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David Ray Clarkson Jr., 23, loved to make people laugh.
He loved telling jokes, according to his mother, Tammy Lawson. And, he was always popular with the girls because of his good looks, she said.
But, Clarkson, like millions of Americans, suffered from mental illness.
He was diagnosed as being bipolar and schizophrenic. He would see imaginary people and hear voices.
“You really don’t understand the illness until you live with somebody who has it,” Tammy Lawson said. “Mental illness is like a cancer of the brain. It takes over the mind.”
Eventually, Clarkson became convinced that people, including his friends and family, wanted to harm him.
On May 30, 2012, Clarkson was sent to Eastern State Hospital in Lexington and was labeled “high risk” for suicide. However, after being assessed, he was sent home in a taxi. Three days later, he committed suicide.
Members of Clarkson’s family believe if he had been admitted to Eastern State Hospital that night, he would still be alive today.
“If you go to a hospital and say you’re suicidal they should take it seriously and keep you,” said April Lawson, Clarkson’s sister.
“They knew he was suicidal. He still didn’t get the help he needed,” Tammy Lawson said, tears welling up in her eyes. “They should have kept him and not let him leave until he was OK.”
But, Clarkson’s story goes far beyond his treatment, or lack thereof, at Eastern State Hospital. His story is a sad example of the challenges people with mental illness face in this state and country. And, unfortunately, his story is just one of many.
The first signs something was wrong…
David Ray Clarkson Jr., affectionately known as “Bubba” to his mother, didn’t begin showing signs of mental illness until his early 20s. However, he told a family physician that he began experiencing symptoms when he was 8 years old, his mother said.
And while Tammy Lawson didn’t notice any symptoms when her son was young, she does remember an incident when he was 10 years old.
“He was outside playing and he said he saw a little girl running after him,” she said. “But no one was there.”
His symptoms didn’t become noticeable until he was around 20. And those symptoms worsened when he was wrongfully indicted for rape in January of 2009, according to both his mother and sister.
“That’s when it really started,” April said, “He didn’t trust anyone. He thought people were out to get him.”
According to the indictment, which ran on the front page of the Jan. 14, 2009 edition of The Lebanon Enterprise, on or about Oct. 11, 2008, Clarkson engaged in sexual intercourse with another person by forcible compulsion.
“When he saw his face on the front page of the newspaper it tore him apart,” Tammy said. “He would hardly go out in public.”
According to his family, there was no evidence of rape but Clarkson didn’t want to go through a trial, so he accepted a plea deal and the rape charge was downgraded to a misdemeanor. Court records show that Clarkson entered an Alford plea on July 31, 2009, and pled guilty to sexual misconduct, which is a Class A misdemeanor. Under the Alford plea, the defendant does not admit guilt but admits that sufficient evidence exists with which the prosecution could likely convince a judge or jury to find the defendant guilty beyond a reasonable doubt. Clarkson was sentenced to 24 months of probation and was ordered to pay $500 to reimburse the victim for counseling she received.
Being publically accused of rape changed Clarkson, according to his family, and Tammy began to notice significant changes in her son.
“He would stay up all night. He would turn on all the lights in the house … all the outside lights …” she said. “That’s when he started seeing people that weren’t there.”
But, being indicted for rape wasn’t the first time Clarkson came face to face with the law, and it wouldn’t be his last. Before the alleged rape incident in 2009, Clarkson had a string of criminal charges, including second-degree wanton endangerment, assault, violation of E.P.O./D.V.O., resisting arrest, public intoxication, DUI and possession of marijuana.
Clarkson’s family admits that he did experiment with alcohol and drugs prior to being prescribed medication for his mental illness. But, after seeking counseling at Communicare he was prescribed medication that helped him tremendously. However, his delusions continued.
“He thought the cops were out to get him,” April said. “He said they were going to kill him and bury him so nobody could find him.”
One night three officers approached Clarkson and he attempted to flee, April said. He spit at the officers, tried to escape from the patrol car and bashed his head against the patrol car windows, she said. After that incident, Tammy remembers Marion County Sheriff Deputy Anthony Rakes (who was killed in the line of duty in November of last year) told her that her son needed help. But, Tammy said she had a very difficult time getting a mental inquest warrant for her son, which would have required him to receive treatment at a state hospital.
“I didn’t know what to do or where to turn to,” Tammy said.
Assistant County Attorney Lisa Nally-Martin said in order to get a mental inquest warrant a person must show that the individual in question is an immediate threat of harm to themselves or others. The person’s condition has to be a result of mental illness and not because of alcohol or drug related issues, Nally-Martin said.
“If a person is intoxicated or under the influence, even if they are threatening suicide, they will not take them and keep them,” she said.
Nally-Martin said she recalls filing mental inquest warrants for Clarkson, but the hospitals didn’t always keep him for further evaluation.
“It is a very frustrating process and does not always give a family the answers they need,” Nally-Martin said.
Clarkson becomes suicidal…
Last year, Clarkson complained about his medication causing him to gain weight, and requested that it be lowered, which it was. But, in turn, his symptoms worsened, according to family members. He continued to go to counseling, but his delusions returned. He began seeing people again, and became suicidal.
Records show that on May 30, 2012, Clarkson’s therapist sent him to Ephraim McDowell Regional Medical Center in Danville because he was threatening to commit suicide. However, the psych ward was full and no beds were available. The hospital got a mental inquest warrant issued for Clarkson and an officer from the Boyle County Sheriff’s Department transported him to Eastern State Hospital in Lexington.
Clarkson’s family assumed that he would be admitted to the hospital and receive the help he so desperately needed.
But, that’s not what happened.
No will to live…
According to Clarkson’s medical records, which his family obtained from Eastern State Hospital, Clarkson was suicidal and in the past had attempted to kill himself by hanging, cutting his wrist and overdosing.
“Says he has no reason to live, no money, no job, no home, no friends, etc.,” a hospital therapist wrote. (The therapist’s signature is illegible.)
Records also show he was listed as “high” risk for self-harm.
The therapist wrote, “He reports that he has nothing to live for – no home, no job, no income… States that he has become increasingly depressed, anxious and hopeless since Sunday, and has contemplated suicide, though could not identify a specific plan. He reports multiple prior attempts including overdosing, cutting his wrists, and trying to hang himself, but states that it has been two years since his last attempt. Client also reports a history of drug addiction, and confesses that he feels worried that he is at risk for overdosing in his current state of mind.”
According to the therapist’s notes, Clarkson showed no signs of paranoia or delusions, for the most part, and that he just wanted to have his meds readjusted. However, she also wrote, “He states that he is losing the will to live and fears he may try to kill himself again.”
The therapist arranged for Clarkson to have an emergency appointment with his psychiatrist the next morning at 9:15 a.m., and according to the paperwork, inpatient treatment at Eastern State Hospital wasn’t necessary.
“He does have a lot of high risk factors, and poor protective factors; but we were able to arrange for an emergency appointment with his own psychiatrist, and he seemed to feel this would be sufficient to meet his needs,” the therapist wrote. “This less restrictive option seems more appropriate at this time.”
The paperwork shows that Clarkson was transported back to Danville by cab where a family member was to pick him up.
“I can’t imagine what was going through my brother’s head when they put him in that taxi cab,” April said.
Three days after his visit to Eastern State Hospital, Clarkson committed suicide.
While staying with his father in Campbellsville, he overdosed on his medications. His father, David Clarkson Sr., found him on the morning of June 5, 2012, lying lifeless on the bed in his room.
“I was just devastated,” Clarkson Sr. said. “It’s just sad, the whole story.”
He believes Eastern State Hospital sent his son home on May 30 because he didn’t have insurance or the means to pay for any medical bills.
“If they had admitted him that night, my honest opinion, I believe he would be here,” he said. “I watched him beg for help those final days.”
Jimmy Avritt Jr., who represented Clarkson when he was accused of rape, said he doesn’t understand why Clarkson wasn’t admitted to Eastern State Hospital that night.
“It makes no sense whatsoever,” he said. “If they are at high risk for suicide, you hold them for at least 72 hours.”
Avritt clearly remembers Clarkson’s mother going to great lengths to get her son help.
“She kept running into a wall,” Avritt said.
But, sadly, what happened with Clarkson is not unique, Avritt said. He’s had a number of clients who were charged with possession of a controlled substance or trafficking a controlled substance who had serious substance abuse issues themselves. While they would qualify for drug court, they would get rejected because they had mental health issues.
“Drug court’s position is that it’s only set up to help people with substance abuse issues, not mental health issues… but most of these individuals are unemployed and have both substance abuse and mental health issues. They don’t have insurance and they don’t have funds to get treatment on their own. They are literally left with whatever services the state can provide, which are very, very limited. It happens every day.”
Mental health awareness…
Mental health in this country has been brought to the forefront within the past several months, especially after the Sandy Hook Elementary School shooting in Connecticut. In addition to calling for changes in how the country handles gun sales, President Obama recently proposed several provisions to strengthen and expand mental health services. Those provisions include improving mental health and substance abuse treatment for individuals between the ages of 16 and 25, and training more than 5,000 additional mental health professionals to serve students and young adults.
However, at the same time, while President Obama is announcing new provisions to improve mental health treatment in this country, Kentucky Governor Steve Beshear announced recently that the nonprofit Bluegrass Regional Mental Health, which contracts with the state, is eliminating 30 jobs (and not filling 30 vacancies) as a way to reduce its projected $6 million to $7 million operating deficit. The Bluegrass Regional Mental Health-Mental Retardation Board approved the job cuts recently at a meeting of its board of directors. Bluegrass employs more than 2,100 people in 17 counties, and also operates Eastern State Hospital. David E. Hanna, Ph.D., interim president and CEO of Bluegrass, who is also a licensed clinical psychologist, said the cuts will allow Bluegrass to restructure and provide more non-traditional services to those people who desperately need it.
“We are in a very serious financial situation. I’m not trying to downplay that and we certainly regret every position we’ve lost,” Hanna said. “But we are particularly committed to people who have severe and persistent mental illnesses… those conditions that tend to have lifelong challenges to deal with. We’re going to try to continue to make those services available.”
While resources continue to be limited for mental health services, Hanna is encouraged by the recent attention mental health has received from the government and the news media.
“I certainly welcome the renewed interest in mental health services and support for substance abuse treatment,” he said. “People need to be aware that it is a needed service for communities. It is an effective service.”
However, many communities put much of their focus on law enforcement and very little on mental health services, he said.
“Unfortunately, our communities have put a lot more emphasis on dealing with criminal behavior,” Hannah said. “There is more support for law enforcement than there is for treatment.”
And funding has always been an issue. According to Hanna, historically, substance abuse funding and mental health funding have been kept very separate. In Kentucky, if you have a Medicaid card it will pay for mental health treatment but not substance abuse treatment.
“For us as a provider, sometimes it’s been difficult to know just how to address that,” Hanna said. “We’ve had an initiative underway to cross train our clinicians in both mental health and substance abuse treatment to be able to address both issues. Fortunately, there are some efforts underway in Frankfort to change that. There’s some hope that if the Affordable Care Act is implemented that there will be coverage for substance abuse and mental health.”
Often, mental health illnesses and substance abuse problems are intertwined because those that suffer from a mental illness use drugs, alcohol or both to deal with the stresses of their mental illness, Hanna said. More often than not, those same individuals will eventually break the law and end up in the court system. In the end, Hanna said, society tends to see the “problem” and not the “person.”
“Everybody knows somebody who has struggled with depression and everybody knows someone that has struggled with substance abuse,” Hanna said. “It is something that touches every family in Kentucky. Whether a person has a mental illness or not, we need to regard every person in our community as someone with potential strengths and resources and not as a ‘bad person.’ I think sometimes people forget that every single person is important. Everybody has potential within them. Everybody is loved by somebody. Their life has value.”
WHAT THE LAW SAYS
KRS 202A.026 Criteria for involuntary hospitalization.
No person shall be involuntarily hospitalized unless such person is a mentally ill person:
(1) Who presents a danger or threat of danger to self, family or others as a result of the mental illness;
(2) Who can reasonably benefit from treatment; and
(3) For whom hospitalization is the least restrictive alternative mode of treatment presently available.
“The last one is difficult for people to understand,” David E. Hanna, Ph.D., interim president and CEO of Bluegrass Regional Mental Health, who is also a licensed clinical psychologist, said. “There are many people in our communities who chronically think about hurting themselves or hurting somebody else but they can be treated with various kinds of outpatient support. It is always a balancing act between protecting an individual’s civil liberties versus the restrictions that would be necessary to ensure safety.”
According to Hanna, the law says if there is an alternative treatment available then you can’t hospitalize someone against his or her will.
“People would like to be able to do more than sometimes the law allows,” he said. “The language in the law is very clear.”
What is mental illness?
A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible.
Mental illnesses can affect persons of any age, race, religion or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.
* Source: National Alliance on Mental Illness.
To learn more about mental illness and to read about treatment, support and programs, go to the following website: www.nami.org