The day before Ricky Nelson died, he told his dad he was spiraling again.
“My dopamine is down,” he said, referring to the brain chemical linked to mood. “The medication is not working.”
It was late February, and Ricky and his father were returning from the Roseville Galleria where they had taken Ricky’s iPhone to be fixed. Rick senior told his son that he and wife Sandi would keep looking for new treatments. They would find something better.
They never found the magic pill or lifesaving therapy they had been searching for since Ricky first showed signs of mental illness as a child. On Feb. 24, Ricky, a talented songwriter and musician, lay down on the railroad tracks not far from the upscale neighborhood in Folsom where he grew up. A freight train rolled over his body, killing him. He was 35 years old.
Sign Up and Save
Get six months of free digital access to The Sacramento Bee
“We tried everything to help him,” Rick Nelson said recently, sitting in the living room of the family’s home and gripping his wife’s hand. “Everything.”
The couple searched out the best doctors, the most promising treatments, the finest facilities in search of an answer to the puzzle of Ricky’s illnesses, which over the years had been diagnosed as anxiety, depression, bipolar disorder and most recently schizoaffective disorder.
They had worked hard to help their four children develop full and active lives. Rick was a successful financial adviser. Sandi did volunteer work for Loaves & Fishes and other organizations. But even with their means, they were helpless in the face of Ricky’s mental torment.
Ricky would get better for awhile, then lapse into psychosis and depression. He would have a few good hours or days, followed by terrible weeks or months. It’s a common story for people dealing with mental disorders, according to the National Alliance on Mental Illness.
Despite the development of drugs that better control symptoms and have fewer side effects, many families of mentally ill people remain frustrated – not just because of the limitations of the medications, but because patients often will stop taking them or take them inconsistently.
Studies have shown that as many as half of people who respond well to medications to treat psychosis related to mental illness fail to adhere to their drug regimens. In some cases, patients refuse to admit that they are mentally ill. Others are unable to afford the drugs. Some are unwilling or unable to follow directions for when and how to take psychiatric medications. And “side effects are still a major issue,” said David Bain, executive director of NAMI’s Sacramento chapter.
At various times, Ricky took medications that seemed to fog his brain. Other pills made him gain weight, even though he was conscious about diet and working out. On the day he and his dad went shopping, he said nothing was seeming to help with his depression.
That night, Rick Nelson left a message for his son’s psychiatrist. What more could they do to help Ricky? he asked.
The next morning, Folsom police appeared at their front door with words the Nelsons forever had feared.
“Your son has passed away,” they said.
Promise, then despair
Ricky lived by himself in an apartment in Orangevale, about 10 minutes from his parents in Folsom.
Sandi and Rick lived in fear. Every visit to Ricky’s place was a wild card; every phone call potentially explosive. How was he? What was his state of mind?
“Ricky wanted to be independent,” Sandi said. “He didn’t want to live with us.”
But his illness made functioning independently impossible, his parents said. Rick and Sandi helped him with his medical appointments and paperwork, made sure his apartment was tidy and his refrigerator stocked. They queried him about his medications. They searched for supportive housing in Sacramento, they said, but found only waiting lists and resistance from Ricky. They worried about him constantly.
Bain, of NAMI Sacramento, said a lack of supportive housing for mentally ill people is a serious problem in Northern California and across the country. Even in the private sector, housing programs that offer daily assistance in managing medications and behavior are scarce. Too often, seriously mentally ill people wind up in locked facilities, with relatives who are not equipped to care for them, or on the streets, Bain said.
More than anything, his parents said, Ricky wanted a “normal” life, one that would include a job and a family of his own like his brothers Greg and Jeff had. But his sole focus in recent years, his father said, “was that he was sick, and he wanted to get better.”
Ricky always had been a nervous kid, a child who had outsized concerns about issues such as war and homelessness, his parents said. He was “6 going on 36,” a neighbor once said. He began taking medication and seeing counselors when he was in elementary school.
Beginning in his teens, he wrote music that reflected his sharp wit and political beliefs. He sang to his little sister Michelle when she was upset, and considered his grandfather, Ed Fafara, his best friend. Ricky taught himself to play piano and guitar, and his musical mentors included Michael Jackson, the Beatles and Elvis Presley. He had blond hair, a lean build and a stage presence that made girls swoon when he sang and deejayed at parties and wedding receptions, his parents said.
In 1999, he and his best friend Jordan Jackman cut a CD featuring songs about love and loss. After high school, Ricky attended college at San Diego State University. His mental illness left him unable to concentrate on his studies, and he never finished.
“He had a beautiful mind and a beautiful soul,” Sandi said. His gentleness showed itself in his love of nature and his affinity for stray animals, she said. But Ricky’s mental state was fragile. His thoughts were scattered. He would be calm, then explode in anger for seemingly no reason. He would be verbally abusive, then intensely apologetic, his parents said.
Ricky’s behavior became more bizarre as he got older. When he was in his early 20s, he started having hallucinations about “little men” tunneling under the sink at the family’s condo in Mexico. He was convinced that his computer was talking to him. At times, he failed to recognize his parents, once accusing them of breaking into their own home. “Who are you?” he asked them. “What is your name?”
His mental pain seeped into his music. In a song called “Mania,” he spilled his emotions about insomnia and his desperation to be OK. “Why am I awake to see all these things?’ he sang. “Why are my eyes refusing to shut?” He was living, he wrote, “under a Lithium waterfall.”
In his darkest periods, he talked of his frustration and sadness about being different from others, and unable to achieve his goals of being a professional musician and having a family. He felt worthless.
Over the years, new medication brought Ricky and his family promise, then despair. Ricky took a variety of pills he hoped would correct the broken chemical composition in his brain: Prozac for depression, Seroquel for bipolar illness, Thorazine for schizoaffective disorder, and as many as 20 others, including the Lithium that he sang about.
“He tried them all,” his mother said.
But Ricky’s parents never were sure he was using the medications properly. Sometimes, he doubled or tripled the prescribed doses. Sometimes, because of side effects such as rapid weight fluctuations or loopiness, he would quit taking them. In recent years, he had developed tardive dyskinesia, a nerve condition that causes involuntary movements of the limbs and is linked to anti-psychotic medications. He had doctors and counselors who were not always on the same page about his treatment, his parents said.
Some mentally ill patients have improved after taking medications that can be administered by injection and are effective for several months at a time, said Dr. Peter Yellowlees, a professor of psychiatry at UC Davis. Ricky never tried this approach, according to his parents. “There are newer drugs coming through, and newer ways to use the older drugs,” Yellowlees said. “There is cause for hope.”
But challenges remain. Symptoms of major mental illnesses “do change over time as individuals evolve,” Yellowlees said, leaving doctors constantly searching to find the correct drug, or combination of drugs, to effectively treat them. Mental disorders including schizophrenia and depression also “have degrees of severity,” he noted, which can change over time. “Some patients are simply unlucky, in that they have a very severe illness that doesn’t respond well to therapy,” he said.
With the right treatment, about two-thirds of people with serious mental illness can live independently, work and have families, he said. But some patients stop taking their medications when they start feeling better, and some cannot tolerate the side effects.
“When I looked at Ricky I would think, ‘He’s suffering so,’ ” Sandi said. “I kept hoping that something would come along, and he was going to get better. I believed it would happen.”
When standard treatments failed him, Ricky researched alternative approaches, including herbs and other supplements. He made dietary changes. For awhile, he believed that a substance called kratom, derived from the leaves of a tropical tree in Southeast Asia, was lifting his mood.
But each time things seemed to be on an upswing, he inevitably would crash. Ricky’s parents sought help across California and even outside the state, once placing him in an exclusive inpatient treatment facility in Arizona they heard had been successful in combating symptoms of mental illness. When his thoughts and feelings spun out of control, he checked into hospitals until he became stable. He was hospitalized off and on in Sacramento, and three times he wound up in facilities outside of the county.
Sometimes he arrived in a police car. Folsom police, his parents said, knew Ricky as someone prone to uncontrollable outbursts and hallucinations and often were able to talk him down without having to arrest him. Ricky “was not violent. He wouldn’t hurt a spider,” his mother said. But his desperation and unhappiness tore at his family.
“Am I going to be OK, Mom?” Ricky would ask after yet another failed treatment. “Am I ever going to be OK?”
“I promise you will,” she told him. “I promise it will get better.”
Earlier this year, Ricky took his guitar and keyboard and laid them next to the garbage cans at his apartment complex without explanation. He threw out a couple of expensive pieces of art that had hung in his apartment. The artwork was “evil” he told his parents.
On the morning of Feb. 22, a Wednesday, he phoned his mom and asked her for tips about cleaning and caulking his bathtub. When she arrived at his apartment, she was thrilled. His place was neat, his clothes were hung in the closets, his laundry had been done. They shared a meal of rotisserie chicken and potato salad.
“I thought he was getting better,” Sandi recalled.
But then the anger came forth, fiercely and unexpectedly. “I can’t live like this, Mom!” he said. “I’m in so much pain.”
Ricky seemed calmer on Thursday morning, when Sandi called him before she left for Tennessee to visit her son Jeff and her grandchildren. He told her he loved her before they hung up.
That afternoon, Rick picked up his son so that they could replace his cracked iPhone. At a store in the Galleria, Ricky became agitated, barking at his dad and the clerk. Rick tapped a note into his phone and showed it to the salesperson. “Schizophrenia,” he wrote. “Mentally ill.” The clerk nodded in understanding.
Ricky left with a new iPhone 6s Plus, but he seemed despondent. He refused dinner with his dad. He said he felt suicidal. It was a thought he had expressed more than a hundred times in his lifetime. “Should I call 911?” Rick asked his son. “Should we go to the hospital?”
No, Ricky said. He wanted to borrow one of the family’s cars, a blue Hyundai, to go to the store to fill a prescription for an anti-anxiety drug, Klonopin, and buy groceries.
Rick hesitated. “I’m not sure if it’s safe for you to drive,” he said. “If you have ideas about driving that car into a wall ... ”
“No, Dad, I’m fine,” Ricky assured him. He thanked him for buying the phone, took the car keys with his dad’s permission and left. Rick left a message for Ricky’s psychiatrist, describing his son’s state of mind.
After 10 that night, Ricky called his father. He had just spent a couple of hours on the phone with his cable provider and was frustrated and anxious. He wanted the problem fixed now. “Don’t worry about it,” Rick told him. “We’ll take care of this tomorrow.”
On Friday morning, Rick rose from bed and went about his routine, which included a 45-minute walk around the neighborhood. He read the newspaper, went through the mail.
When two Folsom police officers approached the door at around 11 a.m., shock pulsed through his body. “Is my son OK?” he asked.
No, they answered. “Can we come in?” A chaplain was on the way.
A few minutes later, Rick made the most difficult phone call of his life. Ricky is gone, he told his wife.
A Union Pacific employee had found Ricky’s body at the railyard, near Vernon and Fourth streets in Roseville, at around 7:30 a.m. In his pockets were his new phone and a newly refilled, empty bottle of 60 Klonopin pills. His parents are unsure when, or whether, Ricky swallowed them. Toxicology tests are incomplete.
Back at his apartment, Ricky’s mailbox was stuffed with insurance notices and medical bills. On the refrigerator was a handwritten note his parents had never seen, although it had been composed weeks earlier. Ricky, who grew up Mormon, had not written a suicide note, but a letter to God.
“Lord,” it said, in part, “I’ve never felt this much danger in my life. … If I am healthy enough to overcome my disabilities, I would like to hold down a job and earn money to live. … I have a lot of love in me for others. … Thank you for your mercy, love and forgiveness.”
Ricky “fought a hard fight,” his father said, his voice quavering at his son’s memorial service. “He never really wanted to die. He just wanted to stop the pain.”