Adam Aurand spent nearly a decade of his life stuck in a loop.
He cycled for years among emergency rooms, psychiatric hospitals, jails, and the streets in and around Seattle. During that time, he was diagnosed with schizophrenia, bipolar disorder, and schizoaffective disorder. He also used opioids and methamphetamine.
Each time he entered an institution for care or incarceration, he was released back into homelessness. And the cycle started again.
“I don’t know what the answer is, but I know that wasn’t the answer,” said his mother, Heidi.
In 2023, when Aurand was discharged from Washington’s largest psychiatric hospital and dropped off on the streets of downtown Seattle, she made a last-ditch effort to interrupt this pattern. This week on Reveal, with reporters from the Lost Patients podcast by KUOW and the Seattle Times, Aurand’s mother shares her attempts to save her son from “the churn” and the forces that pulled him back in.
This churn has contributed to the rising visibility of people in mental health crises on the streets of US cities. It’s fed a political narrative that American cities have fallen into chaos and decay. And it’s powered efforts from New York to California to add psychiatric hospital beds and make it easier to institutionalize people against their will.
This is an update of an episode that originally aired in July 2024.
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Dig Deeper
Listen: Lost Patients (NPR, KUOW, and the Seattle Times)
Read: The Lost Patients of Washington’s Abandoned Psychiatric Hospital (Seattle Times)
Read: How Washington’s Mental Health Labyrinth Claimed a Life (Seattle Times)
Credits
Reporters and producers: Will James, Sydney Brownstone, and Esmy Jimenez | Producer: Najib Aminy | Editor: Liz Jones | Additional editing: Diana Samuels, Jonathan Martin, Brendan Sweeney, Marshall Eisen, and Jenny Casas | Production managers: Steven Rascón and Zulema Cobb | Music: B.C. Campbell | Sound design: Jim Briggs and Fernando Arruda | Digital producer: Nikki Frick | Interim executive producers: Brett Myers and Taki Telonidis | Host: Al Letson
Lost Patients is a production of KUOW and the Seattle Times.
Support for Reveal is provided by listeners like you, and the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Robert Wood Johnson Foundation, the Park Foundation, The Schmidt Family Foundation, and the Hellman Foundation.
Transcript
Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.
| Al Letson: | From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. | |
| For as long as his family can remember, Adam Aurand wanted to fix things. | ||
| Heidi Aurand: | As a kid, like 6, 7 years old, he’d go get lawnmowers that adults had given up on, put them back together, and they’d run. | |
| Al Letson: | Heidi Aurand is Adam’s mom. She has a photo of Adam from when he was even younger, around three years old. He’s underneath his red, yellow, and blue tricycle, a Big Wheel, pretending to be a mechanic working under a car. | |
| Heidi Aurand: | That is Adam. He was working on his Big Wheel. He was going to fix it. | |
| Al Letson: | Adam grew up to be an actual mechanic, giving new life to banged-up cars up and down the Pacific Northwest. | |
| One night around 2013, Adam calls his sister Bethany in the middle of the night. | ||
| Bethany Anderson: | It was probably midnight, 1:00 in the morning, and my oldest brother, he gets a call and I get a call, both from Adam, telling us that there’s somebody there outside of the shop. | |
| Al Letson: | It wasn’t what Bethany and her other brother expected. | |
| Bethany Anderson: | And I remember Jason and I, we both pulled up and we were like, “What’s going on?” There was no one there. | |
| Al Letson: | Adam was showing signs of paranoia. At one point he attacked a couch in his mother’s house with an ax. And later, Adam talked about this light inside of him that he believed could protect and heal those around him. | |
| Doctors would eventually diagnose Adam with schizophrenia, bipolar disorder, and schizoaffective disorder. Adam’s family isn’t sure when it started, but at some point, Adam also started using heroin and meth, and it became increasingly difficult to untangle which had become the cause and which was the effect. | ||
| Adam spent about eight years of his life, almost all of his thirties, cycling in and out of jails, emergency rooms, short hospital stays, and a stint in prison. Adam would ultimately end up living on the streets, becoming caught in what is often referred to as the churn, when someone with serious mental illness goes in and out of different treatment systems, often for years, without getting the lasting help they need. | ||
| In 2022, state authorities committed Adam against his will to Washington’s largest psychiatric hospital, Western State. Adam’s family hoped he would get the help he needed. | ||
| Heidi Aurand: | I was excited that maybe somebody was going to get to the bottom of the mental illness and help him. | |
| Al Letson: | But unfortunately, that’s not what happened. | |
| Today, we’re revisiting an episode we made in partnership with the podcast from KUOW and The Seattle Times called Lost Patients. It takes a deeply reported look at failures in mental healthcare through stories based in Washington State. | ||
| Reporter Will James picks up the story with what happens to Adam after he gets committed to the state hospital. | ||
| Will James: | There’s not a lot of publicly available information about Adam’s time at Western State, but we know from his family that he was put on medication and it seemed to be working. | |
| Heidi Aurand: | When he was on the medication at the mental hospital, I talked to Adam every day. Sometimes I talked to him twice. | |
| Will James: | That’s Adam’s mom, Heidi, again. These cogent conversations were a huge change compared to how Adam was before his hospitalization. Adam’s sister, Bethany Anderson, agrees. | |
| Bethany Anderson: | Once the fog lifted, we were having normal conversations we used to have. He has a normal sense of humor. His calm demeanor was back. You could tell he was depressed. You could tell he didn’t want to be there, but he was fine. There was no voices. At his worst, he would talk to the side like this, like this, like this, like this, and real deep. That wasn’t happening. | |
| Will James: | But Adam’s mom, Heidi, also noticed some things that worried her. Adam seemed to avoid talking to staff in the hospital and spent a lot of time walking the hallways alone. It went like this until about nine months into Adam’s stay when his family learned he was going to be discharged. | |
| My reporting partner, Esmy Jimenez, spent months digging into Adam’s case and asked the state why they released him | ||
| Esmy Jimenez: | On January 6th, 2023, the treating psychologist noted that Mr. Aurand did not meet commitment criteria and is completely asymptomatic. So, effectively, Adam is not having the best judgment as to what choices he should make perhaps, but he’s not gravely disabled. He’s not hurting himself or others, therefore he doesn’t meet the bar for civil commitment. | |
| Will James: | Adam was held at Western State as a civil patient under the state’s Involuntary Treatment Act. Every 90 or 180 days, someone from the hospital had to go back to court and argue Adam was still either a danger to himself, a danger to others, a danger to someone’s property, or gravely disabled. And at a certain point, they opted not to go back to court to try to renew Adam’s commitment again. | |
| Aaron Goddu oversees the discharge process for Western State Hospital and other state institutions in Washington. He’s in charge of a team of social workers who figure out where someone goes next as they get ready to leave Western State. | ||
| Aaron Goddu: | The decision to not refile for a continued commitment is based on the fact that the patient no longer requires active treatments. | |
| Will James: | Aaron said he couldn’t talk about Adam specifically because of patient privacy rules, but he could speak to the process generally. | |
| Aaron Goddu: | If they’re no longer requiring active treatment, it’s unethical for us to continue to keep them detained at a facility for any longer than they should be. | |
| Will James: | The team of social workers that Aaron leads help line up homes and follow-up care for patients like Adam as they get ready to leave the hospital, but they can’t force Adam to go anywhere. All they can do is offer placements in facilities that could be helpful. | |
| Aaron Goddu: | We have to work with the patient and say, “We have this opportunity at this enhanced service facility. It will require you living there. There’s going to be staff on site. There’s going to be some level of engagement. You’ll have to agree to that, but we can’t force you to go there.” | |
| Will James: | Social workers asked Heidi if she could take in Adam at her house in Portland, Oregon. Adam hadn’t lived with his mom for about a decade. | |
| Heidi Aurand: | I do not know anything about mental illness. I do not know how to deal with it. And my meaning maybe was not clear, but my meaning was I need help with that. I can’t do that on my own. | |
| Will James: | As Heidi tells it, she didn’t write off the possibility of taking in Adam at her house. She just wanted some kind of professional support. | |
| Just before Adam was discharged from Western State, his mom noticed something was wrong. | ||
| Heidi Aurand: | Right before he left, he started talking to himself. I could hear it. And then he said the light would take care of him. So, no, he wasn’t okay. | |
| Esmy Jimenez: | I remember you had sent emails to the social worker when you learned that he was being discharged, and you had said, “Hey, Adam’s telling me about this light.” What was going through your head at that point? | |
| Heidi Aurand: | I was frantic. I didn’t know what to do. I just don’t think they realized or cared because in all the notes, I didn’t see anything where they talked to a psychiatrist and said, “Adam’s talking to himself again.” | |
| Will James: | Aaron says social workers take families’ input into account when they’re discharging a patient, but families’ wishes don’t always line up with the laws the hospital has to follow. | |
| Aaron Goddu: | Just having delusions doesn’t mean that you should be committed at a state hospital. And there are some people in the community that will have continued delusions, and that may just be their baseline, but we really do have to look at it from the civil commitment criteria and our ability to stabilize and to treat and to continue to petition and tell the court that this person’s a danger to others. | |
| Will James: | Ultimately, social workers offered to send Adam to a halfway house and he turned that down, so they discharged him to a homeless shelter. | |
| Esmy Jimenez: | How often do people get discharged to homeless shelters? | |
| Aaron Goddu: | Not often. It’s always our last resort. | |
| Will James: | Some states have made it illegal to discharge someone from a psychiatric hospital into homelessness. Washington is not one of those states. | |
| Heidi decided if Adam was going to be homeless again, she was going to try to prepare him. | ||
| Heidi Aurand: | So, I looked up the streets of where he wanted to go and where the help was, all of that, and I had it all written out so he wasn’t shooting in the dark if he was going to really do this. | |
| Bethany Anderson: | My mom was really on top of it. She was calling, emailing, leaving voicemails for the social worker constantly. She was, “Hey, can we do this? Can we do this?” This is where, as a family, we’re trying our best. | |
| Will James: | Adam was released on February 7th, 2023. Heidi says she was told Adam was put in a taxi and dropped off in downtown Seattle. Records show he was released with his ID, $40 in cash, 30 days of medicine plus a prescription, but the records don’t say what it was for, and a 1-800 number for the county’s crisis hotline. | |
| As we saw in the records, Adam was officially handed off to a homeless shelter, the Bread of Life Mission. When Esmy checked with shelter staff later, they had no record of Adam staying the night there. It’s not clear he ever stepped inside. | ||
| Staff member: | He’s not in our system, so he didn’t stay here overnight. A lot of times, the hospital would release certain people and say, “Go to the Bread of Life Mission,” but that don’t mean that they will come here and stay. | |
| Will James: | Staff told Esmy psychiatric hospitals send patients to the shelter three or four times a month, but they often don’t show up. | |
| Heidi had helped Adam make a plan. After he got released, he was going to head over to a Social Security office half a mile away and sign up for disability benefits so he’d have an income. But right away, that plan fell apart. | ||
| Heidi Aurand: | So, I heard from him the day he was discharged. He was having a hard time. He was at Social Security, but he had lost his bag, which had his release papers. I guess somebody stole his bag. He was borrowing somebody’s phone and we were setting him up with a plan. | |
| Will James: | They decided Adam would buy a phone so they could stay in touch. Heidi waited, but didn’t get another call from him. She started calling homeless shelters, trying to find him. | |
| Heidi Aurand: | None of the missions would let you know whether they saw him. So, I started watching the street cams to see if I saw him. | |
| Esmy Jimenez: | Heidi told me that she found Adam through street cameras. And I remember I was like, “What do you mean?” And she was like, “The cameras in Seattle.” And sure enough, there are these cameras all over downtown Seattle pointing at some of these key intersections. | |
| Will James: | These cameras monitor traffic for the Seattle Department of Transportation. Heidi says she heard about cameras like these on a science fiction TV show called Fringe. She figured out how to tune into their live streams. | |
| Esmy Jimenez: | And she said that she found her son because of the specific gait of his walk. | |
| Heidi Aurand: | So, I took off. I went around to where the fountain was and he wasn’t there, and so I came around this way to the park and he’s over here on the sidewalk. And I said, “Adam, get in the car.” And I don’t know if he recognized me or not, but he got in the car. I tried to talk to him. He was talking to himself. I said, “Did you do drugs today?” And he says, “Well, I smoked something out of a pipe.” And I’m like, “Okay.” And so we talked and I said, “Do you want to come home?” And, “No, I don’t want to go to your house.” And I was like, “Okay.” | |
| Will James: | Heidi got a hotel room for both of them that night. She was trying to buy time to let Adam sober up and to come up with a plan. Maybe she could convince Adam to come home with her. Now that she saw how badly his discharge was going, that didn’t seem like such a bad idea anymore. | |
| Heidi Aurand: | I turned the TV on. I told him, “We can go get you some clothes and you can take a shower.” And I talked to him, and he talked to himself quite a bit. | |
| Adam Aurand: | I’m sorry if I’ve run into you. They don’t want to run into you. | |
| Will James: | This is when Heidi decided to make a video of Adam. She wanted a record of how he was doing just days after leaving Western State. | |
| Heidi Aurand: | Who are you talking to? | |
| Adam Aurand: | You doing all right? | |
| Heidi Aurand: | Yeah. | |
| Adam Aurand: | Can I just be here for a minute without a camera, Mom? | |
| Heidi Aurand: | I don’t to this day know if it was drugs or if it was the schizophrenia. If it was drugs, I was trying to wait him out as long as I could. | |
| Will James: | Heidi says she stayed up watching the news. Some of the stories were about the mental health crisis on Seattle streets. Adam stayed up drinking sodas, not really talking with her. Heidi slept for a couple hours and thinks Adam might’ve slept a couple hours too. | |
| Heidi Aurand: | Then in the morning, I started again. “Do you want to go to the house, get cleaned up, maybe see if we can’t get you some medicine?” And, “Nope, I don’t want to. I’m going to live my life my way.” | |
| Will James: | Heidi got Adam in her car and started driving around, still trying to stall him. She called a crisis hotline and the person on the phone told her to take Adam to a hospital. | |
| Heidi Aurand: | I took him to Swedish because that’s what the emergency people said to do. And he says, “Where are we going?” I said, “Well, let’s go to Swedish and then we can get your paperwork.” He says, “If you don’t turn the car around, I’m getting out.” I said, “Adam, we can get your paperwork.” And he started getting out of the moving car, and so I said, “Fine, we won’t go.” | |
| Esmy Jimenez: | And so at that point, she was like, “Well, what can I possibly keep doing here? I don’t want him to hurt himself while I’m trying to get into the hospital.” So, she gave up on that. | |
| Heidi Aurand: | So, I parked and I let him go. And I called the crisis line and told him he wouldn’t go, and they said they couldn’t do anything, to call the police. So, I called the police. | |
| Esmy Jimenez: | They said they would check up on Adam. She didn’t hear back from police until she left Seattle and drove all the way back to Portland. | |
| Heidi Aurand: | By the time I got here, they had just sent somebody to the park. Just sent somebody. It’s a three-hour drive and they didn’t find him. I don’t know what the answer is, but I know that wasn’t the answer. | |
| Derrick Derricks: | Howdy. | |
| Will James: | Hello, Derrickk? | |
| Derrick Derricks: | Yes. | |
| Will James: | Hey. | |
| Derrick Derricks moved to Seattle from a rural town in Washington. He started a new job in finance and moved into an apartment a few blocks from Seattle’s Space Needle. Esmy and I met him a short walk from where he lives. | ||
| Derrick Derricks: | So, the bus stop right there, I saw him laying on the ground. And then there’s another dude walking and he sprung into action immediately. And he starts giving him chest compression and he puts Narcan up his nose because he’s like, “This guy is not breathing. He’s not responding.” So, I just called the cops. They came. It probably took them 10, 15 minutes to get here. And they tried for a little bit, but they didn’t try very long. And I saw them pretty much wrap him up and put him in the paramedic truck. | |
| Bethany Anderson: | My mom wasn’t going to tell me my brother died. She waited all day. She didn’t tell me all day. Normally, she doesn’t care when my husband’s home, but I had video called her and she asked me if my husband was home. “No. You don’t care. What do you… Why?” “Call me back when he gets home.” And I didn’t think anything of it. I didn’t think anything of it until I went to call her back when my husband walked in the door. And I remember I hit call and it hit me. I was so angry at my brother, but at the same time, I was glad he wasn’t in pain anymore. | |
| Will James: | Adam had overdosed on fentanyl less than a month after Western State discharged him onto the streets of Seattle. | |
| Heidi Aurand: | This is not a one person failure. We all failed Adam somehow or another. | |
| Will James: | Esmy, my reporting partner, collected hundreds of pages of records from the years Adam spent cycling through emergency rooms, psychiatric hospitals, jails, and prison. I talked with Esmy about why this pattern kept repeating. | |
| When you look back at Adam’s story and everything that went wrong, how much of it is the individual aspects of Adam’s story and how much of it is universal problems? | ||
| Esmy Jimenez: | Technically, everything worked right. He went to ERs. The ERs took care of him for the 24 hours that they were going to, made sure he didn’t hurt himself or others, stabilized him, sent him on his way. The jails did what they were supposed to do. He was charged with crimes. They held him. When the court system said, “Well, it was a misdemeanor, it’s not high enough, and Western State has backed up,” dismissed the charges. They let him go. | |
| When I talked to the social workers, when I talked to the ER, when I talked to the police, when I talked to Western, they all think that they did the right thing. And legally, they did. Technically, everything worked exactly as it should. They followed the letter of the law. They said, “Here’s the way that we’re going to interact with this person,” and they provided that limited specific care. | ||
| The issue was that there was nothing else beyond that. So, when you’re looking at actually stabilizing a person like Adam with severe mental illness, substance use, and medical needs, that’s a lifelong commitment to his healthcare, his housing, his ability to live like a full human being just like everyone else. And there’s nothing that does that. There’s nothing that does that in our current setup. | ||
| Al Letson: | When we come back, the team from Lost Patients goes back in time. | |
| John F. Kennedy: | If we launch a broad new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care. | |
| Al Letson: | In the hopes of understanding why the safety net that was designed to catch people like Adam has fallen apart over the years. That’s coming up next on Reveal. | |
| Al Letson: | From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. We’re revisiting our partnership with KUOW, The Seattle Times, and the team behind the podcast Lost Patients, a show that investigates the state of mental health care in the US. | |
| John F. Kennedy: | With respect to mental illness, our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger. | |
| Al Letson: | Back in the 1960s, during John F. Kennedy’s administration, our country’s relationship to mental health care was going through a revolution. For about a century at that point, many people with serious mental illness were treated in state-run psychiatric hospitals held on sprawling campuses where they were sometimes separated from society for the rest of their lives. Depending on the latest trend in psychiatry, doctors might subject patients to forced sterilizations, induced comas, lobotomies. But President Kennedy had a new vision, shutting down these asylums and transferring patients to smaller treatment centers in their communities. This was based in part on the idea that newly discovered anti-psychotic drugs could cure people with conditions like schizophrenia. In 1963, Kennedy signed the Community Mental Health Act, setting aside $150 million to build and staff 1500 community mental health centers around the country. | |
| John F. Kennedy: | We launch a broad new mental health program now. It will be possible within a decade or two to reduce the number of patients now under custodial care by 50% or more. | |
| Al Letson: | This marked the beginning of a process known as deinstitutionalization, and over the next 50 years, the US would see more than 80% of state psychiatric beds vanish. Reporter Will James takes us back to the 1980s, when it had become painfully clear that deinstitutionalization had gone disastrously off course. | |
| Newsreel: | From National Public Radio, this is Horizons. | |
| Will James: | This NPR story from 1984 documents a phenomenon people were seeing in cities all around the US at that time, a rise in people who seemed seriously mentally ill and were living on the streets. | |
| Newsreel: | In this edition of Horizons, Frank Stasio reports that some experts fear the streets have become the asylum of the ’80s. | |
| Frank Stasio: | After more than two decades, deinstitutionalization has yet to be carried out as it was first planned. While hospitals have emptied their beds, follow-up care is erratic and often neglected. | |
| Will James: | By the early ’80s state psychiatric hospitals had been shrinking and closing for two decades. Meanwhile, the rollout of community care was slow, and eventually those efforts stalled because of funding problems. A decade and a half after Kennedy called for 1,500 community mental health centers, only half of those were built. | |
| Frank Stasio: | Patients left the hospital for locally-operated halfway houses and community mental health centers, but the dollars never followed. | |
| Will James: | The community mental health centers that did exist provided a mishmash of different types of care. While these centers technically treated mental illness, many of them catered to people who were very different from the patients who had been at state psychiatric hospitals. | |
| E. Fuller Torre…: | The community mental health centers, with only rare exceptions, have never picked up and taken care of the seriously mentally ill. | |
| Will James: | Psychiatrist E. Fuller Torrey spoke with NPR in 1984. Fuller Torrey would later become a leading voice calling for more involuntary commitment. Back then, he was reflecting what a lot of mental health workers were seeing. | |
| E. Fuller Torre…: | The community mental health centers have been middle-class psychiatry for people with problems of living. They have not confronted the problem of people with schizophrenia, manic depressive disorder, and the severe mental illnesses. | |
| Will James: | It was clear by this point that the anti-psychotic drugs that had given psychiatrists so much optimism decades earlier, the drugs that set the stage for deinstitutionalization did not work as well as they had hoped. It turned out these drugs were useful tools for managing psychosis but not a cure. By the ’80s, there had been no major advances in these drugs for three decades. | |
| There was something else going on too, something that’s often unappreciated in the story of how deinstitutionalization contributed to people with serious mental illness ending up on the streets. Kennedy’s vision was to treat patients “in their communities and homes.” Community care assumed that seriously mentally ill people could find places to live. From the 1970s onward, in many cities around the US, homes for the poorest people were disappearing. | ||
| Kim Hopper, an anthropologist who has studied mental illness and homelessness, also talked with NPR in 1984. | ||
| Kim Hopper: | The difference between the absolutely abject marginal population today and the absolutely abject marginal population of 15 years ago is that 15 years ago they could afford crappy housing, and today there isn’t even any of that. | |
| Will James: | Here in Seattle, the city’s center was home to canyons of residential hotels where for decades, thousands of the city’s poorest people could rent a room for a few dollars a week. These were called single-room occupancy buildings, or SROs. Many were fire traps and poorly maintained, but SROs were a reliable source of housing. Someone could afford on government assistance or poverty wages. Just as deinstitutionalization swept the country, these residential hotels got regulated and redeveloped out of existence, sometimes transformed into more upscale apartments. | |
| Sydney Brownsto…: | This is an era of massive change for the most vulnerable people in our society. | |
| Will James: | Sydney Brownstone is an investigative journalist at The Seattle Times who dug into the impact of this time period for our podcast series. | |
| Sydney Brownsto…: | And yet that wasn’t really felt by middle-class or otherwise comfortable people at all. It went by without a lot of comment, without a ton of political strife, and we carried on as if things were normal, until we fast-forward 20 or 30 or 40 years and all of those decisions that we made are breaking through the surface. | |
| Will James: | Sydney was searching in The Seattle Times archives for evidence of what happened to the lost patients of hospitals that closed around here, hospitals like Northern State, a sprawling psychiatric complex that first opened in the early 1900s and was closed during deinstitutionalization in 1973. In the archives of stories about Northern State, Sydney stumbled on a missing link connecting the era of deinstitutionalization to today. | |
| Sydney Brownsto…: | Oh, wow. The headline of this piece is The Mentally Ill Victims of an Experiment that Failed, and this is how it begins. “Crowds rush past them on downtown streets pretending not to hear their confused or angry chatter. They are studiously…” | |
| Will James: | Sydney noticed this story from 1981 had some of the same language she used in her reporting on homelessness more than four decades later. Even the institutions were the same. | |
| Sydney Brownsto…: | Oh my God, this paragraph was written in 1981. “Many mentally ill people find themselves caught in a revolving door that leads them from Harborview Medical Center to Western State Hospital, to a place like the Downtown Emergency Center in the Morrison Hotel, and then back onto the streets, where the cycle begins again.” | |
| It froze me. A lot of things were flooding my brain at once, like, “Holy (beep), the exact same thing is happening now. People are bouncing from the Morrison to the downtown King County Jail, to Western, and back again.” We’ve been stuck in the same calcified loop for 40 years, and it’s like we have made a decision as a society to not care about this or that we are okay with this. And then what does that say about us? | ||
| Will James: | As Sydney looked through the archives, she read more and more about how deinstitutionalization played out here in the Seattle area with the closure of Northern State Hospital, and one name came up again and again, Dan Evans. | |
| Dan Evans: | Hello, Will. This is Dan Evans calling. | |
| Will James: | He’s the former governor of Washington state who shut down the psychiatric hospital, citing both the shift to community care and the need to cut costs. | |
| Dan Evans: | I understand you’ve been trying to get in touch with me regarding a story. I’d be happy to talk with you. | |
| Will James: | Sydney and I made a trip to the former governor’s house in a suburban-looking neighborhood of Seattle. We wanted to know how he looked back on his decision to close Northern State more than 50 years ago in light of the mental health crisis of today. | |
| Hi there. | ||
| Dan Evans: | Hi. | |
| Will James: | Hi, Governor Evans. How are you? | |
| Dan Evans: | Good. Great to see you. | |
| Will James: | Evans leads us into a living room with high ceilings and tall windows looking out onto a lake. The former governor, wearing shorts and a collared T-shirt, settles into a high-backed chair near the fireplace. | |
| And if it’s not too rude, what is your age today? | ||
| Dan Evans: | 97. | |
| Will James: | Nice. So we brought some pictures of Northern State Hospital. This is the campus. I wonder if you recall if you’d ever been there, or visited, or walked the grounds? | |
| Dan Evans: | Oh, yes. | |
| Will James: | You did? | |
| Dan Evans: | Mm-hmm. It was just part of my responsibilities as governor, and I made visits to various state institutions to see physically just what they were like. | |
| Sydney Brownsto…: | Back in the early ’70s, around the time of your decision to close Northern State Hospital, that was a really fraught time, and I’m wondering, when you look back on that decision, what emotions does it bring up for you? Is it a source of pride? Is it a source of pain or confusion? | |
| Dan Evans: | Probably a little bit of all. But we were at a point where we were beginning to see the end of centralization and the very large multi-hundred patient institutions that we had when I became governor. So it was a time of real change, and the change was one that was not without controversy. | |
| Sydney Brownsto…: | So the historical narrative is one where this change began in the ’60s with the Kennedy administration to transfer mental health care to these community clinics. But then it’s also widely acknowledged across the country that this system of community care never fully materialized. I’m wondering on a local level here in Washington state, what were the obstacles to creating that system of community care? | |
| Dan Evans: | Well, there was a lot of interest and I think a lot of recognition that just housing mentally ill patients in a very large institution, impersonal institution was not a very good treatment, but I don’t think there was a lot of really good knowledge about alternatives. So it was a time of recognizing that we had a problem, but not really knowing exactly what the best answer to the problem was. | |
| Mental illness is one of the more difficult challenges we have because it occurs in so many different ways. I think that people who are in positions of authority where they have that responsibility are not happy with that responsibility. It’s difficult and generally not rewarding in any direct way. Mental illness is a lot tougher than most other challenges that you face. | ||
| Will James: | As Sydney and I drive away from the former governor’s house, we agree, it’s not entirely fair to hold one man to account for decisions politicians all around the country were making at the same time, decisions his successors had half a century to fix if they wanted to. But the last thing he said about responsibility echoes in our heads, that dealing with mental health care is difficult and generally not rewarding in any direct way. | |
| Sydney Brownsto…: | It is recording, it is recording. | |
| I think he did acknowledge though. He said, “No one really wants responsibility for this thing. It’s something that everyone struggles with and is really tricky,” and I think… | ||
| Will James: | Responsibility. What Evans said to us about that, that the care of seriously mentally ill people is something people in power don’t want responsibility for, it cost a lot of money, was complicated to manage, and never delivered satisfying political wins, and once people in government saw that opening, they slipped through it. Once you understand those motivations, it’s clear why all of this unfolded as haphazardly as it did and why these mistakes echoed for decades without anyone fixing them up. | |
| Al Letson: | When we come back, we meet someone with severe mental illness who’s navigating a patchwork of services on their own with success. | |
| Lew Middleton: | So I have a nice relationship with my voices. | |
| Al Letson: | Improvising your way through a mental health crisis, that’s next on Reveal. | |
| Al Letson: | From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Back in 1989, Lew Middleton was in his thirties, working in a warehouse, and living in the heart of Seattle. Lew was listening to a lot of eighties metal and dance music at the time through speakers in his apartment. One day, he noticed what sounded like voices mumbling in the background. | |
| Lew Middleton: | I would turn on a song, and a person would say, “Oh. Gosh. I knew he was going to play that song. I hate that song.” | |
| Al Letson: | The voices were criticizing Lew’s taste in music. He says at one point, he actually knocked on his neighbor’s door to see if it was them complaining from the other side of the wall. They didn’t know what he was talking about. | |
| Lew Middleton: | I liked Annie Lennox a lot, and I would be listening to the Eurythmics. Then, suddenly, right in the middle of the song, I would hear like, “Hi. This is Annie Lennox, and we have this special code. We’re trying to send this out to people like you that hear voices.” Then, I would put on another album, and then that singer would say the same thing. I’m going like, “How is this happening?” | |
| Al Letson: | Lew was experiencing the early stages of psychosis. As Lew got more stressed, the voices came to him in other forms, not just in music, but also in the buzzes or hums of appliances. They said they were after him. He started to believe them. | |
| Lew Middleton: | I was just completely consumed. Every movement, everything I was doing was because of the voices. | |
| Al Letson: | He was eventually diagnosed with bipolar disorder with auditory hallucinations. Reporter Will James talked to Lew, because his story is an example of someone navigating their mental illness towards a recovery that works for them, even when federal and state services fall short. Will starts at a low point in Lew’s journey, when he was living in the woods in Washington state. | |
| Will James: | In each story of recovery from serious mental illness that I’ve come across, there’s a moment that shocks someone out of the loop they’re stuck in, a moment they can step outside their illness and start to see it for what it is. | |
| Lew Middleton: | I was running from nothing. I’d hear, like, “He’s over that way. Let’s go follow him,” and the more I thought about maybe people chasing me, the more it became people chasing me. | |
| Will James: | For Lew, it started with a bite wound. He says at some point while he was homeless, he got in a fight. He doesn’t remember the details, but somebody bit his arm. That night, he happened to see an ex-girlfriend, someone he had kept in touch with over the years, someone who still looked out for him, tethered him to the mainstream world. | |
| Lew Middleton: | She’s the one that got me to go to the hospital. | |
| Will James: | This ex-girlfriend convinced Lew to get the bite wound checked out, and then she convinced him to stay for a psychiatric evaluation. | |
| Lew Middleton: | They asked me these questions, and I shared these things about … that were going on. I can’t remember exactly what it was. They were just very delusional answers, and when they came back for the assessment, it was like literally telling me I was crazy. I was like, “Wait a minute. How do you know? You weren’t there, and you’re trying to tell me that this is going on?” So I found myself strapped on a bed going up to Harborview 5, I think it is. | |
| Will James: | He’s talking about Harborview Medical Center, one of the only hospitals in the Seattle area with a specific unit for psychiatric emergencies. Lew says he thought he was living through invasion of the body snatchers and that the psychotic medication they were offering him was poison. But even in the middle of his delusions, he would have what he calls window periods when he’d have more clarity. One of these windows happened to open while he was in the hospital, and he agreed to take the meds. | |
| Lew Middleton: | It started helping to calm. The voices didn’t go away completely. I just kind of brought it down to the point of where they weren’t so loud. | |
| Will James: | Lew says his medication eventually gave him tardive dyskinesia, a possible side effect of antipsychotic meds that causes facial tics and other involuntary movements, and he had to stop taking it. Other meds actually seemed to make the voices louder. Eventually, Lew got off medication entirely, but for a while, at least, early on, the medication opened up some space for Lew, gave him a reprieve from the voices, even if it didn’t squelch them entirely. | |
| He was placed in a federally-funded housing program at the hospital, and from there, he was able to move into his own apartment. Lew’s life had changed radically. Within a couple years, he went from homeless in the woods to having an apartment and a car, but the voices were not done with him. | ||
| Lew Middleton: | I was hearing somebody, “Lew, Lew, help me. Help me. Please. These people are trying to kidnap me,” and I said, “Well, who are you?” They said, “Well, I just heard about you, and there’s this channel that we can communicate with each other on. Please come and help me.” I said, “Well, how do you look?” He says, “You’ll see me. Please hurry. Don’t ask all these questions. I got brown hair. Okay?” I go, “Yeah, but where are you going to be?” He goes, “Hurry, will you?” | |
| Will James: | The voices sent Lew on a rescue mission to the Paramount Theatre in downtown Seattle, and then, when he got there and didn’t find anyone, they sent him to the Space Needle, about a 10-minute drive away. | |
| Lew Middleton: | So I’m driving over there and looking around at that Space Needle, trying to find anything suspicious, and he’s like, “Lew, Lew, they took me up to Capitol Hill. I’m up at Capitol Hill.” Meanwhile, I’m looking at my gas tank, and it’s running low on gas. I’m thinking, “Wait a minute here. Why is it that you know where you’re at?” | |
| Will James: | For years at that point, the voices had ruled Lew’s life. Whatever they told him became his reality, but this time, he had questions. The voices did not like that. | |
| Lew Middleton: | It’s just like the first thing he says, “You (censored) son of (censored), I’m going to kill you.” I said, “Well, how can you kill me if you’re being kidnapped? I mean, this doesn’t make sense.” He says, “I’m going to kill you,” and I said, “Fine.” | |
| Will James: | Lew says he went home and waited with a baseball bat for someone to try to kill him. | |
| Lew Middleton: | I left my back door wide open, and I said, “Come on. I’m tired of you threatening that you’re going to kill me, and since you have so many people with you, I’m here. Come.” So here, about a couple hours pass, and I said, “Well, where are you?” “Well, we have something to do, but we will be there soon.” I said, “Why am I going to leave my door open to some guy, some idiot that’s busy doing things? Then, the next morning, you’re not going to be here, but I’m going to continue leaving my door open, waiting for you, to be killed?” I said, “That sounds real stupid,” and then it just stopped. Just stopped. There was no threats. There was no nothing. It was just like the reason just completely stopped what was going on. I thought, “Wow. You know something? There’s something to what’s going on here.” I said, “How much is it? Is it me?” | |
| Will James: | Anosognosia is the scientific term for being so sick you don’t know you’re sick. From ancient Greek, it roughly translates to disease without knowledge, and in psychiatry, the opposite of anosognosia is insight, the realization that these experiences are coming from inside you. For Lew, it took a connection with a friend, his ex-girlfriend, who was there at the right moment, and then hospitalization, medication, housing. All of this created the conditions for Lew to come to this realization for himself. From there, Lew was able to build on that insight. Lew has an autoimmune disease and learned that eating certain foods could cause it to flare up, and that would make the voices louder and meaner. He started paying a lot of attention to his diet and found the voices were like a meter telling him how well he was taking care of himself. | |
| He learned the voices reflected his own feelings. If the voices were cruel, it meant that somewhere inside, Lew was being cruel to himself. And so the voices taught him to be gentler with himself. At one point, Lew came across the Hearing Voices Network, a community of people who hear voices and support each other. Lew wanted to make sure no one else like him ever went through what he did, running from the voices alone. | ||
| He got a job with the Downtown Emergency Service Center. Lew was there for 25 years, becoming the longest-serving certified peer counselor in Washington state history. He spent years leading support groups for people, many of them homeless. | ||
| Speaker 1: | [inaudible 00:09:40] reference. | |
| Speaker 2: | Oh. Hey. | |
| Speaker 1: | I’ll be right back. [inaudible 00:09:42]? | |
| Speaker 2: | Deal. | |
| Speaker 1: | Hi. | |
| Speaker 2: | This is Lew. | |
| Speaker 1: | Hello. | |
| Lew Middleton: | Hi. | |
| Speaker 1: | Nice to meet you. [inaudible 00:09:45]. | |
| Will James: | On this day, Lew is visiting DESC’s Lew Middleton Drop In Center for the first time since he retired a few years ago. How does it feel to be here? | |
| Speaker 3: | Hey, Michelle. I’m going to [inaudible 00:09:58]. | |
| Lew Middleton: | Yeah. Well, colors made a big difference. I remember that we were talking about adding colors to kind of brighten up. This used to be my little office. | |
| Will James: | This was your office right here? | |
| Lew Middleton: | Yeah. This was my office. I think one of the fun things was music, playing music in here. They love music. | |
| Speaker 2: | All right. You do. | |
| Will James: | Lew would lead his support groups in a back room of this center. People would share stories with Lew and with each other about their voices. It was a gradual process of getting people to see these voices not as outside entities, but as parts of themselves, parts they had some power over. | |
| Lew Middleton: | I would try to be very positive with my voice and say, “Okay. Look, you know what? You’ve done that before, and I’m not going to get bothered by it. I understand you’re having a difficult time right now, and I need to listen to what you’re saying.” I’d hear this, “Thank you. Wow, you’ve changed,” that kind of thing. So I have a nice relationship with my voices. This is my experience. Others have their own experiences that they’re dealing with, their own life, but there is a path that they can walk along. But the biggest part of it is being able to learn how to listen to yourself. | |
| Will James: | For Lew, and for lots of people with serious mental illness, recovery does not mean the symptoms are gone. If you don’t mind me asking, are you hearing voices now as we sit together in this room, or are they quiet right now? | |
| Lew Middleton: | Sometimes, they’re talking, but most of the time, they’re kind of subdued. They’re quiet, and I just kind of hear, in the background, them saying, “Lew, Lew, Lew,” like that. So it’s interesting. I feel that they developed this fear that I’m separating from them, and they start calling out my name. It’s like, “Hey. You’re in the same place in the brain.” I said, “You haven’t moved anywhere.” They’re not perfect. We’re not perfect, and if we’re going to learn how to work with our voices, we have to realize they’re imperfect. Then, we have to realize what we’re doing to our own self. | |
| Al Letson: | Starting in 2024, policymakers in King County, where Seattle is, are rolling out a plan to build five new crisis mental health centers and expand psychiatric hospital beds and staff. Leaders call it an attempt to undo mistakes made decades ago during the age of deinstitutionalization, when real community-based solutions failed to materialize. Lost Patients is a production of KUOW and The Seattle Times. You can listen to the full Lost Patient series anywhere you get your podcasts, and there’s so much more. Will and his reporting partners expand on Adam Aurand’s story, dive deeper into the national history of mental healthcare, and ask people who experience psychosis what it feels like and where the system goes wrong. | |
| The Lost Patients team includes reporters Will James, Sydney Brownstone, and Esmy Jimenez. It was edited by Liz Jones. Our lead producer for today’s show is Najib Aminy. Jenny Casas edited the show. Nikki Frick is our fact-checker. Victoria Baranetsky is our general counsel. Our production managers are Steven Rascón and Zulema Cobb. Score by B.C. Campbell. Sound designed by the dynamic duo, J Breezy, Mr. Jim Briggs, and Fernando “My man, yo” Arruda. They had help from Aisha Wallace-Palomares. | ||
| Our interim executive producers are Brett Myers and Taki Telonidis. Our theme music is by Comorado Lightning. Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Robert Wood Johnson Foundation, the Park Foundation, the Schmidt Family Foundation, the Hellman Foundation, and by listeners like you. Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson, and remember, there is always more to the story. | ||