stars is Brian, when he was 14, 15 and 16.
In exchange for performing, Brian would be plied with the latest skis, poles and other gear, given to him by equipment manufacturers as part of their marketing. By 2001, however, mental illness was taking hold, made worse by drug abuse.
"I really think Brian has some serious potential to be one of the best free-skiers in the country," an executive for Scott USA, one the biggest equipment marketers, wrote in an email to the Lungrens in January 2001.
"It seems that he might be veering off the path and not making quite the correct decisions," the executive added. "I realize that this is not my business, and I may be incorrect, but I just want to help out any way I can."
A month later, Brian was skiing in Squaw Valley with two friends, Bryan Richmond and Brendan Allen. He decided to stay behind when they headed down a closed run between Squaw and Alpine Meadows. They died when an avalanche buried them beneath 5 feet of snow.
Soon afterward, Nancy Lungren began keeping a journal, the first entry of which included these recollections:
"Bri basically stopped skiing after that (avalanche), stood around smoking all season, couldn't ski. Then he began flipping out on us, using coke, etc., and being violent. Anger and sorrow, hating us, maybe the world.
"Bri is definitely a master skier. Fearless, strong and impossible to keep up with.
"Also, fearless partying. Bri started hearing voices or imagining people could read his thoughts. Brian started being unable to function physically and mentally."
Few placement options
The Lungrens found few facilities that could handle their son. There simply aren't many that care for young people with severe mental disorders.
He did stay at one in Sonoma County for three months in the summer of 2001, but its funding ran out and it closed. From there, he went to a home in Napa County but was kicked out after he punched another resident in the face. A therapist summed up his condition:
"At this time, we believe that Brian may be suffering from a condition that could ultimately be diagnosed as a chronic psychiatric disorder. With this in mind, (we) strongly recommend continued close psychiatric treatment, a specialized education program, and family and individual therapy, without which, we feel that prognosis for any success is extremely guarded."
The Lungrens scrambled to find another place on short notice but failed, and brought him home in October 2001. Three days later, Nancy Lungren wrote in her diary:
"In bed with door bolted my cell phone beside me and a hammer. After tonight's bizarre conversation if you can call it that I think he needs to go to a mental hospital."
The next month, their son turned 18. Some families are incapable of caring for mentally ill adult children. Many want nothing to do with them. The Lungrens, however, tried to assert themselves.
On three different occasions, they petitioned judges to appoint them or the Placer County guardian as Brian's conservator so they or someone could have a say over his care.
Conservatorship is an adversarial process, and Brian resisted. His court-appointed lawyer convinced judges each time that he did not meet the legal standard for being deemed "gravely disabled."
The Lungrens' first failed attempt to become his conservator came in March 2002. Nancy Lungren described his state of mind in her journal that month, following his release from jail for a minor crime:
"Bri will deny all what I'm writing down but it was a most amazing conversation. He says he's supernatural and that when he was in jail, people would come up to him and give him respect like he was a gang member mafia dude. That they were scared of him.
"Tupac came to him all friendly and told him he would be God. He saw faces in the dartboard, and the Tupac and devil spirit told him he could have his powers in one year.
"Tupac became bad like the devil and told him he'd have to commit suicide, then he could come back as god on earth. He told me that he had incredible surges of energy and power."
Even if they had become his conservator, it's not clear that the Lungrens could have found a place to accept him. If they could have found a place, they could not have afforded it. In one year when he was a minor and still covered by their insurance, his care cost $90,000.
Government pays for broken bones and diseased hearts of adult indigents who have physical disabilities. It also pays for the care of people with developmental disabilities. But state law says counties are obligated to pay for the care of adults with mental illness only "to the extent resources are available."
A dad's desperate efforts
The Lungrens tried many things: psychiatrists, special schools, drug treatment. There were many people who tried hard to help. Nothing worked.
At wit's end, Brian Lungren Sr. tried to scare him straight. He brought his son to Loaves & Fishes. As they walked among bedraggled and homeless, he told his son that he might end up there. Later, he pulled a string and got him a tour inside Folsom State Prison.
"After he came out, he said it was cool to see the inside and they all 'hit the iron' hard and were buffed," Lungren said. "I told him he could be locked up inside there if he went down the gang style road. He told me not to worry."
As he tried to piece together what had gone wrong, Brian Lungren Sr. jotted down some memories, and recalled taking his wide-eyed 12-year-old son to South Bend, Ind., for a Notre Dame football weekend.
The older Lungren had graduated from Notre Dame, as did his two brothers, and their father, a physician. He assumed young Brian would carry on the tradition.
"Bri had the smarts, it seemed," he wrote of his son at age 12. "He was speaking so well in any setting. When he was young he could converse with the old folks. He was athletically talented. He talked about music, sports, fashion. He had a great sense of humor."
In October 2007, most of the Lungren clan gathered in South Bend for the Notre Dame-USC football game.
As she strolled across the campus with her family, Nancy was missing young Brian, and decided to call the drug treatment facility in Auburn where he was being housed.
The therapist told her he wasn't there, that Brian had been arrested for stabbing another patient. She spent much of the day in tears.
Whatever the reason for the attack, if there was a reason that was grounded in reality, the event may have saved Brian's life. A Placer County Health and Human Services Department therapist made clear her view to the judge deciding his fate, writing in February 2008:
"It was apparent that Brian was not taking any psychotropic medications and was experiencing psychosis. He did state that he was experiencing telepathic voices that were urging him to be a gang banger and do drugs."
The judge concluded he was not guilty by reason of insanity, and sentenced him to Napa State Hospital. There, for the first time, he is receiving round-the-clock care and taking medication that has calmed his illness.
Adjustment to Napa hospital
Whenever they can, Brian and Nancy Lungren drive over to Napa. Rather than stop at the wineries, they turn off the highway, past a guard booth, make their way to the sally port, pass through a metal detector, get wanded by guards, take their seats in the visiting room and wait for their son.
Brian walks up with a swagger. His hair is buzzed short, and he is wearing a state-issued uniform of khaki pants and sweat shirt. He speaks in bursts, jumping from topic to topic. He talks about being a professional skier, Tupac, and how the wind would talk to him.
"I know I need meds for schizophrenia," he told me the other day when I accompanied his parents on a visit. "I would love to get out. I don't know if I can. It's sickening that I'm here. I don't want to be here."
His adjustment wasn't easy. He assaulted a staff member and got in scrapes with other patients. He told me he spends much of his time avoiding conflicts with "weird people" at Napa.
He thinks about starting work therapy, but is tired. Sometimes his shoulder hurts. He pulls aside his shirt to display a thick scar on his shoulder from an operation to repair a ski injury.
He hopes to be released in October. His parents worry that if that were to happen, he would quit his antipsychotic medication, find street drugs and become captive again to his delusions.
"Without Napa, my son would be dead," Brian Lungren said.
Involuntary treatment urged
Sometimes Brian Lungren Sr. puts aside lobbying for his high-end business clients, and shows up in legislative committee hearings to argue for bills he thinks can help his son and people like him.
Recently, he aligned himself with public employee unions advocating legislation by Assemblyman Mike Allen, D-Santa Rosa, that would permit state hospital doctors to more easily medicate psychotic patients against their will.
The bill would be a small step. There should be others. Policymakers ought to confront reality. There must be a way to provide care for people with the most severe mental illness before they stab somebody. There ought to be something between state prisons and state hospitals, and nothing.
In the 1960s, California had 14 state hospitals that housed 36,000 patients. Gov. Ronald Reagan pushed to empty the facilities, and found allies among conservatives who saw a chance to save money, and liberals who saw abuses and sought to grant patients greater rights. They emptied the hospitals, but never sent money to counties to fund community care.
The state hospital population fell to 3,410 patients by 1995. The pendulum is swinging. The population under the care of the California Department of Mental Health is expected to reach 6,324 next year.
However, the mix is very different. Twenty years ago, half the people in the few remaining state hospitals had committed no crime. Now, 92 percent of the patients are in for Penal Code violations. Many thousands more severely mentally ill people are housed in state prisons.
Counties rarely send people with severe mental disorders who haven't committed crimes to state hospitals. They can't afford it. The state charges counties $184,000 a year to house a noncriminal at a state hospital.
But if an individual commits a crime and is deemed not guilty by reason of insanity or incompetent to stand trial, the state picks up the cost. That creates an incentive to criminalize mental illness, whether intentional or not.
"We called it 'trans-institutionalization.' It was transferring severely mentally ill people from the health system to the criminal justice system," former Assemblywoman Helen Thomson said.
A psychiatric nurse by training, Thomson was at the center of legislative battles over mental health care in the late 1990s and early 2000s. She pushed to permit involuntary treatment of the most severely mentally ill.
"There are people who need rules to live by," said Thomson, now retired. "They are in denial of their illness and are psychotic."
For the most part, she lost. Civil libertarians and patient advocates persuaded legislative leaders to maintain the status quo, which permits individuals to decide whether or not to accept treatment, no matter how ill they are.
In 2004, then-Assemblyman Darrell Steinberg sponsored Proposition 63 to raise taxes on the wealthiest Californians to pay for mental health care.
Since its approval, the initiative has generated $4.7 billion for programs, but none for involuntary treatment. That was intentional, said Steinberg, now Senate president pro tem.
"We believed and I know it was the right call that if we were going to have a chance of success, we could not have a divided mental health community," Steinberg said.
Mental health care advocates are wont to claim that 20 percent of the population has a diagnosable mental disorder. By suggesting that mental disorders are the norm, they diminish the problem. Severe mental illness is not quirky. People who suffer from it are not jerks. They're sick.
Most do no violence to anyone other than maybe themselves. Most cause no serious harm outside their circle of family and friends. But when their quiet suffering becomes public, we are reminded again how we fail that fraction of the populace who truly are ill.