Two years ago, Philip Mazeikas answered the front door of his family home. The course of his life changed when he opened it.
At 24-years-old, Mazeikas found himself in the middle of his first psychotic episode.
He thought he'd been contacted by aliens who were using him in a scheme to control the world. He wasn't eating well. He was drinking his own urine.
“I was storming around the house, really angry, when I heard a knock at the door,” Mazeikas recalls. “I remember thinking to myself, stay cool, act normal, whatever you do, don’t say anything about aliens, because they'll think you're crazy.”
On the other side of the door stood Teresa Shackelford and Ellie Merrick from the Idaho Department of Health and Welfare's Mobile Crisis Unit. Two police officers were there too.
“Philip was very friendly and talkative at first,” Shackelford remembers. “But what he was talking about was very bizarre and disorganized. He was having some disturbing delusions and hallucinations.”
Shackelford said some people can function well despite delusions, but Mazeikas wasn’t one of them.
Mazeikas' parents, Mike and Deanna, felt they were out of treatment options for their son. Insurance had covered some therapy sessions but had run out. They had called police a handful of times when Philip's behavior became too volatile.
On the third police visit, an officer told Mike Mazeikas about the Mobile Crisis Unit. He and his wife decided it was time to call.
DE-ESCALATION FIRST, MENTAL HOLDS SECOND
Idaho has mobile crisis teams scattered throughout the state. They work with law enforcement and first responders to connect families like the Mazeikases' with services to treat mental and behavioral illnesses.
Often, mobile crisis workers are called to homes to de-escalate a conflict or potentially dangerous situation, and to evaluate the mental state of a person. The evaluation determines if a person qualifies for a mental hold or an involuntary commitment to a treatment facility.
Mental holds are typically required when the person lacks a grasp on reality and refuses to seek help. Last fiscal year, 5,095 Idahoans were placed on a mental hold. That’s nearly a 40 percent increase since 2008.
“The day I called Teresa (Shackelford), Philip was completely out of it,” his father said. “I told him we were going to the hospital, and he said ‘no’.”
As they stood at the Mazeikas' front door two years ago, Shackelford asked Philip basic questions to understand if he was taking care of himself, or to see if his delusions had so affected his everyday life that he was a danger to himself.
“We were pretty concerned about his health,” Shackelford said. “He had lost a great deal of weight, and was engaging in behaviors that just weren’t safe. He just wasn’t able to take care of himself or make rational decisions at all.”
Shackelford went back to her office and filled out the paperwork to send Mazeikas to the state hospital against his will. A judge signed the order, Philip began the first of two stints at Idaho State Hospital South in Blackfoot.
“The first time, I didn’t change my mind about my beliefs,” Mazeikas said. “The second time I went to the state hospital, I started thinking maybe it’s not aliens, and maybe it is schizophrenia.”
It’s that return to reality that health professionals hope for when they respond to crisis calls.
CRISIS TEAMS: A RESPONSE TO DEFUNDING?
Sgt. David Cavanaugh manages Boise Police Department’s Crisis Intervention Team, which is essentially law enforcement’s version of mobile crisis units the state health department deploys.
Since 2007, Cavanaugh has been developing and implementing a collaborative plan that gives police officers the tools they need to better respond to mental-health crisis calls.
“You should be able to call 9-1-1 and someone will come help,” Cavanaugh said. “We're not mental-health professionals, but we do want to help people.”
Cavanaugh said all police officers in Idaho receive some basic training in how to de-escalate a potentially dangerous situation. Of the Boise Police Department’s 286 sworn officers, about a quarter have had 40 additional hours of crisis-intervention training.
Crisis-intervention teams and mobile-crisis units have become the response to the defunding of mental health care across the country, said Laura Usher, a program coordinator at the National Alliance on Mental Illness (NAMI).
“Most people are not really getting good diagnoses or good services – sometimes for years or decades after they start to experience symptoms,” Usher said. “That's because our system is so underfunded, fragmented and difficult for people to navigate.”
Instead of early intervention, or preventive mental health screenings, too often people enter the system once they're in the midst of a crisis.
“It's like if we didn't screen for high blood pressure, and we didn't screen for high cholesterol, and we just waited for people to have heart attacks and then said, ‘OK, I guess this person has heart disease’,” she said.
Of Idaho’s $2.5 billion Department of Health and Welfare budget, just *8.8 percent went to mental health programs in the last fiscal year. That’s a decline from 11 percent in 2006.
State spending for mental health crisis and treatment has declined most years following a 2008 peak. At the same time, the agency's total mental health spending, including federal Medicaid dollars has increased steadily during the last decade.
Cavanaugh says one result of the cuts is that police departments are now saddled with the cost of crisis care.
"The Legislature seemed really proud of themselves because they saved all this money," Cavanaugh said. "But, all you really did was shift it to the local level. Now, instead of calling my counselor or my therapist or changing my medication regime – now, it’s call 9-1-1."
Usher said crisis teams are adept at handling initial encounters, but it's important the care doesn't stop once the officer or social worker drives away.
“There are a lot of opportunities where a person can fall through the cracks,” she said. “The spirit of collaboration is something that really needs to happen.
CRAFTING IMPROMPTU ACTION PLANS
At the Idaho Department of Health and Welfare's Region 4 headquarters in Boise, social workers and mental-health care providers in an open-concept bullpen calmly answer incoming crisis calls.
“This is John with mobile crisis in Boise,” John Greene quietly said to a caller. “Hey, we're trying to figure out what’s going on with your brother. Is he doing OK today?”
Greene was responding to an unfolding crisis situation in a small town outside Boise.
“He actually did shoot neighbors' cats?” Greene asked, “At neighbors cats. Gotcha.”
When Greene hangs up, he turns to his supervisor, Shackelford, and Merrick. The three devised an action plan.
In less than 20 minutes, after several phone calls, Merrick and Greene were on the road to meet police officers at the home of the caller’s brother.
After speaking with him, the officers and social workers agreed that while the man needed mental health care, he didn’t meet the strict guidelines for an involuntary mental hold or commitment.
“His delusions don’t seem to be overtaking every area of his life,” Merrick said to the officers.
“Lots of time people need help, and they don’t want that – and we can’t make them do that,” Merrick explained later. “The bar for civil liberties is intentionally high, and should be that way.”
The group agreed to continue monitoring the situation, but their task, for now, was finished.
THE GOALS: STAY OUT OF JAIL, AVOID EMERGENCY ROOMS
The ultimate goal of law enforcement and mental-health crisis workers responding to calls is to avoid jail and the hospital emergency room. At its best, the system is intended to encourage people in crisis to seek long-term help through services the professionals can recommend.
For Philip Mazeikas, it took being held against his will in Blackfoot to come to the realization that he needed medication and ongoing care to live a healthy life with schizophrenia.
“At this very moment, I feel kind of nostalgic and sad remembering all of this,” Mazeikas said. “But basically I consider myself pretty happy. I do feel like maybe everyone has some delusions in their life, but I’m pretty certain the TV isn’t sending me secret messages.”
Mazeikas is now on Medicaid, the state-federal health insurance program for low-income and disabled children and adults. He isn’t able work, but he is volunteering at the Department of Health and Welfare and recently began the certification process to become a peer-support specialist.
He may eventually help other Idahoans navigate mental illness.
“My survival has been dependent on others because of my illness, and I’m really thankful for that,” he said.
Learn more about Philip Mazeikas' life with a mental illness in this video.
"In Crisis" is a series exploring Idaho's mental health system. The reporting has been a collaboration between Boise State Public Radio and the Idaho Statesman.
*We originally reported the state share of mental health funding has declined to 7.5 percent, it has declined to 8.8 percent of the total Dept. of Health and Welfare budget.