This September, 2002 Ann Arbor Observer feature addresses some of the questions raised by the January 8, 2011 shootings in Arizona. For a more recent, and encouraging, account of the local response to mental illness, see this story from July 2009.

Brian Williams was sure someone had been in his apartment. Nothing was missing, nothing was damaged, but someone had taken his personal papers and left duplicates in their place. Someone had also put two dead cockroaches in his rice container. The night before, he told Ypsilanti police officer Yeshimbra Gray, he returned home to find that a prowler had “peed in my pop.” Someone also had taken a $10 bill from his wallet and replaced it with one with a different serial number.

A few months later, in October 1996, the Ypsilanti Police Department filed another “suspicious situation” report from Williams. This time the Ann Arbor Police Department had been taking his newspapers and replacing them with old ones. Someone was stealing his mail, because he hadn’t received some things that he was expecting. His Social Security card had also been stolen from a locked box. When asked whether there were any signs of forced entry, he said no, and added that his apartment had never been broken into.

A week later Williams returned to the YPD to report that once again people were replacing his personal belongings with duplicates. In addition, someone was trying to steal his wallet. He often felt a hand slipping into his pocket, but when he turned around, no one was there.

This time the reporting officer classified the incident as an “insanity/mental complaint.” Williams indicated that he was a former community mental health client who had stopped taking his medications because he didn’t think he needed them.

Officer Gray contacted psychiatric emergency services at the U-M. According to her report, she was told that “it is not illegal to be insane and that because it was a weekend and Williams’s situation is not considered an emergency, options for treatment were limited at this time.” Williams could go to community mental health on a weekday and get treatment if he wanted to. Gray wrote that Williams agreed that he needed some kind of help but said he wanted time to think about it.

Williams evidently decided not to pursue treatment, because in November officer David Stroud was called to the group home where Williams lived. Williams told Stroud that someone had unlocked his security box and changed the address on his Social Security card.

The delusions grew worse. In December officer Thomas Eberts was called to the group home. He found Mary Beth Dobbins holding a chunk of her hair in her hand. She told Eberts that Williams had been walking up and down the hallway and repeatedly looking into her room. The second time she asked him what he was doing, he came into her room, screaming, “I’m gonna punch you. I’m gonna kill you.” Williams hit her in the face several times and pulled out her hair. He then left, walked into his own room, and slammed the door.

The incident report states that when officers spoke to Williams he was “acting very strangely . . . continually mumbled his words [and] was very hard to understand.” He gave two reasons for attacking Dobbins: because she spit in his food and because he had a sexually transmitted disease. He said he didn’t know where he had contracted the illness. Williams also told the officers that he was diagnosed as paranoid schizophrenic.

Dobbins pressed charges, but they were later dropped in a plea agreement. The judge issued a no-contact order to keep Williams away from her, and the case was closed.

Williams then dropped off the police radar screen until August 12, 2000, when he was spotted walking near West Cross and Ballard in downtown Ypsilanti carrying a kitchen knife with an eight-inch blade. When sergeant Paul DeRidder asked him why he had the knife, he said he was looking for a man he’d had an argument with a couple of hours before. He claimed not to know the man’s name but said they lived in the same apartment building. Williams was arrested for possession of a weapon in a public place and released later that day “pending warrant authorization from the city attorney.”

Four days later officer Scott Fouty responded to a larceny call from Ted’s Campus Drug. Clerk Melissa Ann Winter said that a man took a Pepsi from the cooler and placed it on the counter. While she was distracted by a coworker, the man picked up the Pepsi and walked out without paying for it. To Fouty, the man she described sounded a lot like Brian Williams.

Officers found Williams at the group home. He explained that he wanted the Pepsi but had forgotten his cash. He would be willing to pay now that he’d found his money. He rode back to the store with Fouty. After paying for the beverage, he was read a no-trespassing order and told not to return.

The following day, August 17, 2000, Williams’s battle with insanity reached its climax. He began the morning by threatening a bus driver in Ypsilanti. Next he went to Ann Arbor, where he was thrown out of a coffee shop on State Street for falsely insisting there was a bomb in the toilet. He was then spotted at the Ann Arbor Transportation Authority’s downtown Blake Transit Center, where his behavior attracted the attention of AAPD officer Jack Foster. As Williams tried to enter a toilet there, Foster confronted him and ordered him to leave. Williams then went to the Greyhound depot on Huron, where he boarded a bus for Kalamazoo.

At the Kalamazoo bus depot, Williams’s bizarre and threatening behavior continued. Mario Price went into the men’s room to get some tissue and found Williams there. “Hey, you, come here. What’s your name?” Williams demanded. Price ran out of the room.

Gilberto Rodriguez also encountered Williams in the men’s room. Williams stared at him the entire time he was using the facilities. He followed Rodriguez out of the room. When Rodriguez asked him what his problem was, Williams became angry and sat down on a bench in the waiting room.

Next Williams approached three women. He told them he was a police officer and that they should come with him because he had some questions to ask them. When one of the women requested identification, he showed her a white card with the word “security” on it. When she insisted on seeing photo identification, he walked away.

U-M student Kevin Heisinger arrived in Kalamazoo from Chicago on Indian Trails bus 4560. He had a one-hour layover before continuing on to Ann Arbor—but never made his connection.

At approximately 3:15 p.m. the Kalamazoo Public Safety Department responded to a call reporting a “man down” in the men’s room of the bus station. Brian Williams had just beaten Kevin Heisinger to death.

Only Heisinger’s death makes Brian Williams’s story unusual: mentally ill people are more often the victims of crime than the perpetrators. But every day, people like Brian Williams fall through the holes in the state’s mental health services and into the criminal justice system.

More than thirty years ago, Congress passed a series of mental health bills that began a nationwide process of “deinstitutionalization”—shifting treatment for the mentally ill from state hospitals to agencies in the community. David Neal, an assistant professor of social work in the U-M department of psychiatry, estimates that before deinstitutionalization Michigan alone confined 30,000 people to psychiatric hospitals. Currently, just 1,300 people are hospitalized—while 180,000 “seriously and persistently mentally ill” residents are dealt with through the state’s community mental health services (CMH).

Many of those people are doing well. With the help of improved medications—an amazing 47 percent of the Medicaid budget now goes to buy psychiatric drugs—they are able to live independently or in group homes, receiving outpatient care through CMH. When the system fails, however, it fails catastrophically: people who once had a measure of safety in state hospitals wind up in homeless shelters instead—or in jails.

Washtenaw County sheriff’s sergeants Skyla Kruzel and Donna Johnston started working at the Washtenaw County Jail in the early 1970s. At the time, they recall, it was easy to get a prisoner with mental problems into the nearby Ypsilanti Regional Psychiatric Hospital. Police could just take someone there and have the person admitted.

The system provided many people with needed help, but abuses were rife. All it took was the signature of one family member and one doctor, who was not even required to be a mental health professional, to have someone committed. There were no mandatory reviews of patients’ conditions and no limits on how long they could be held. State hospitals were communities where people often lived for years; some never left. Ypsi State even had a golf course.

In the mid-1970s the U-M’s Neal was appointed to a committee that worked with the legislature to rewrite the involuntary commitment laws and reorganize the state mental health system. About the time that the committee was completing its work, a patient filed a lawsuit against the state claiming it was a violation of civil rights to detain people indefinitely without review. The courts agreed, declaring the state’s mental health commitment laws unconstitutional.

The new law greatly curtailed involuntary commitment. Under its provisions, people could be committed only if they posed an immediate threat to themselves or others. The change accelerated the emptying of the state’s mental hospitals.

The new rules largely shut down the movement of people from the county jail to Ypsi State even before the hospital closed in 1991. But even if mentally ill prisoners weren’t dangerous, they weren’t necessarily able to look after themselves. Indeed, as deinstitutionalization progressed, many people ended up in jail by default, simply because they lacked the skills to find a place to stay or the money to obtain permanent housing. Before the founding of Ann Arbor’s Shelter Association in 1984, for instance, the only way a mentally ill homeless person here could get in out of a storm or find a place to sober up was to throw a brick through a window and get arrested. Others were picked up for minor crimes like public urination and open intoxicants.

“Judges would put them in jail because they knew there wasn’t really an alternative,” recalls Johnston. “They no longer had a safe haven [in the state hospitals]. So to save them from freezing to death in the wintertime, you arrested them for trespassing—threw them into a nice warm cell, three square meals a day.” In effect, the jail provided the community’s only guaranteed low-income housing.

“I was with the sheriff’s department twenty-six and a half years, and sixteen and a half of those were as the sheriff,” says former Washtenaw County sheriff Ron Schebil. “I saw it before and I saw it after [deinstitutionalization], and there are a tremendous number of folks in the [criminal justice] system who weren’t there before.”

Once mentally ill people got involved with the criminal justice system, they were likely to be seen over and over again. Workers at the jail called it the “revolving door”: someone would come to the jail, receive medications, get connected with services, and begin functioning at a very high level. After being released from jail, the person would remain stable for a short while, stop taking medications, and end up back in jail—or, worse yet, commit a violent crime and end up in prison.

In response to Heisinger’s death, Michigan representatives Virg Bernero and Tom George initiated a proposal called “Kevin’s Law.” Introduced into the legislature in September 2001, the package of three bills would make it easier to secure an involuntary commitment, or for a court to order an individual into outpatient treatment. But the bills never made it out of committee and are expected to die at the end of the current legislative session.

Many people who work with the mentally ill would welcome legislation that made it easier to require treatment. But even if Kevin’s Law had been in effect on August 17, 2000, it might not have saved Kevin Heisinger.

The current state mental health code, adopted in 1996, is a less stringent version of the 1974 law. It permits involuntary commitment of any individual “reasonably likely” to harm himself or others in the near future.

Professionals in both the mental health and criminal justice systems are often frustrated by these criteria. Though Brian Williams was clearly in an acute phase of his mental illness in 1996, for example, he probably didn’t meet the standard for involuntary commitment.

In 2000, however, he probably did: a person with a well-documented history of mental illness and violence, found walking the streets with a knife in his hand, seems to fall well within the requirements for involuntary commitment. At the time, Geralyn Lasher, a Michigan Department of Community Health spokeswoman, told the Ann Arbor News that “in the case of Brian Williams, there is nothing in the mental health code that would have prevented officials from taking action.” Yet when Williams was picked up for possession of a weapon on August 12, no one even tried to have him committed.

The YPD has no official comment on the Williams case. Captain Matthew Harshberger says that the department has no formal training programs concerning mental illness. Its protocol is to try to resolve nonemergency incidents on site. If the situation escalates, there is a CMH hotline officers can call to get advice. Only if all attempts to quell the disturbance fail do they take the person to U-M psychiatric emergency services and begin the petition process for involuntary commitment.

Should YPD officers have tried to have Williams committed? In hindsight it’s easy to say they should. But just asking the question highlights one of the strangest results of deinstitutionalization: that life-and-death decisions are often made not by mental health professionals but by shelter workers and police officers.

Jack Foster has been patrolling the Blake Transit Center and its immediate surroundings for the last three years. His most frequent problems with the mentally ill involve people who are so drunk they’re incapacitated. Occasionally someone will threaten a passenger or touch a bus driver, but the situation rarely goes beyond verbal confrontation.

Foster is also an agent of the Ann Arbor Transportation Authority, so he has the power to read a no-trespass order against anyone causing a disturbance, something he does frequently. “If I suspect them to have a mental illness, I just take it on my initiative to call CMH,” Foster says. “That’s pretty much my cure-all. Every time I’ve called they’ve been really helpful.” Once CMH gets involved and people are back on their medications, he says, he doesn’t see them causing problems as often.

Foster would like to see stronger involuntary commitment laws. “I wish the legislation would grant the medical professionals the authority to hold people longer and make sure they’re on medication before releasing them out into the general public,” he says. Asked whether he might have done anything differently when Brian Williams tried to get into the Blake Transit Center toilet, Foster says his hands were tied: “I had no legal grounds to stand on other than a gut feeling.” His only recourse was to force Williams to leave, which he did.

A complicating factor was that by the time Williams killed Heisinger, he had caused trouble in three different jurisdictions. No one police officer or agency was in a position to recognize that Williams’s madness had reached a critical threshold.

When there is a breakdown in the community-based supervision of the mentally ill, the consequences are often tragic. On the other hand, when the system is at its most compassionate and creative, patients can achieve stability and pursue their goals.

Amy was in her early forties and taking seven medications to manage her bipolar disorder. She also had a substance abuse problem and was serving time at the Washtenaw County Jail for breaking and entering.

Because her offense was nonviolent, Amy qualified for the Community Corrections program, a joint venture between the city of Ann Arbor and Washtenaw County designed to provide offenders treatment as an alternative to incarceration. She accepted an offer to be transferred from jail to a drug treatment center. But she relapsed and did not complete her first rehabilitation program, and she was refused admittance to another at the door because of funding problems. She came back to Ann Arbor and turned herself in at the jail.

Amy was finally sent to a ninety-day program at Turning Point in Pontiac. She had to leave just over halfway through the program because she needed her medication adjusted, but she continued drug treatment as an outpatient at Clear House. She got help with job referrals from the Options Center, an organization that helps people who are released from jail reintegrate into the community. Options stayed in close contact with her CMH case manager. She also reported to probation and to Moira Payne of Community Corrections, who helps eligible inmates find treatment.

When problems arose, staff members at the four organizations developed solutions to keep Amy on track. When she was having trouble keeping her appointments straight, Options staff sat down with her and wrote out a calendar of the things she had to do every day. When she didn’t have bus money to get to her job, she notified staff at Clear House, who contacted Payne, who found a way to get her bus fare. Amy’s supporters even helped her work around her fear of the dark: throughout the term of her probation, the agencies and counselors never asked her to do anything that might keep her out at night. One evening, when she missed her bus from Clear House, staff members waited with her in the dark until the bus arrived.

“It takes incredible patience,” says Payne about the effort. “You don’t get the same results as you would from another type of person. With mental health consumers it can be disheartening. The most important piece is that we don’t give up.”

This time patience was rewarded. Amy successfully completed her probation and started down the road to a new life—a success Payne credits to Amy’s passionate desire to get well, supported by the agencies’ “wraparound service.”

Amy was fortunate to get into a substance abuse program that accepted her while she was taking medication for her bipolar disorder. Most facilities require patients to be free from all mood-altering chemicals, including psychotropic medications. Conversely, mental health facilities won’t accept a person who is abusing drugs, because the chemicals not only can mask real mental illness but also can induce symptoms that mimic disorders. For example, separating cocaine-induced psychosis from schizophrenia can be next to impossible in someone who is still using drugs. The consequence is a major treatment gap for people classified as “dual diagnosis”—both addicted and mentally ill.

Homelessness can cloud the picture even further. “I feel horrible about referring someone to the homeless shelter,” says Moira Payne. “How can a person focus on anything [else] when they’re just focusing on survival?”

AAPD lieutenant Khurum Sheikh estimates that 50 percent of the homeless with whom police come in contact suffer from some form of mental illness. In contrast to stereotypes that the mentally ill are dangerous, he finds that they are a high-risk group for victimization. Mentally ill people living on the streets are often robbed, assaulted, and sexually abused, and are at high risk for an early death.

For the mentally ill, especially those who are addicted to drugs, homelessness is often the last stop before entering the criminal justice system. “If you don’t have a place to live, you’re going to get into so much more trouble,” says Brant Funkhouser, an attorney who has been representing indigent clients in Ann Arbor for twenty-four years. The cases he most frequently handles for the mentally ill are alcohol violations, open intoxicants being the most common; urinating in public; creating a disturbance; and disorderly conduct (including begging and panhandling). “There are some people who are not very mentally ill who get in a lot of trouble, and the mental illness contributes to them getting into the criminal justice system. Then I know some people who are really crazy who hardly ever get in the criminal justice system. A lot of times the difference between the two people is whether they’re using substances. A lot of times the difference between the two people is having a place to live.”

Shelter executive director Ellen Schulmeister estimates that about half of all her guests are addicted to substances and that one-third are mentally ill. “We, in a sense . . . , like the police, deal with the fallout of the system,” she says. “I think hospitalization should be more easily accessible and for a longer duration.” She has seen U-M psychiatric emergency services release psychotic clients in as few as two or three days. “I don’t think we should necessarily rebuild institutions,” she says, “but I think cutting back on hospitalization is really damaging, because sometimes it takes a while [to stabilize].”

Schulmeister lauds the efforts of Avalon Housing as an effective way to break the cycle of homelessness and reintegrate people into the community. Spun off from the Shelter Association ten years ago, Avalon’s mission is to permanently house people who are traditionally screened out of renting: people with bad credit, no credit, or history of evictions; the homeless; and those labeled “service resistant.” Since Avalon opened its doors, executive director Carol McCabe estimates that it’s received a dozen calls a day, every day, for the last ten years. Avalon opens its applicant list for one month every two years. The last time was in October 2001, and 300 applications came in.

“Our whole philosophy is we will meet people where they’re at,” McCabe says. “Our service providers might spend a year just trying to get somebody to go have coffee and a cigarette. Then, maybe eighteen months into the relationship, they might ask the tenant if they would like to go to a detox facility. The goal is to reintegrate people at whatever pace you can, and it’s not quick. Not everyone recovers.”

Avalon contracts out support services through Catholic Social Services. CSS workers provide a highly individualized, flexible response to whatever people need to keep their housing and meet their personal goals. “People can’t work on all these issues if they don’t have a safe, decent, affordable place,” says McCabe. “It’s simply impossible.” McCabe estimates that out of 141 Avalon households, seventy to eighty clients are “severely and persistently mentally ill.”

Generally, the biggest threat to people’s tenancy at Avalon is their inability to say no to outsiders who want to move in with them. Many residents come from the shelter and have a social network there, so it often becomes problematic when one person gets a place and the person’s friend is still homeless. Avalon staff teach residents how to turn away guests who might want to use the residence as a base for dealing drugs or for prostitution.

That’s why McCabe was thrilled when a homeless person broke the front window at an Avalon house one night. Staffers had been working with tenants at the house, urging them to say no to difficult guests—and the attack confirmed that they had stood together and rebuffed the troublemaker. Replacing a window was a small price to pay for that good news.

With nearly all of the state’s mentally ill residents now living in the community, it’s a constant challenge to make sure they receive the care they need—especially those whose lives are too troubled or chaotic to take advantage of CMH’s outpatient services.

For “Jackie,” the help she needed came from the Assertive Community Treatment team. ACT is a branch of CMH that goes into the community to provide services for the mentally ill: team members meet people at shelters, deliver medication, and take people to medical appointments, in addition to other services.

A successful professional woman, Jackie suffered a sudden psychotic break in her early forties. Evicted from her home at the onset of her illness, she was diagnosed with schizophrenia and began the long, difficult process of stabilizing her life.

The shelter connected Jackie with ACT. According to Susan Iekel-Johnson, director of programs and services at the Shelter Association, ACT focused on securing affordable housing that would allow her to get out of the shelter. Although Jackie received Social Security disability payments and was eligible for a housing subsidy voucher, her mental illness had left her with bad credit, so no landlord wanted to rent to her. ACT’s solution was to find a third-party payee—a person who was willing to collect her disability benefits, handle her bills, and cosign for an apartment.

Then there are the people who resist treatment—who, for example, refuse to take their medication once they’re discharged from the hospital. For those who fit the criteria for mental illness but fall short of the requirements for involuntary commitment, there’s a powerful tool called an alternative treatment order (ATO). Probate judge John Kirkendall, who presides over involuntary commitment hearings, also issues and renews ATOs. He says that most are combined orders that commit the person to the hospital for a brief period, usually a week to ten days, followed by mandatory outpatient treatment. The ATO typically states that a person must go to all doctor appointments, take medications, and comply with CMH’s treatment plan. If the consumer misses an appointment or fails to take medication, CMH can petition the court for a pickup order. The police are dispatched, and the person is hospitalized immediately.

Kirkendall recalls that when he first was on the bench he saw a lot of consumers returning to his court again and again. The implementation of ATOs, he says, has helped to slow, if not close, that revolving door.

Serious problems remain. Judge Elizabeth Pollard Hines says that it’s gotten increasingly difficult to get people help in recent years, and laments that CMH resources have diminished. Even when funding is available, Hines notes, the way the money is earmarked can also be very restrictive—for example, a substance abuse program’s guidelines may forbid it to treat the mentally ill. “It’s really a problem when you have people who have various issues across the board,” says Hines. “They may be homeless, they may have a mental health issue, they may have a substance abuse issue, and trying to get them help is really complicated. You really have to go the extra mile to get them services. . . .

“Unfortunately, I do think there are cases where the only way you get services for people is if they come through the criminal justice system, and I don’t think that was ever intended,” Hines adds. “Some treatment programs, again because of funding, are more accessible through the jail. So you might order someone released to a jail program. . . . The intent is not to keep them there, but get them into treatment.”

One troubled person whose path to treatment led through jail was Brian Williams. Kalamazoo police officers apprehended Williams near the bus station shortly after the attack on Heisinger; he resisted arrest and tried to kick out the windows in the squad car on the way to the station. During interrogation he told officers that the microphones in his head had told him that “they” were dropping atom bombs on the earth and that he was the planet’s savior. It was his job to stop the attack by holding the planet in his hands.

Ultimately, Williams confessed to killing Heisinger. He was found not guilty by reason of insanity. For privacy reasons, the state will not confirm Williams’s current whereabouts—but records in Kalamazoo indicate that he was transferred back to Ypsilanti.

This time, though, he’s no longer living in the community. Williams now resides at the Center for Forensic Psychiatry. Designed for inmates who are considered violent or escape risks, the center is guarded by motion detectors and fences; inmates’ movements are severely restricted. Brian Williams has finally qualified as one the 1,300 people still institutionalized in Michigan.

The next time someone like Williams loses control, the AAPD expects to be better prepared. The department belongs to the Crisis Relief Task Force, a major initiative that brings together fifteen agencies, offices, and nonprofits, including CMH and the local chapter of the National Alliance for the Mentally Ill. Part of a growing national trend to refine how the police deal with the mentally ill, the task force provides a forum for representatives of the criminal justice system, service providers, and mental health consumers to share information.

Within the department, Lieutenant Sheikh is trying to organize a team dedicated specifically to working with the mentally ill. “Police have a lot of contact with the mentally ill, but the criminal justice system really isn’t geared for that,” he notes. “It’s [considered] more of a health care issue—yet it’s something police find themselves in.”

Sheikh and other task force members went to Tennessee to observe the Memphis Police Department’s crisis intervention team. The Memphis CIT was initiated after officers were dispatched to an apartment where Joseph Robinson, a schizophrenic, was stabbing himself repeatedly with a butcher knife. Fearing that Robinson would attack them, the officers—who had minimal training in handling mental illness—shot him several times.

The public outcry spawned the new program, which seeks to better prepare officers to work with the mentally ill. “CIT is a mind-set,” Sheikh explains. “It develops sensitivity and understanding regarding mental illness.” Officers on the Memphis team focus on empathy and developing long-term close relationships with mental health consumers.

So far, fifty Ann Arbor officers have participated in two full-day training sessions on mental illness. The first day covered symptoms and manifestations of mental illness along with intervention strategies, developmental disabilities, substance abuse, and fetal alcohol syndrome. Representatives from CMH and U-M psychiatric emergency services explained how to navigate the mental health system. Organizations that deal with homelessness also outlined their roles. The second day of training was a closed session in which police officers shared their personal experiences with mental illness.

Eli Lilly—which makes some of those expensive psychotropic drugs—provided an educational grant to cover expenses for the training. Sheikh is still looking for funding to make the team fully operational. Following the Memphis model, he’d like to see officers going to the shelter and other gathering places to meet the homeless and mentally ill, building personal relationships that may help to defuse future conflicts.

It’s a long way from traditional police work, but the evolution makes sense to Jack Foster. The officer who confronted Brian Williams at the Blake Transit Center was among those who took part in the training.

“This is a community issue that we must strive to solve as a community,” says Foster. “Because no one wants a situation like what happened in Kalamazoo.”