RIP
My niece, Chaunte Michele Briere, passed away a few weeks ago due to complications related to serious brain disease. She lived and died in Massachusetts. She was treatment compliant, great at appearing neurotypical when necessary, and let down by a mental health system that ignores the needs of the seriously mentally ill and their families. I think of the current “system” in MA as suffering from anosognosia and allowing those with SMI/SBD to make decisions as if they were rational and clear-headed while being actively ill.
Despite being quite ill, she experienced a few years of relative stability punctuated by a steady routine, family support, and good friends. Typical of chronic illnesses where there are periods of remission and periods of increased symptom activity, Chaunte attempted to manage the illness.
The past two years were especially difficult for her as she was entering the perimenopausal stage of female development thus rendering medication management difficult. With her wonderful prescriber, she experimented with assorted options. She was experiencing symptoms of tardive dyskinesia and that meant that many of the anti-psychotic solutions were no longer viable. Unfortunately for Chaunte to remain safely in the community she needed an antipsychotic that she could tolerate as well as a continuum of supportive treatment options. She needed to be in a structured environment where the demands of a “normal” life were balanced with sufficient support. In the absence of viable solutions, she returned to self-medicating with alcohol and added cocaine injections to the mix. She went in and out of several detox rehab programs which only focused on substance use and not on the SMI that was driving the substance use.
There were three calls to the police in the last 6 weeks of her life. One call was from a concerned friend, her AA sponsor, and while Chaunte was taken to the hospital, she told the triage team that she was not suicidal, and they released her. This hospital is part of the community-based treatment team, and they should have known better since Chaunte has a long history of serious suicide attempts. The next day, Chaunte shaved her head because she was convinced that her scalp was crawling with bugs.
The next call was made by her boyfriend and me thereby reducing Chaunte’s wiggle room to not be hospitalized. This time she was forcibly admitted for a 72-hour hold. Fortunately, this was long enough for her to realize she was where she needed to be (her words). Back in a psychiatric setting and she began to relax, recover, and realize that she is extremely ill and needs more intensive treatment. After 2 weeks, she was discharged and expected to attend a day treatment program on her own. Neither her boyfriend nor I was notified about this by the hospital.
An aside is needed here: I was her health care proxy, and I was her legal agent through a Power of Attorney document. The state of MA considers psychiatric inpatients rational and reasonable. It is part of the system’s complete lack of insight into serious mental illness/serious brain disease. Its anosognosia cost her, her life.
Chaunte returned home, alone, and did not go to the day treatment program. Instead, she resumed self-medicating. She told me, “Mara, I just cannot do this anymore. I am so tired. It is too hard to not drink.” She also informed me that she could keep her cat anymore because she was not a good mother to him. She was defeated.
I suggested returning to the hospital. She said, “I’ll kill myself before they get here.” I believed her.
With plans to be away, she knew how to stay connected. She called a few times; she texted a few times. We returned home due to an accident. I called her and she did not call me back. That was Monday. Tuesday, I texted her that we had been in an accident and could she call me. No response. This was not like her at all. I called the police to do a well-person check. Their response? Why do you think she is suicidal? I explained her behavior, the things she said. That was not enough, however. “Did she say the words, “I am going to kill myself.” She did not have to!!!!! They humored me and found her deceased.
Chaunte suffered from a serious brain disease and enjoyed partial response to medication. She was consistently betrayed by systemic anosognosia and professionals who refused to collaborate with family members and caregivers.
I cannot help but think that everything we did to improve her life was undermined by misinterpretations of so-called client rights. Clients are part of families. Clients have the right to receive care, especially when they ask for it and their supportive caregivers ask for it on their behalf.
The Treatment Advocacy Center promotes advocacy to reform state laws is necessary to make it possible to treat people before illness caused them to fall into homelessness or incarceration, or to become dangerous to themselves or to others. MA has consistently voted against assisted outpatient treatment and the continuum of supports it demands to improve outcomes for the seriously mentally ill and their families. It is this consistent refusal to care for the sickest that continues to cause incarceration and death.
It is so incredibly sad that there are solutions, and they are ignored to the detriment of those with SMIs, their families, the communities they live in, and the obligations we all must protect the vulnerable.
