Idaho mental health system in question

Nikki Agidius immediately knew her friend was dead when she opened the newspaper in Whitefish, Mont., to the headline and photograph of Crystal Hamilton's house.

Hamilton was shot and killed by her husband, Jason, at their rural Moscow home May 19. Hamilton then shot and killed Moscow police officer Lee Newbill and First Presbyterian Church sexton Paul Bauer over the course of the next few hours. Latah County Sheriff's Office Sgt. Brannon Jordan and University of Idaho student Peter Husmann were wounded in the attack, during which Hamilton fired more than 185 rounds into and around the Latah County Courthouse.

Agidius worked with Crystal Hamilton at the courthouse until her recent move to Montana.

"Knowing how (Jason Hamilton) could get, it didn't surprise me," she said.

Hamilton got more possessive and jealous during the rough times, Agidius said. There also were good times, when he was more easygoing.

"(How he was doing) was evident in the number of times he would call," Agidius said.

Agidius wasn't surprised to learn that Hamilton directed his aggression toward the courthouse and those who work there.

"Motive-wise it makes sense that he would come to the courthouse. He had so much of a grudge (against the people who work there) for being Crystal's friends," she said. "They were there for Crystal, and that made him angry and jealous."

It is unclear whether Jason Hamilton had been diagnosed with a mental illness, but after a May probation violation hearing he was given more time to attend a court-mandated counseling session.

In February, he was placed in protective custody on an involuntary mental hold for attempting suicide.

During a press conference earlier this week, Moscow Assistant Chief of Police David Duke said mental health professionals indicated Hamilton had said if he planned to kill himself he would take out other people at the same time, either with guns or a bomb.

He later recanted those remarks.

A problem with the system?

Agidius said the mental health system failed Jason Hamilton.

"It wasn't a problem with the legal system. It wasn't the judge or the sheriff's office, they all did that they could," she said. "Everyone involved tried, the system just isn't set up to work as well as it should."

Bob Carolla, with the National Institute of Mental Health, said people with mental illnesses are no more violent than the rest of the population.

"Violence is the exception, which means something has gone wrong at some point or another, usually within the mental health care system," he said. "People may not have access to treatment, or there is no follow-up inside the system. Maybe they are resistant to treatment."

He said two thirds of people who need treatment aren't able to get it, particularly in Idaho.

"The national average was a D (for treating mental health), but Idaho received an F," he said. "We have a long way to go before people are going to be taken care of in a way that's fundamentally decent."

Diana Pals, a Moscow counselor and president of the Idaho Mental Health Counselors Association, said the recent incidents with Hamilton and John Delling - who police allege shot and killed University of Idaho student David Boss and Boise resident Bradley Morse and shot and injured Jacob Thompson of Tucson, Ariz. - point to a larger problem with the mental health system.

Delling had told people he thought Boss had been "stealing his powers."

Seung-Hui Cho, who recently shot and killed 32 people at Virginia Tech, also showed a history of mental health problems.

Commitment laws

Some say both Hamilton and Delling showed enough warning signs to have been committed.

"It's very difficult to have someone involuntarily committed," Pals said. "During a period of time in history some thought it was a good idea to de-institutionalize mentally ill people. Since the law was put forward it has been perpetually difficult to institutionalize."

Pals said that under Idaho law, people can be hospitalized against their will if they're found likely to hurt themselves or others, but there must be an "imminent" risk shown in the patients' past behaviors, or that a specific person has reason to feel threatened by a patient.

Pals said she is working with the Region 2 Mental Health Advisory Group to revise the law.

"Even if it was the best law in the world, will the judge do what needs to be done?" she asked.

Clayton Cramer, a Horseshoe Bend, Idaho, resident who is writing a book on commitment laws, said the Idaho law is reasonable, but many people just don't understand it.

"It's fairly broad," he said. "If a (mental health professional) is able to persuade a judge someone is not mentally well, they are locked up."

Cramer said in Hamilton's case, he thinks signs would have been there.

"In light of the fact he made a threat to kill a lot of people, I would love to know why he wasn't committed on that basis alone," he said.

Latah County Prosecuting Attorney Bill Thompson said in Hamilton's situation, there is nothing that could have been done differently from a legal standpoint.

"We are desperately in need of change," he said. "It is unfortunate tragic events like this happen because of the inadequacy."

Thompson said in order to involuntarily commit someone based on mental illness, two designated experts must certify someone mentally ill and determine that they pose a present danger to themselves or others. If that occurs, the case can be heard by a judge.

A hospital or law enforcement agency can take someone into custody if they're actively suicidal, Thompson said. If the first expert says the person is suffering from mental illness and determines there to be an imminent danger, they are taken to St. Joseph's Regional Medical Center in Lewiston - the only certified psychiatric hospital in the area - for a second exam.

Oftentimes, the professional determines the person is no longer posing an imminent danger by the time the second exam is conducted.

"This can be because they have received medication or intervention in the meantime," Thompson said.

"When the crisis is alleviated we can't proceed further," he added. "This happens more times than not on people taken into mental holds. It's very common to have a person taken into custody at a hospital temporarily, then they stabilize and are no longer committable."

He said once the person is back in the community there is no follow-up procedure to make sure the patient received the proper treatment.

Dr. Arnold Kadrmas, medical director of psychiatric services at St. Joseph Regional Medical Center, said the phrase "imminent danger" is interpreted differently by various professionals and judges.

"If they aren't committable at that time there is no option but to let them go," Kadrmas said. "They can go out, get in trouble again and do the same kind of things."

Kadrmas said the state should consider lowering the bar for commitment when a person has a track record or history of recurring mental illness.

"That should be taken into account in the commitment process," he said. "It can't be done now."

Thompson said Idaho needs to explore laws that allow mental health professionals to work with people from a long-term standpoint to ensure they truly are stable.

"Longer term temporary custody and treatment options can be very beneficial," he said. "But the Department of Health and Welfare doesn't have resources in place for ongoing treatment and monitoring."

Other issues

Thompson said there is no question that some people are committing criminal acts largely because of mental illness.

"The prison system is the only resource we have to deal with (mental illness) sometimes," he said. "We try to apply it through the criminal system. It's not efficient, but sometimes it's the only resource we have."

Kadrmas said because of the lack of space in Idaho's mental hospitals, patients have to be exceedingly ill to get in the door.

"It's a hot political issue," he said. "Where do you draw the line for people who would be eligible for services?"

Cramer said his research shows that acts of violence related to mental illness are not increasing.

"I'm not sure (the number of) incidents is getting larger," he said. "We have more data available to find out why people are doing these things. There are possibilities to gather information about people from a variety of sources."

Mary Zdanowicz, executive director of the Arlington, Va.-based Treatment Advocacy Center, said people might be experiencing mental illness and not realize it.

"The mental health system is not prepared to deal with the issue," she said. "The community mental health system is set up for people who come knocking on the door and asking for help."

Pals agreed.

"It's time for us to look at how we can get help to people who need it," Pals said. "Mentally ill people and folks with additional problems often don't see the need for treatment until after they've had it."

Agidius said despite Jason Hamilton's problems, Crystal Hamilton was convinced he could get better.

"She loved him very much," she said. "When you deal with somebody in your life, maybe you are the only one to help this person get well.

"You love them and believe in them. That's how you keep sticking around."

Omie Drawhorn can be reached at (208) 882-5561, ext. 234, or by e-mail at odrawhorn@dnews.com.