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Mental Disorder

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For mentally ill children in N.C., a weak network of services

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For 14-year old Zachary, home is a maddening rotation of hospitals and group homes, where doctors and therapists try to calm his troubled mind.

The good places bring weeks or months of stability as doctors fine-tune a cocktail of medications to rein in his bipolar disorder and frequent outbursts. The bad ones bring him more chaos as staffers struggle to control Zach’s illness, given his low IQ and lack of impulse control.

For Zachary’s adoptive parents, Cathy and Latham Hamner of Raleigh, the past decade has been a trial as they try to parent in a state that has long struggled to care for its fragile youth. A scant network of facilities in the state serves children with complex and profound problems such as Zachary’s, so hundreds are forced to seek care in neighboring states.

After a violent outburst last year, Zachary went to live at a psychiatric residential treatment facility in Rock Hill, S.C. The managed care organization that handles Zachary’s Medicaid services says he’s stable enough to leave. Zachary will move this week to a group home in Concord, outside Charlotte.

Cathy Hamner knows this cycle well. Each stay in a facility is a brief detour along a hopeful path toward Zachary’s homecoming. His stability is fleeting, and he eventually unravels. Back to the hospital, then to another group home.

“We’d love to have him home, but each time, I feel like we keep setting him up for failure,” Cathy Hamner said.

Zachary’s life has spanned more than a decade of failed reforms of North Carolina’s mental health system. The courts have held repeatedly that people with mental illness and other disabilities are entitled to be home, near their families, in a place that brings as many of the comforts and freedoms of independence as possible. The lack of facilities for children affects families regardless of income, although well-off families would have chances to find care far away.

The state’s efforts over the years to shutter state hospitals that warehoused the mentally ill in favor of services in communities has been fraught with abuse and scandal. The state has cut some medical services for the poor and disabled and has relied on a patchwork of private facilities to treat and stabilize those with disabilities. But as state leaders shift policies and priorities, the facilities come and go.

“Our system needs more services for kids closer to home,” said Corye Dunn, director of public policy for Disability Rights North Carolina. “We need a system that’s more nimble to respond to these families’ needs. We rely on the private sector, but if they can’t do it, someone else has to.”

In mid-July, 208 N.C. children with mental illness were receiving care at a psychiatric residential treatment center outside the state, while 355 were getting care at such centers in-state. The state has been working to lower the number being served out of state and since last year, the number served out of state dropped from about 300.

In the meantime, families such as Zachary’s try to hold on.

As Zachary’s discharge from a locked psychiatric facility nears, worries wash over the Hamners.

What if he acts out the moment he leaves the structure and security of New Hope Carolinas? What if he tries escaping from his new group home like he has so many times before? Will the school system in Concord be able to help him with his developmental delays? What if his sexual fixations can’t be controlled before he’s 16, when an outburst could land him in prison? What happens when Cathy and Latham, 57 and 60, are no longer alive or well enough to navigate the system for him?

“He’s a child, and every child deserves a chance,” Latham Hamner said. “You can’t get it locked away or bouncing around the system.”

‘Hard to serve’

Zachary came to Cathy Hamner as a toddler, shy and hyperactive. Social workers took him and his siblings away from their parents after neighbors saw the children begging for food and rummaging through Dumpsters for scraps.

Hamner had always wanted to be a mother. She had spent her career traveling the country as a pianist with an opera company and never settled down. At age 45, she decided she could take care of some of the state’s most fragile children.

In 2000, Wake County social workers delivered Zachary and his 4-year-old sister to Hamner’s home. Soon, social workers figured out that Zachary’s sister had significant mental health issues and needed more intensive care than Hamner could provide. As Hamner left the little girl at the psychiatric hospital crying and screaming, she made a promise to herself: She would never abandon Zachary.

Hamner adopted Zachary after the courts gave up on his parents’ ability to take care of him. She still remembers the social workers’ assurances: Don’t worry. You aren’t alone. We’ll be here every step of the way. We’ll provide for his medical needs.

Zachary’s needs became vast. He got kicked out of daycares for throwing tantrums, biting other children and fondling himself. Hamner had to quit her job to take care of him. A few years later, she met and married Latham, and the two began juggling Zachary’s care.

The first psychiatrist to see Zachary, when he was 4, hazarded a diagnosis: childhood bipolar disorder. The specialists who’ve evaluated Zachary since have come to the same conclusion.

Cognitively, he’s far behind his peers. Tests register his IQ in the mid-60s, a number that secured another label for Zachary: developmentally disabled. The combination poses tremendous challenges for therapists and teachers; treatment and methods that can help with one may exacerbate the other.

Zachary’s moods swing wildly between sweetness and violence. He fidgets constantly, and when he’s anxious, Zachary acts out sexually, masturbating in public or stealing women’s underwear. He has escaped from group homes to shoplift underwear from nearby stores; more than once, he has sneaked out of the Hamners’ Raleigh home to steal undergarments from neighbors.

In the last eight years, doctors committed Zachary to acute psychiatric hospitals nine times, records provided by the Hamners show. He’s moved through four different group homes and seen dozens of doctors and therapists. Zachary now carries another label: “hard to serve.”

On a good day, psychotropic and stimulant medications slow Zachary down just enough to remind Cathy of the sweet, cuddly boy she welcomed into her home years ago. On the worst days, Cathy is terrified of her own child.

Last year, a group home aide dropped Zachary off at Holly Hill Hospital in Raleigh, an acute psychiatric hospital. Staff at the group home had decided they couldn’t handle Zachary’s outbursts. But doctors at the hospital couldn’t admit Zachary since he posed no danger to himself or others. The Hamners brought him home and held their breath as they waited for another crisis.

Alone with her son one day after Latham left for work, Cathy saw a familiar look of detachment stretch across Zachary’s face.

A few moments later, Zachary was choking her with a belt from his robe. Cathy eventually managed to talk Zachary down enough to break free and call police.

“I threw up my hands,” said Latham Hamner, who rushed home from work. “I told the officer to take him. He wasn’t safe here, and we weren’t safe, either.”

The officer took Zachary to a crisis assessment center for monitoring. After five days, doctors said he was stable enough to be discharged. A group home in Fayetteville agreed to take him. Within a few months, though, that arrangement fell apart when Zachary escaped from the home and ran across a busy highway to steal underwear from a nearby store.

Help in S.C.

Every other week since September, Cathy and Latham Hamner have driven three and a half hours one way to remind their son that he has parents who love him.

New Hope Carolinas is a private facility located in an old hospital just over the border of South Carolina near Charlotte that has been converted into a locked treatment center for boys and girls with mental illness and behavioral problems. Children who end up there mostly come in crisis – a court referral or a step-down from an acute hospital. They are expected to stay only as long as it takes to stabilize them. Staffers document every tiny bit of progress or regression , from good handwriting to biting.

During a visit last month, Zachary slid closer to his mother on the couch of a sterile visiting room and asked if he could hug her. He squeezed too tightly, and Cathy reminded him to be gentler with his affection. Zachary talked frenetically about a movie he watched about aliens and the end of the world. Nearly 15 and 6-foot-1, he towers over both his parents. But his words and ideas are simple, more child than teen.

Zachary looked away when asked if he knows why he ended up at New Hope. He recited an answer he has been fine-tuning in his regular therapy sessions: “I did something bad. I’d rather not go back into the past. I like to think of the future, like when I’ll get married and have kids and get jobs.”

Near the end of their visit, Zachary asked his parents when he can come home. Cathy Hamner told her son the truth. She doesn’t know.

Back in the car, guilt ate at Cathy.

She didn’t agree to become a mother to keep her son locked away at a facility so far away. Guilt faded to frustration when she thought about the social worker who promised the state would help care for her fragile son.

As the Hamners eased into a rush-hour gridlock outside Charlotte after their visit, all of Cathy Hamner’s anger and disappointment dissipated.

She thought about their outing that afternoon to a nearby frozen yogurt shop. As Zachary devoured a bowl of yogurt, everything felt wonderfully normal.

Just like that, the same sweet feeling that has carried Cathy Hamner from one day to the next since she first saw Zachary returned. It was hope.

Locke: 919-829-8927
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