Hard Choices

Advocates for mentally ill push for care before crisis

Posted January 23, 2013

— Gun control and security measures often get much of the attention following a mass shooting. Another part of the equation is mental health, a challenge many of the shooters dealt with. Investigations have revealed many of the shooters had a history of mental illness. The availability of care can determine if the state is doing enough to prevent the next mass shooting from happening in North Carolina.

For Cathi Zichi, looking at old pictures of her son brings back good memories. Now 33, Tony Zichi is in a state psychiatric hospital in Butner, suffering from paranoid schizophrenia. Cathi Zichi drives from her home near High Point to visit her son about every three weeks.

As a child, Tony Zichi was smart and athletic. He earned a scholarship to an elite private high school based on teacher referrals, test scores and his IQ.

At age 20, Tony Zichi was diagnosed with a severe case of schizophrenia. That same year, his mother says she told mental health officials he was dangerous and that he was going to hurt someone. No one listened, she said.

From 2000 to 2005, Tony was placed in about a dozen group homes in three different counties.

“He had hit people in the face in more than one group home,” Cathi Zichi said, adding that her son also fired a gun several times in a group home and stabbed someone in the neck with a pencil.

Jail cells and hospital rooms became her son's temporary home away from home.

“They would basically put him in confinement, because the jail wasn’t set up to know what to do with him, and that was just a short term thing until they let him back out,” Cathi Zichi said.

She pleaded for long-term hospitalization to get her son the care he needed as well as to protect the people around him. She says he didn't qualify.

“He was going to be released to the streets with no medicine, no place to live, unless I stepped in,” Cathi Zichi said.

In 2005, her son was charged with first -degree murder. One night, he grabbed a knife from the kitchen because he thought he saw his 85-year-old roommate, Ruth Terrell, covered in rats.

“He jumped on top of her and, from what he said, he was trying to kill the rats because he knew they were hurting her,” Cathi Zichi said.

Multiple surface cuts covered the elderly woman's upper body. She had to be hospitalized and later died of other complications.

“That should not have happened. The mental health center should have stepped in when they got the call the day before that he was having unusual hallucinations,” Cathi Zichi said. “I feel the system failed him.”

In addition to failing her son, Cathi Zichi says she believes the system failed Terrell and her family as well.

Advocates push for mental health funding

Deby Dihoff, executive director of National Alliance on Mental Illness North Carolina, agrees and says “the right services should have been there” for Cathi Zichi’s son.

“I think it could happen (again), because we’re just not where we need to be right now,” Dihoff said. “Sadly, I do think people almost do have to commit a crime to get the services they need, which is usually a hospital bed.”

Dihoff says the state’s mental health system needs more money, adding that it’s generally “far underfunded.”

“But the other thing we need to do better is to do better with the money we do have by better coordinating it, making it less fragmented, making it easier for somebody like Tony Zichi to get his needs met,” she added. “We’re stuck in a reactive mode, basically.”

Deby Dihoff, executive director of National Alliance on Mental Illness North Carolina Mental illness advocates push for care before crisis

State Rep. Nelson Dollar, R-Wake, acknowledges that managing North Carolina's mental health needs is a major challenge. Over the past decade, the state's mental health system has undergone various reforms. The latest ongoing effort is two years in the making.

“The gaps we’ve seen in the mental health system in the past have been very significant and have had significant impacts,” Dollar said. “We’ve seen a conversion to a system we believe will far better manage the mental health dollars we have in this state and, more importantly, better manage the care of individuals who suffer from mental illness.”

Republican leaders in the General Assembly have indicated the solution is controlling costs, not more money.

“The resources are going to be relatively flat for the foreseeable future. We know that,” Dollar said.

Dihoff says that’s “a problem … a big problem.”

Mother pays thousands to help explosive, aggressive 7-year-old

WRAL News recently spoke with a woman whose 7-year-old daughter is battling mental illness – a mood disorder, anxiety and attention deficit hyperactivity disorder. To protect their identities, WRAL News agreed to refer to the mother as “Ellen” and the daughter as “Emily.”

“We need more accessibility,” Ellen said. “It’s sad and frustrating … I don’t want her to be teased for something that’s not her fault.”

Emily is explosive and aggressive, “so any tiny little thing can set her off, and you can’t control it,” her mother said, adding that the episodes typically happen at home with family and often with her younger brother.

“She’s been hurting him since he was born. Even when he was a tiny baby, she would stop, take off a shoe and hit him in the face,” Ellen said. “So, we locked his door from the very beginning at night.”

It too Ellen and her husband years to even begin to understand how to navigate through the system, which she described as “just going from place to place.”

“It’s frustrating. It’s a very individual process,” Ellen said. “We have paid tens of thousands of dollars out of pocket for services we thought we needed.”

Ellen says she believes insurance companies often just make it harder on families.

“It has been very difficult, and it does feel a lot of the time like they’re trying not to pay for things,” she said. “And it makes me angry for someone else to tell me that my child does not need what I know my child needs.”

Psychiatrist: ‘It’s about breaking down the barrier to stigma’

Dr. April Harris-Britt is a psychologist in Durham. Dr. Amy Fairchild is a psychiatrist with a private practice in Cary. Both take issue with the higher deductibles, higher co-pays and lack of access for mental health care.

“There’s not quite the party between mental health and physical medical health,” Harris-Britt said. “It can pretty much, you know, eliminate the possibility of getting any type of services.”

“It’s about finding an equal playing field with mental health and medical help, and it’s about breaking down the barrier to stigma,” Fairchild added. “We are seeing sicker and sicker children and families in more crisis because they are waiting because of a financial barrier.”

One of the stigmas is the stereotype that people with mental illness are violent and will either hurt themselves or someone else. Experts say that's not always true and that a majority of people with mental health issues are not violent or aggressive.

“When it goes untreated, mental illness, then that’s when we need to start being concerned,” Harris-Britt said.

Whether it's Aurora, Colo., or Newtown Conn., many in the public say it's not a matter of if another mass shooting will happen, but when and where.

“The best prevention is to try and make sure preventative services are there,” Harris-Britt said. “There are some limits on preventative services. You don’t go in somewhere saying, ‘I want to make sure it doesn’t get that bad.’ It’s usually in the point of crisis where people are getting services.”

Pat McCrory, North Carolina's new governor, says he believes the state's focus should not be on changing gun laws but rather focusing on the mental health system, a system he says is broken.

“We’ve got a lot of laws on the books,” he said. “If you look at all these incidents throughout the nation, it’s been these loners that have serious, serious issues.”

Harris-Britt and Fairchild say everyone can play a role in trying to prevent a tragedy. They suggest paying attention to the warning signs and risk factors, such as someone feeling marginalized and not accepted or being the victim of bullying or abuse.

“It is perplexing when you have young adults and teenagers that can plan and plot. And how do people not know?” Fairchild said. “It’s really about connecting with your loved ones about how they’re doing.”

Report: 75,000 NC public school students have mental illness

As of the most recent report in 2011, North Carolina's public schools, K-12, were aware of more than 75,000 students with a mental illness. There are likely thousands more children that school systems are not aware of.

“It’s incumbent on advocates to say, ‘We need more money to create a system that we need, so we don’t have things like Sandy Hook,” Dihoff said.

Cathi Zichi says she always feared her son would hurt someone and says she thinks he was capable of a mass killing similar to the one at Sandy Hook Elementary School in Connecticut.

Tony Zichi has spent the past seven years in a North Carolina psychiatric hospital, the very place his mother long begged for him to be, but it took someone's death for him stay long term.

“He is no longer violent or assaultive. It’s what he needed years before,” Cathi Zichi said. “And I often wonder if that had happened sooner what his life could have been.”

The state's psychiatric hospitals are currently bursting at the seams. During the past fiscal year, patients in crisis had to wait, on average, more than three days for a spot to open up at the state's newest facility in Butner. During the past six months, patients trying to get in had to wait even longer than they did last year, about three-and-a-half days.

This story is part of WRAL's prime time special "Soft Targets, Hard Choices." We welcome your comments and questions. Send email to hardchoices@wral.com or use #hardchoices on Twitter.


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  • affirmativediversity Jan 25, 2013

    The Democratic Party, Obama and every other progressive are not even remotely interested in people with mental illnesses...the are 100% obsessed with "new controls" on everyone.

    The mentally ill...just like people with disabilities and seniors are good for nothing other than poster children for some hack job scare campaign.

  • Gork Jan 24, 2013

    AND, even if you have health insurance, the "facilities" I called for a daughter wanted the potential $10,000 co-pay UP FRONT - of course, there is no guarantee their facility would be of any help whatsoever, but they want the cash. It's a racket, preying on people who need help.

  • Paynattention Jan 24, 2013

    I submitted a comment after the presentation last night, questioning the statement about going to the WRAL website to find Mental Health Resources, and it was not published. Cover up. It takes 3-4 wks. to get an appt with a mental health provider.

  • billybob72 Jan 24, 2013

    Dorothea Dix Hospital never should have been closed. Those missing beds are desperately needed. Sure, Dix had problems in the past. But a new management team put in place around 2000 really turned it around and improved it greatly. Not perfect, but vastly better. I know, because I worked there at that time and knew them. Closing Dix was a huge mistake by Easley.

  • almagayle50 Jan 24, 2013

    It's my understanding that the recent death at Central Regional was another case of mechanical restraints and the patient being left alone to choke on his own vomit. Nothing will change. The family has no plans to sue.

  • mford20 Jan 24, 2013

    "The state's psychiatric hospitals are currently bursting at the seams." The average wait is 3.5 days and the actual inpatient time is 5 days or less. It takes 2-3 months for some meds to take effect. How is a patient to ever recover? We need more hospital beds. Now. Nothing else will work.

  • happy4ver Jan 24, 2013

    I have always caught news reports and articles about how lacking mental illness help in NC is...well in the last few weeks I have definitely learn this, first hand. My dad is suffering from dementia. For those fimilar with the term, he has sundowner's pretty bad. After four days of not sleeping and getting incresingly agatated, we went to seek help. He was co-operating to do a self commit in a county medical hospitaly mental unit. They placed my Dad in a 6x8 room with nothing but a slab for a bed, for 8.5 hours and said that he did not meet their critieria for admit. Take him back home, another episode another visit to the ER, again did not meet their criteria. So we to followup with primary care physician, had to see the walk in DR. This man told me to go to the magistrate to have my dad involuntary committed and he would be able to go to the place of my choice. BIG FAT LIE. Thank good the magistrate was able to give me the correct information. So go to another ER, they had better acc

  • Scubagirl Jan 24, 2013

    How sad it is that one must harm or kill someone else to get the help they need.
    It's backwards! and something needs to be done

  • nic Jan 24, 2013

    Thank you Cathi for sharing Tony's story. I've worked at Dorothea Dix and at Central Regional Hopsital and see first hand the revolving door of patients just being pushed through the system due to lack of money. Many patients stay short term and are readmitted just days or weeks later and this continues until they finally hurt someone and are admitted to our forensic unit. It is a sad situation and co-pays of $64 to see a psychiatrist do not help. Many people wait until they are in true crisis because they can't afford the co-pays. I personally had a family member try to kill themselves and they waited in the ER for 3 days waiting for a psych bed with no meds or treatment, just a babysitter to sit and watch them. Once a bed was open they started on meds and were discharged two days later. A week later a second attempt was made and the process started all over again. The system needs to be fixed.